The COST of liver disease: The Cirrhosis Outcomes Score in Trauma Study.

Autor: Appelbaum RD; Vanderbilt University Medical Center, Vanderbilt University School of Medicine, USA. Electronic address: rachel.appelbaum@vumc.org., Riera KM; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: kriera@wakehealth.edu., Fram MR; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: mfram@wakehealth.edu., Russell GB; Atrium Health Wake Forest Baptist, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, USA. Electronic address: grussell@wakehealth.edu., Ii SPC; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: scarmich@wakehealth.edu., Martin RS; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: romartin@wakehealth.edu., Hoth JJ; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: jhoth@wakehealth.edu., Mowery NT; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: nmowery@wakehealth.edu., Nunn AM; Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, USA. Electronic address: amnunn@wakehealth.edu.
Jazyk: angličtina
Zdroj: Injury [Injury] 2023 May; Vol. 54 (5), pp. 1374-1378. Date of Electronic Publication: 2023 Feb 03.
DOI: 10.1016/j.injury.2023.02.002
Abstrakt: Background: Cirrhosis in trauma patients is an indicator of poor prognosis, but current trauma injury grading systems do not take into account liver dysfunction as a risk factor. Our objective was to construct a simple clinical mortality prediction model in cirrhotic trauma patients: Cirrhosis Outcomes Score in Trauma (COST).
Methods: Trauma patients with pre-existing cirrhosis or liver dysfunction who were admitted to our ACS Level I trauma center between 2013 and 2021 were reviewed. Patients with significant acute liver trauma (AAST Grade ≥ 3) or those that developed acute liver dysfunction while admitted were excluded. Demographics as well as ISS, MELD, complications, and mortality were evaluated. COST was defined as the sum of age, ISS, and MELD. Univariate and multivariable analysis was used to determine independent predictors of mortality. The area under the receiver operating curve (AUROC) was calculated to assess the ability of COST to predict mortality.
Results: A total of 318 patients were analyzed of which the majority were males 214 (67.3%) who suffered blunt trauma 305 (95.9%). Mortality at 30-days, 60-days, and 90-days was 20.4%, 23.6%, and 25.5%, respectively. COST was associated with inpatient, 30-day, and 90-day mortality on regression analyses and the AUROC for COST predicting mortality at these respective time points was 0.810, 0.801, and 0.813.
Conclusion: Current trauma injury grading systems do not take into account liver dysfunction as a risk factor. COST is highly predictive of mortality in cirrhotic trauma patients. The simplicity of the score makes it useful in guiding clinical care and in optimizing goals of care discussions. Future studies to validate this prediction model are required prior to clinical use.
Competing Interests: Declaration of Competing Interest The authors do not have any conflicts of interest to report.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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