Evaluation of hematological parameters on admission for the prediction of 7-day in-hospital mortality in a large trauma cohort.

摘要

BACKGROUND: We evaluated the complete blood count (CBC) for the prediction of 7-day in-hospital mortality in a large adult trauma cohort. METHODS: We conducted an analysis of two prospectively collected databases on 1673 patients aged >/=18 years admitted to a level I trauma center (2005-2007). Comparisons between survivors and non-survivors within 7 days after admission and between single and multiple trauma patients were made. Discriminative performance for 7-day in-hospital mortality was assessed using the area under the receiver operating characteristic curve (ROC). Logistic regression was used to identify independent prognostic factors for 7-day in-hospital mortality. RESULTS: Comparison between survivors and non-survivors showed significant differences in white blood cell (WBC) count, absolute neutrophil count, segmented neutrophil count and most red blood cell (RBC) and platelet indices. Comparison between single and multiple trauma patients showed significant differences for WBC count and differential count and most RBC and platelet indices. Among the CBC parameters, RBC count (ROC=0.748), hemoglobin concentration (Hb) (ROC=0.734), hematocrit (Ht) (ROC=0.726), platelet count (PLT) (ROC=0.684) and plateletcrit (PCT) (ROC=0.696) showed the highest ROC. Using logistic regression we showed that RBC count, Hb, Ht, PLT and PCT were predictors of 7-day in-hospital mortality independently of patient's age, injury severity and initial physiological state. CONCLUSIONS: Significant differences in CBC parameters were found between survivors and non-survivors and between patients with single and multiple trauma, but most of the CBC parameters demonstrated poor to moderate predictive ability for 7-day in-hospital mortality in adult trauma patients. Routine laboratory workup of trauma patients should be performed as treatment guidance. However, prognostic value of initial hematological parameters remains limited.