重癥創(chuàng)傷患者臨床指標及PLR聯(lián)合MA值與死亡相關(guān)性分析摘要：目的：探討重癥創(chuàng)傷患者的臨床指標及PLR聯(lián)合MA值與死亡之間的關(guān)系。方法：選擇2018年1月至2019年12月收治的重癥創(chuàng)傷患者資料進行回顧性研究,以死亡為結(jié)局指標，進行多因素Cox回歸分析，評估PLR及MA值對死亡的預測能力，且以ROC曲線檢驗合并臨床指標與PLR和MA值后的預測能力。結(jié)果：經(jīng)過篩選入選301例重癥創(chuàng)傷患者。PLR、淋巴細胞計數(shù)（LYM）及MA值與死亡呈顯著相關(guān)(P均<0.05)，篩選入入多元Cox回歸后，仍有PLR、MA值與死亡呈顯著相關(guān)（HR2.14,95%CI：1.06-4.32,P=0.032；HR=1.70,95%CI：1.04-2.77,P=0.034）。并且PLR聯(lián)合MA值與臨床指標（年齡、GCS評分、ISS評分、CAGS評分）及LYM的聯(lián)合預測能力最佳，ROC曲線分析顯示該聯(lián)合預測模型的AUC為0.855，而且其擬合程度也充分。（χ2=39.648，P=0.963）。結(jié)論：重癥創(chuàng)傷患者PLR及MA值參與復雜的生物學過程，聯(lián)合MA、PLR及臨床指標可以更好地預測死亡風險，為臨床治療提供參考。

關(guān)鍵詞：重癥創(chuàng)傷患者；PLR；MA值；死亡風險預測；臨床指標

Abstract:Objective:Toexploretherelationshipbetweenclinicalindicators,PLRandMAvaluesofcriticallyilltraumapatientsanddeath.Methods:RetrospectivestudywasconductedondatafromcriticallyillpatientswithtraumatreatedfromJanuary2018toDecember2019,andCoxregressionanalysiswasperformedwithdeathastheoutcomemeasure,evaluatingthepredictiveabilityofPLRandMAvalues,andROCcurveswereusedtoevaluatethepredictiveabilityofthecombinedclinicalindicatorsandPLRandMAvalues.Results:Atotalof301criticallyilltraumapatientswereincluded.PLR,lymphocytecount(LYM)andMAvalueweresignificantlycorrelatedwithdeath(P<0.05);afterscreeningwasperformed,PLRandMAvalueswerestillsignificantlyassociatedwithdeathinmultivariateCoxregressionanalysis(HR2.14,95%CI:1.06-4.32,P=0.032;HR=1.70,95%CI:1.04-2.77,P=0.034).Furthermore,thecombinationofPLR,MAvalue,clinicalindicators(age,GCSscore,ISSscore,CAGSscore)andLYMhadthebestpredictiveability,andtheROCcurveanalysisshowedthattheAUCofthiscombinedpredictionmodelwas0.855,andthefitwassufficient(χ2=39.648,P=0.963).Conclusion:PLRandMAvaluesareinvolvedincomplexbiologicalprocessesincriticallyilltraumapatients.ThecombineduseofMA,PLR,clinicalindicatorscanbetterpredicttheriskofdeath,providingreferencesforclinicaltreatment.

Keywords:criticallyilltraumapatients;PLR;MAvalue;riskpredictionofdeath;clinicalindicatorInrecentyears,criticallyilltraumapatientshavebecomeamajorchallengeforhealthcareprovidersduetotheirhighmortalityrateandcomplexpathophysiology.Therefore,thereisanurgentneedforreliablepredictivemodelstoidentifythoseatriskofdeathandinformtreatmentplans.

ThepresentstudyevaluatedtheroleofPLRandMAvaluesinpredictingtheriskofdeathincriticallyilltraumapatients.TheresultsindicatedthatbothPLRandMAvaluesweresignificantlyassociatedwithmortality,andtheircombineduseimprovedthepredictiveaccuracyofmortalityrisk.

PLRisasimpleandcost-effectivemarkerofinflammationthathasbeenshowntobeprognosticofmortalityinvariousclinicalsettings.Thepresentstudydemonstratedsimilarfindingsincriticallyilltraumapatients.Ontheotherhand,MAvalueisameasureofclotstrengththatreflectsthehemostaticbalanceandisaffectedbymultiplefactors,includingplateletcount,fibrinogen,andclottingfactors.Therefore,theassociationbetweenMAvalueandmortalityincriticallyilltraumapatientsmayreflectthecomplexpathophysiologyoftrauma-inducedcoagulopathy.

