Comparison of base excess, lactate and pH predicting 72-h mortality of multiple trauma

Association between base excess and mortality in critically ill patients with ischemic stroke: a retrospective cohort study

BACKGROUND

Base excess (BE) is associated with mortality from many diseases. However, the relationship between BE and mortality in patients with ischemic stroke remains uncertain. Our aim is to investigate the relationship between BE values upon admission to the ICU and mortality rates in critically ill stroke patients.

METHODS

The current study enrolled 1,572 patients with ischemic stroke (863 males and 709 females). The associations of BE with intensive care unit (ICU), hospital, 28-day, and 1-year mortalities were assessed using multivariable logistic regression or Cox proportional hazards model. The potential impact of the Sequential Organ Failure Assessment (SOFA) score (< 5 or ≥ 5) on the prognostic value of BE was further evaluated with interaction and subgroup analyses.

RESULTS

BE values less than - 3 mmol/L, greater than 3 mmol/L, and within - 3 to 3 mmol/L (normal BE) were observed in 316 (20.1%), 175 (11.1%), and 1,081 (68.8%) patients, respectively. The restricted cubic splines analyses revealed that a U-shaped curve between BE and the mortality risk. Multivariable analysis indicated that patients with low BE (<-3 mmol/L) had higher rates of ICU mortality (odds ratio [OR], 1.829; 95% confidence interval [CI], 1.281-2.612; P = 0.001), hospital mortality (OR, 1.484; 95% CI, 1.077-2.045; P = 0.016), 28-day mortality (hazard ratio [HR], 1.522; 95% CI, 1.200-1.929; P = 0.001), and 1-year mortality (HR, 1.399; 95% CI, 1.148-1.705; P = 0.001) than patients with normal BE. Subgroup analyses showed consistent results pertaining to SOFA scores ≥ 5.

CONCLUSIONS

In critically ill patients with ischemic stroke, an initial BE of <-3 mmol/L at ICU admission may indicate an increased risk of ICU, hospital, 28-day, and 1-year mortalities.

Is the lactate value predictive of the return of spontaneous circulation during CPR in nontraumatic OHCA?

AIM OF THE STUDY

Cardiac arrest is a major public health issue, in which emergency medical services (EMS) initiating or continuing resuscitation in about 50% to 60% of cases. The aim of this study was to determine whether blood lactate levels and their course during cardiopulmonary resuscitation are prognostic indicators of the return of spontaneous cardiac activity (ROSC) in non-traumatic out-of-hospital cardiac arrest (OHCA).

METHODS

This was a prospective, interventional, multi-center study between 2017 and 2020. Patients above the age of 18 years (>50 years for women) who had non-traumatic OHCA and did not achieve ROSC before the arrival of the EMS, and for whom the medical team decided to initiate or continue cardiopulmonary resuscitation have been included. The primary endpoint was the return of spontaneous cardiac activity during out-of-hospital cardiopulmonary resuscitation, and secondary endpoint was survival at day 28. The lactate was initially measured simultaneously on a venous and capillary sample and then in capillary samples throughout the CPR, using POC device.

RESULTS

A total 60 patients were included. Median age was 71 [IQR: 62-84] and 21.3% were female. Among them, 25% underwent ROSC in out-of-hospital setting, and 13,3% were alive at D-28. The median venous lactate value in all patients at T0 (time at which the EMS set up the peripheral venous line) was 6.2 mmol/L [IQR: 4.6-8.1], with no difference between patients with or without ROSC: 6.4 mmol/L [IQR:4.7-7.9] for patients with ROSC and 6.2 mmol/L [IQR: 4.7-8] for patients without ROSC (p = 0.87). The variables independently associated with ROSC were initial EtCo2 value (aOR = 1.12; 95% CI 1.01-1.25); the initial shockable rhythm (aOR = 10.2; 95% CI 1.18-88.2); and the pre-ROSC adrenaline dose (aOR = 0.54; 95% CI 0.35-0.82).

CONCLUSION

In this prospective multi-center study, there was no independent association between lactate values during cardiopulmonary resuscitation and ROSC in non-traumatic OHCA. However, the post-ROSC pre-hospital kinetics of lactate (i.e., during the first 30 min) seem to be associated with survival.

Independent predictors of mortality for critically ill patients with polytrauma: A single center, retrospective study

Independent predictors of mortality and transfusion therapy in polytrauma patients from the Chinese population remain unknown. Here, we aimed to identify these predictors by retrospectively collecting and analyzing vital signs and laboratory results for 408 critically ill patients suffering from polytrauma who were treated in Affiliated Kunshan Hospital of Jiangsu University, Jiangsu Province, China from January 2020 to December 2021. We identified risk factors for mortality and transfusion therapy using logistic regression analysis. As a results, we enrolled a total of 408 polytrauma patients, with a male-to-female ratio of 2:1, a mean age of 49.02 ± 16.84 years, a mortality rate of 15.9 %, and a blood transfusion rate of 45.8 %. The multivariate logistic regression showed that decreased Glasgow Coma Scale (GCS) score (Odds ratio (OR) = 0.72, 95 % confidence interval (95%CI): 0.63-0.83, P < 0.001), decreased base excess (BE) (OR = 0.77, 95%CI: 0.67-0.87, P < 0.001), and increased Injury Severity Score (ISS) (OR = 1.12, 95%CI: 1.06-1.17, P < 0.001) were independent risk factors for the mortality. In addition, increased GCS score (OR = 1.17, 95%CI: 1.03-1.35, P = 0.020), increased heart rate (OR = 1.05, 95%CI: 1.04-1.07, P < 0.001), decreased systolic blood pressure (SBP) (OR = 0.97, 95%CI: 0.96-0.99, P < 0.001), increased peripheral oxygen saturation (SpO2) (OR = 1.10, 95%CI: 1.04-1.16, P = 0.002), decreased serum lactate (OR = 0.58, 95%CI: 0.42-0.79, P = 0.001), decreased BE (OR = 0.49, 95%CI: 0.39-0.62, P < 0.001), and increased ISS (OR = 1.25, 95%CI: 1.18-1.33, P < 0.001) were independent risk factors for blood transfusion. The area under receiver operating characteristic curves (AUROCs) of the model to predict mortality and blood transfusion were 0.976 (95%CI: 0.960-0.992, P < 0.001) and 0.973 (95%CI: 0.958-0.987, P < 0.001). In conclusion, decreased BE level was significantly associated with all-cause mortality in polytrauma patients. BE, ISS, and GCS might be independent important predictors for mortality and blood transfusion of polytrauma patients.

