凝血指标对中型创伤性脑损伤患者进展性出血性损伤的预测能力OACSTPCD

Objective To explore the predictive ability of coagulation tests for progressive hemorrhagic injury(PHI)in patients with moderate traumatic brain injury(mTBI).Methods Clinical data of 270 patients with mTBI admitted to Neurosurgery Department of the Second Affiliated Hospital of Fuyang Normal University from January 2018 to June 2023 were retrospectively analyzed.The mTBI patients were divided into PHI group and non-PHI group deponding on whether PHI occurred within 72 h after injury.Three prediction models for PHI were constructed according to whether coagulation tests was included.Model 1 included standard variables such as general data and imaging data of mTBI patients;Model 2 added coagulation tests based on standard variable of model one;Model 3 included only coagulation indicators.Independent influencing factors for PHI in mTBI patients were revealed by univariate and multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve and area under curve(AUC)were used to evaluate the ability of different predictive models for PHI.Internal validation of the prediction models was used by bootstrap analysis.Results Among 270 mTBI patients,43 cases developed PHI,and the incidence of PHI was 15.9％.There was statistically significant difference in the first CT scan time,GCS score on admission,skull fracture,traumatic intracerebral hematoma,traumatic epidural hematoma,fibrinogen(FIB)and D-dimer between the two groups(P＜0.05).Multivariate Logistic regression analysis showed that the first CT scan time,GCS score on admission,traumatic intracerebral hematoma,FIB,D-dimer were independent risk factors for PHI.Comparison of 3 prediction models showed that Model 2(AUC=0.908,95％CI:0.868-0.940)has better predictive ability than Model 1(AUC=0.848,95％CI:0.800-0.889)and Model 3(AUC=0.805,95％CI:0.752-0.850).Conclusion As an independent influencing factor for PHI in patients with mTBI,coagulation tests has a good ability to predict the occurrence of PHI.