Furthermore,thestudyfoundthatclinicalindicators,suchasage,ISS,andGCS,werealsosignificantpredictorsofmortalityincriticallyilltraumapatients.Therefore,combiningPLR,MAvalue,andclinicalindicatorsmayprovideamorecomprehensiveandaccurateriskpredictionmodelformortalityinthispopulation.

Inconclusion,thepresentstudysuggeststhatPLRandMAvaluesarepromisingbiomarkersforpredictingmortalityincriticallyilltraumapatients.Thecombineduseofthesemarkersandclinicalindicatorsmayprovideamorerobustriskpredictionmodelandfacilitatepersonalizedtreatmentstrategies.However,furtherstudiesareneededtovalidateandrefinethismodelinlargerandmorediversepopulationsCriticallyilltraumapatientsrequiretimelyandappropriatemedicalattentiontopreventmortality.Identifyingbiomarkersthataccuratelypredictmortalityriskinthesepatientscanfacilitateearlyinterventionsandpersonalizedtreatmentplans.WhilethepresentstudyhighlightsthepotentialofPLRandMAvaluesasbiomarkersforpredictingmortalityincriticallyilltraumapatients,therearesomelimitationstothestudy.

Firstly,thiswasaretrospectivestudythatincludedarelativelysmallsamplesizeoftraumapatientsfromasinglecenter.Thelackofdiversityinthestudypopulationandtheretrospectivenatureofthestudylimitthegeneralizabilityofthefindings.Furtherstudieswithlargerandmorediversepopulationsarewarrantedtovalidatethefindingsofthepresentstudy.

Secondly,thestudydidnotinvestigatethemechanismsunderlyingtherelationshipbetweenPLR,MAvalues,andmortalityriskincriticallyilltraumapatients.Futurestudiesshouldevaluatetheroleofinflammation,coagulation,andotherpotentialmediatorsofthisrelationshiptobetterunderstandtheunderlyingpathophysiology.

Thirdly,whilethestudydemonstratedthepotentialofcombiningbiomarkersandclinicalindicatorstoimprovemortalitypredictionintraumapatients,itdidnotinvestigatetheimpactofpersonalizedtreatmentplansbasedonsuchmodels.Furtherstudiesarenecessarytoevaluatetheeffectivenessofsuchpersonalizedtreatmentplansinreducingmortalityratesincriticallyilltraumapatients.

Insummary,theutilizationofPLRandMAvaluesasbiomarkersforpredictingmortalityincriticallyilltraumapatientsshowspotential,butfurtherresearchisrequiredtovalidateandrefinethisapproach.Acomprehensiveriskpredictionmodelthatincorporatesbothbiomarkersandclinicalindicatorsmayfacilitateearlyinterventionsandimproveoutcomesinthispopulation.ThedevelopmentofpersonalizedtreatmentplansbasedonsuchmodelsisanareathatrequiresfurtherinvestigationOneareawherefurtherresearchisneededisintheuseofadvancedimagingtechniques,suchasmagneticresonanceimaging(MRI)andcomputedtomography(CT),inpredictingmortalityincriticallyilltraumapatients.Thesetechniquesmayprovideadditionalinformationabouttheextentandlocationofinjuries,aswellashelpidentifypatientswhoareathigherriskforcomplicationsoradverseoutcomes.

Anotherareathatrequiresfurtherinvestigationistheuseofgeneexpressionprofilingtopredictmortalityintraumapatients.Recentstudieshavesuggestedthatcertaingeneticmarkersmaybeassociatedwithanincreasedriskofmortality,andthatgeneexpressionprofilingmaybeavaluabletoolforidentifyinghigh-riskpatientsandguidingtreatmentdecisions.

Finally,thereisaneedforbetterunderstandingoftheunderlyingmechanismsthatcontributetomortalityincriticallyilltraumapatients.Abetterunderstandingofthepathophysiologyoftraumaanditsimpactonthebodycouldleadtothedevelopmentofnewtreatmentstrategiesandtherapiesthatcanimproveoutcomesandreducemortalityrates.

Overall,whiletherehasbeensignificantprogressinthedevelopmentofbiomarkersandclinicalindicatorsforpredictingmortalityincriticallyilltraumapatients,there