to compare the different evolution of conventional laboratory parameters between three severe trauma phenotypes.
DesignObservational study of a prospectively collected cohort of severe trauma patients, with retrospective database completion, studied between 2012 and 2022.
SettingA trauma intensive care unit (ICU).
PatientsSevere trauma patients were defined by an Abbreviated Injury Scale of ≥ 3 in at least one aspect. Three groups were stablished according to hemodynamic status and Glasgow coma scale (GCS), and they were subsequently subdivided in prematurely deceased and survivors after > 72 h (h). Laboratory parameters were followed up to 96 h, statistical analysis between groups and subgroups was performed at 0 and 24 h.
InterventionsNone.
Main variables of interestPrehospital, clinical variables on admission, prognostic variables (prospective gathering); blood count, biochemistry, coagulation, blood gas analysis (retrospectively collected).
Results1631 patients were included, 8% prematurely deceased. Initial leukocytosis and hyperglycemia were common in all groups. Hemodynamically stable patients with a GCS < 14 stood out due to a high neutrophil-to-lymphocyte ratio (NLR) and hypernatremia, both of them at 24 h, together with initial coagulopathy in the prematurely deceased. Hemodynamically unstable patients exhibited an initial pattern of lactic acidosis, coagulopathy, and decreased platelet-to-lymphocyte ratio, hemoglobin, albumin and calcium, all these changes being most prominent in the prematurely deceased. A 24 h peak in NLR was found in both the hemodynamically unstable and GCS < 14 groups.
ConclusionEvolution of laboratory parameters differ according to the patient’s phenotype. They complete the initial severity evaluation and in hemodynamically stable patients they act as a warning for potential neurological damage.
Comparar la evolución de parámetros convencionales de laboratorio en tres fenotipos de pacientes con trauma grave.
DiseñoEstudio sobre cohorte recogida prospectivamente entre 2012 y 2022 y completada retrospectivamente con valores analíticos.
ÁmbitoUnidad de cuidados intensivos especializada en trauma.
PacientesPacientes con trauma grave definidos por Abbreviated Injury Scale de ≥ 3 en al menos un área. Clasificados en tres grupos según situación hemodinámica (HD) y escala de coma de Glasgow (GCS); después subdivididos en fallecidos precozmente y supervivientes tras 72 horas (h). Se siguieron los valores analíticos 4 días y se compararon a las 0 y 24 h entre grupos y subgrupos.
IntervencionesNinguna.
Variables de interés principalesPrehospitalarias, variables clínicas al ingreso, variables pronósticas (recogida prospectiva); hemograma, bioquímica, coagulación, gasometría (retrospectivamente).
ResultadosSe incluyeron 1631 pacientes, 8% fallecieron precozmente. Leucocitosis e hiperglucemia iniciales ocurrieron en todos los grupos. Pacientes estables HD con GCS < 14 destacaron por un ratio neutófilo-linfocito (NLR) elevado e hipernatremia ambos a las 24 h, así como por coagulopatía inicial en fallecidos precozmente. Pacientes inestables HD mostraron un patrón inicial de acidosis láctica, coagulopatía, y disminución de ratio plaqueta-linfocito, hemoglobina, albúmina y calcio, todos estos cambios siendo más marcados en los precozmente fallecidos. El pico de NLR a las 24 h se encontró tanto en inestables HD como en aquellos con GCS < 14.
ConclusionesEl patrón analítico difiere en cada fenotipo de paciente. Completa la valoración inicial de la gravedad y en pacientes con estabilidad hemodinámica puede alertar sobre una posible lesión neurológica.
Article
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