Analysis of risk factors for the occurrence of early dysfunction of blood coagulation in elderly patients with severe burns
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摘要:
目的 探讨老年严重烧伤患者发生早期凝血功能异常的危险因素。 方法 该研究为回顾性病例对照研究。2015年6月—2025年6月,南昌大学第一附属医院收治158例符合入选标准的老年严重烧伤患者,其中男94例、女64例,年龄60~97岁。根据是否发生早期凝血功能异常,将患者分为早期凝血功能异常组（45例）和非早期凝血功能异常组（113例）。比较2组患者性别、年龄、烧伤总面积、Ⅲ度烧伤面积、伤后入院时间、烧伤原因、合并吸入性损伤、合并基础疾病,入院时改良Baux评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、体温、血液pH值、血小板计数及剩余碱、乳酸、血红蛋白、血钠、血钾、血钙、血浆纤维蛋白原（FIB）水平,住院时间与临床预后。筛选影响老年严重烧伤患者发生早期凝血功能异常的危险因素及独立危险因素,并根据独立危险因素构建预测模型,采用受试者操作特征曲线评价预测模型及各独立危险因素对前述老年严重烧伤患者发生早期凝血功能异常的预测价值。 结果 2组患者烧伤总面积、Ⅲ度烧伤面积,入院时改良Baux评分、APACHEⅡ评分、血小板计数、血钙水平、血液pH值、血浆FIB水平,合并吸入性损伤及临床预后比较,差异均有统计学意义（t值分别为2.270、7.615、5.975、2.319、-2.172、-7.861,Z值分别为-2.168、-2.568,χ2值分别为20.090、10.286,P<0.05）；2组患者其余指标比较,差异均无统计学意义（P>0.05）。单因素logistic回归分析结果显示,烧伤总面积、Ⅲ度烧伤面积、合并吸入性损伤及入院时改良Baux评分、APACHEⅡ评分、血小板计数、血钙水平、血浆FIB水平均为老年严重烧伤患者发生早期凝血功能异常的危险因素（OR分别为1.022、1.074、0.141、1.045、1.070、0.996、<0.001、0.568,95%CI分别为1.003~1.042、1.047~1.102、0.055~0.359、1.027~1.064、1.008~1.135、0.992~0.999、<0.001~0.002、0.380~0.849,P<0.05）。多因素logistic回归分析结果显示,Ⅲ度烧伤面积及入院时改良Baux评分、血小板计数、血钙水平是老年严重烧伤患者发生早期凝血功能异常的独立危险因素（OR分别为1.181、1.254、0.991、<0.001,95%CI分别为1.085~1.287、1.106~1.423、0.984~0.998、<0.001~0.009,P<0.05）。在预测老年严重烧伤患者发生早期凝血功能异常方面,根据独立危险因素构建的预测模型的受试者操作特征曲线下面积为0.977（95%CI为0.959~0.994）,大于Ⅲ度烧伤面积及入院时改良Baux评分、血小板计数、血钙水平的0.844（95%CI为0.781~0.908）、0.782（95%CI为0.711~0.853）、0.634（95%CI为0.526~0.742）、0.838（95%CI为0.770~0.905）。 结论 Ⅲ度烧伤面积及入院时改良Baux评分、血小板计数和血钙水平是老年严重烧伤患者发生早期凝血功能异常的独立危险因素,基于这4个指标建立的预测模型对老年严重烧伤患者早期凝血功能异常的发生具有很好的预测价值。 Abstract:Objective To investigate the risk factors for the occurrence of early dysfunction of blood coagulation in elderly patients with severe burns. Methods This study was a retrospective case-control study. From June 2015 to June 2025, 158 elderly patients with severe burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 94 males and 64 females, aged 60 to 97 years. The patients were divided into early dysfunction of blood coagulation group (45 cases) and non-early dysfunction of blood coagulation group (113 cases) according to the presence or absence of early dysfunction of blood coagulation. Gender, age, total burn area, full-thickness burn area, admission time after injury, cause of burn, combination of inhalation injury, combination of underlying diseases, modified Baux score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, body temperature, blood pH value, platelet count, and base excess, lactic acid, hemoglobin, serum sodium, serum potassium, serum calcium, plasma fibrinogen (FIB) levels on admission, length of hospital stay, and clinical prognosis between the two groups of patients were compared. The risk factors and independent risk factors affecting the occurrence of early dysfunction of blood coagulation in elderly patients with severe burns were screened, and the prediction model was constructed according to the independent risk factors. The receiver operating characteristic curve was used to evaluate the predictive value of the prediction model and each independent risk factor for the occurrence of early dysfunction of blood coagulation in aforementioned elderly patients with severe burns. Results There were statistically significant differences in the total burn area, full-thickness burn area, on admission modified Baux score, APACHEⅡ score, platelet count, serum calcium level, blood pH value, plasma FIB level, combination of inhalation injury, and clinical prognosis between the two groups of patients (with t values of 2.270, 7.615, 5.975, 2.319, -2.172, and -7.861, respectively, Z values of -2.168 and -2.568, respectively, χ2 values of 20.090 and 10.286, respectively, P<0.05). There were no statistically significant differences in the other indicators between the two groups of patients (P>0.05). The results of univariate logistic regression analysis showed that the total burn area, full-thickness burn area, combination of