检验医学与临床2025，Vol.22Issue(9)：1205-1210,6.DOI:10.3969/j.issn.1672-9455.2025.09.010
基于临床资料、凝血-纤溶指标构建车祸创伤并发DIC的预警模型
Construction of early warning model for complicating DIC in car accident trauma based on clinical data and coagulation-fibrinolytic indicators
摘要
Abstract
Objective To construct and verify the warning model for the car accident trauma complicating disseminated intravascular coagulation(DIC)based on clinical data and coagulation-fibrinolysis indicators.Methods A total of 215 patients with car accident trauma admitted and treated in this hospital from March 2023 to April 2024 were selected as the modeling set and divided into the DIC group and the non-DIC group according to whether there was complicating DIC.The general data and coagulation-fibrinolysis indicators[platelets,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fi-brinogen(FIB),D-dimer(D-D),thrombomodulin(TM),coagulation reaction time(R),coagulation time(K),coagulation angle(Angle),maximum amplitude(MA),fibrinolytic index(LY30)and coagulation index(CI)]were compared between the two groups.The independent related influencing factors of complicating DIC in car accident trauma were screened through the Lasso regression and Logistic regression analysis,and a nomogram warning model was constructed by using the R language rms program package and recursive parti-tioning method;the Bootstrap method was used to draw the calibration curve to verify the predictive value.The other 50 patients with car accident trauma admitted and treated in this hospital from May 2024 to August 2024 were selected as the external validation samples.Results Among the 215 patients with car accident trau-ma in the modeling set,82 cases developed DIC(DIC group)and 133 cases had no DIC(non-DIC group),and the incidence rate of DIC was 38.14％.The proportion of diabetic patients,the proportion of the patients with the abbreviated injury scale(AIS)score ≥4 points,injury severity score(ISS),D-D level,TM level and LY30 in the DIC group were all higher than those in the non-DIC group(P＜0.05),and the GCS score,platelet count,FIB level and CI were all lower than those in the non-DIC group(P＜0.05).The GCS score of 12-15 points and CI＞-3.50 were the independent protective factors for complicating DIC in car accident trauma(P＜0.05),and the AIS score ≥4 points,ISS＞25 points,D-D＞578.60 μg/L,TM＞14.50 TU/mL and LY30＞5％were the independent risk factors for complicating DIC in car accident trauma(P＜0.05).The C-index of the warning model for complicating DIC in car accident trauma constructed based on the above inde-pendent related influencing factors was 0.935;the calibration curve demonstrated that the model exhibited high discriminatory power and predictive value in the internal and external validation sets.Conclusion The GCS score of 12-15 points and CI＞-3.50 are the independent protective factors for complicating DIC in car accident trauma,and the AIS score ≥ 4 points,ISS＞25 points,D-D＞578.60 μg/L,TM＞14.50 TU/mL and LY30＞5％are the independent risk factors for complicating DIC in car accident trauma,the early warning model constructed based on these has good predictive performance and can provide a reliable theoreti-cal basis for predicting and preventing DIC after car accident trauma.关键词
临床资料/凝血-纤溶指标/车祸创伤/弥散性血管内凝血/预警模型Key words
clinical data/coagulation-fibrinolysis index/car accident trauma/disseminated intravas-cular coagulation/early warning model分类
医药卫生引用本文复制引用
王艳秋,余汉忠,戴必照,王泉,丁静,张建超..基于临床资料、凝血-纤溶指标构建车祸创伤并发DIC的预警模型[J].检验医学与临床,2025,22(9):1205-1210,6.基金项目
江苏省优势学科建设工程项目(YSHL2371-846) （YSHL2371-846）
江苏省徐州市卫生健康委员会科技重点项目(XWKYHT20210531). （XWKYHT20210531）