inhalation injury, modified Baux score, APACHEⅡ score, platelet count, serum calcium level, and plasma FIB level on admission were all risk factors for early dysfunction of blood coagulation in elderly patients with severe burns (with ORs of 1.022, 1.074, 0.141, 1.045, 1.070, 0.996, <0.001, and 0.568, respectively, 95% CIs of 1.003-1.042, 1.047-1.102, 0.055-0.359, 1.027-1.064, 1.008-1.135, 0.992-0.999, <0.001-0.002, and 0.380-0.849, respectively, P<0.05). The results of multivariate logistic regression analysis showed that the full-thickness burn area, modified Baux score, platelet count, and serum calcium level on admission were independent risk factors for early dysfunction of blood coagulation in elderly patients with severe burns (with ORs of 1.181, 1.254, 0.991, <0.001, respectively, 95% CIs of 1.085-1.287, 1.106-1.423, 0.984-0.998, <0.001-0.009, P<0.05). In terms of predicting early dysfunction of blood coagulation in elderly patients with severe burns, the area under the receiver operating characteristic curve of the prediction model constructed based on the independent risk factors was 0.977 (with a 95% CI of 0.959-0.994), which was higher than 0.844 (with a 95% CI of 0.781-0.908), 0.782 (with a 95% CI of 0.711-0.853), 0.634 (with a 95% CI of 0.526-0.742), and 0.838 (with a 95% CI of 0.770-0.905) of the full-thickness burn area, modified Baux score, platelet count, and serum calcium level on admission, respectively. Conclusions Full-thickness burn area, modified Baux score, platelet count, and serum calcium level on admission are independent risk factors for early dysfunction of blood coagulation in elderly patients with severe burns. The prediction model based on these four indicators has a good predictive value for the occurrence of early dysfunction of blood coagulation in elderly patients with severe burns. -
Key words:
- Burns /
- Aged /
- Risk factors /
- Dysfunction of blood coagulation /
- Prediction model
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参考文献
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Table 1. 2组老年严重烧伤患者一般资料比较
组别 例数 性别（例） 年龄（岁, 烧伤总面积（%TBSA, Ⅲ度烧伤面积（%TBSA, 伤后入院时间[h,M（Q1,Q3）] 烧伤原因（例） 合并吸入性损伤（例） 男 女 火焰 热液 其他 是 否 早期凝血功能异常组 45 30 15 70±7 60±18 45±18 4（3,6） 39 5 1 39 6 非早期凝血功能异常组 113 64 49 68±7 53±17 23±16 4（2,7） 98 9 6 54 59 统计量值 χ2=1.343 t=1.321 t=2.270 t=7.615 Z=-1.240 χ2=1.137 χ2=20.090 P值 0.246 0.189 0.025 <0.001 0.901 0.566 <0.001 注：TBSA为体表总面积；烧伤原因中“其他”指化学烧伤与电烧伤；改良Baux评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、体温、血液pH值、血小板计数及剩余碱、乳酸、血红蛋白、血钙、血钾、血钠、血浆纤维蛋白原水平取入院时统计数据 
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Table 2. 158例老年严重烧伤患者发生早期凝血功能异常相关因素的单因素logistic回归分析结果
因素 OR 95%CI P值 烧伤总面积（%TBSA） 1.022 1.003~1.042 0.027 Ⅲ度烧伤面积（%TBSA） 1.074 1.047~1.102 <0.001 合并吸入性损伤 0.141 0.055~0.359 <0.001 改良Baux评分（分） 1.045 1.027~1.064 <0.001 APACHEⅡ评分（分） 1.070 1.008~1.135 0.026 血液pH值 0.004 <0.001~1.673 0.073 血小板计数（×109 /L） 0.996 0.992~0.999 0.019 血钙水平（mmol/L） <0.001 <0.001~0.002 <0.001 血浆纤维蛋白原水平（g/L） 0.568 0.380~0.849 0.006 注：TBSA为体表总面积；改良Baux评分、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、pH值、血小板计数、血钙水平、血浆FIB水平均取入院时统计数据
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Table 3. 158例老年严重烧伤患者发生早期凝血功能异常相关因素的多因素logistic回归分析阳性结果
因素 OR 95%CI P值 Ⅲ度烧伤面积（%TBSA） 1.181 1.085~1.287 <0.001 改良Baux评分（分） 1.254 1.106~1.423 <0.001 血小板计数（×109 /L） 0.991 0.984~0.998 0.011 血钙水平（mmol/L） <0.001 <0.001~0.009 <0.001 注：TBSA为体表总面积；改良Baux评分、血小板计数、血钙水平取入院时统计数据
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Table 4. 158例老年严重烧伤患者发生早期凝血功能异常的预测模型及各独立危险因素的预测价值
预测模型或独立危险因素 受试者操作特征曲线下面积 95%CI 约登指数 最佳截断值 敏感度（%） 特异度（%） 预测模型（%） 0.977 0.959~0.994 0.841 84.100 95.600 88.500 Ⅲ度烧伤面积（%TBSA） 0.844 0.781~0.908 0.592 39.000 68.900 90.300 改良Baux评分（分） 0.782 0.711~0.853 0.496 123.500 95.600 54.000 血小板计数（×109 /L） 0.634 0.526~0.742 0.299 204.500 46.700 83.200 血钙水平（mmol/L） 0.838 0.770~0.905 0.570 2.015 75.600 81.400 注：TBSA为体表总面积；改良Baux评分、血小板计数、血钙水平取入院时统计数据
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