Does base excess predict kidney injury in neonates with hypoxic-ischemic encephalopathy?

In neonates with hypoxic-ischemic encephalopathy (HIE), we studied the correlation between cord blood base excess (BE) and kidney function. Among 225 infants, 29 % had oliguria. BE levels differed significantly between oliguric and non-oliguric infants (p < 0.01), with a negative correlation to kidney injury (r = -0.544, p < 0.01). BE < -18 had 85 % specificity and 76 % sensitivity in predicting kidney injury (AUC = 0.88). These findings suggest BE as a valuable indicator of impending kidney injury in HIE infants, though underlying mechanisms may vary.

Procalcitonin and blood lactate level as predictive biomarkers in pediatric multiple trauma patients' pediatric intensive care outcomes: A retrospective observational study

Pediatric trauma represents a significant source of morbidity and mortality in children, encompassing a broad spectrum of injuries. Despite advancements in the treatment and prevention of injuries, the risk of trauma in children remains a persistent concern. Severe trauma cases often necessitate admission to a pediatric intensive care unit (PICU). Procalcitonin, an essential biomarker that elevates bacterial infections and trauma, and elevated lactate levels can signal adverse outcomes in critically ill patients. This study retrospectively examined pediatric patients with multiple trauma treated at the Başakşehir Çam and Sakura City Hospital PICU between 2021 and 2023. The analysis sought to evaluate the relationship between initial procalcitonin and lactate levels with the duration of stay in the PICU, the length of invasive mechanical ventilation (IMV), and the duration of inotropic support. Furthermore, a comparison was made between procalcitonin and lactate levels in survivors and non-survivors, analyzing their potential influence on PICU outcomes and mortality. For pediatric multi-trauma patients, the median duration of stay in the PICU was found to be 3 days. Among these patients, 32% necessitated IMV support and utilized it for a median of 5 days. Additionally, 36% of these patients were provided inotropic drug support for a median time of 6 days. The observed mortality rate was 11%. Procalcitonin and blood lactate levels were found to have significant predictive power for mortality with odds ratios of 1.05 (P = .04) and 1.87 (P = .02), respectively. Both blood lactate and procalcitonin levels were significantly associated with the duration of IMV support, the period of inotropic drug administration, and the length of PICU stay (P < .01; P < .01; P < .01, respectively). this research underscores the prognostic value of initial procalcitonin and lactate levels about the intensive care trajectory of pediatric trauma patients. The findings suggest that both procalcitonin and lactate levels may play pivotal roles as potential biomarkers in predicting and managing clinical outcomes in this population.

The efficacy of sodium bicarbonated Ringer's solution versus lactated Ringer's solution in elderly patients undergoing gastrointestinal surgery: a prospective randomized controlled trial

OBJECTIVE

To investigate the effect of sodium bicarbonated Ringer's solution (BRS) on lactate metabolism, acid-base balance, and clinical outcomes in elderly patients undergoing gastrointestinal surgery.

METHODS

A total of 60 elderly patients undergoing gastrointestinal surgery were enrolled in this prospective, randomized controlled study. The participants were randomly assigned to the BRS group (n = 30) or sodium lactated Ringer's solution (LRS) group (n = 30) where they received goal-directed fluid therapy with BRS or LRS, respectively. The primary outcome was the incidence of postoperative hyperlactatemia, whereas the secondary outcomes included pH, bicarbonate, base excess (BE), liver function, and postoperative complications within 30 days. Linear regression was conducted to screen the factors affecting lactate concentration.

RESULTS

After fluid therapy, the probability of hyperlactatemia was lower in the BRS group than in the LRS group (3.3% vs. 40.0%, P < 0.001). No significant difference in bicarbonate, pH, and BE was observed between the groups (P > 0.05). Furthermore, the incidence of major complications and the length of hospital stay were not significantly different (P > 0.05). However, the BRS group had a lower risk of minor complications than the LRS group (50.0% vs. 76.7%, P = 0.032), particularly in terms of impaired liver function (16.7% vs. 43.3%, P = 0.024). Diabetes, hypotension, and volume of LRS infused were highly correlated with lactate concentration.

CONCLUSION

BRS is more beneficial to the reduction of the incidence of postoperative hyperlactatemia and the risk of minor postoperative complications in elderly patients undergoing gastrointestinal surgery. Therefore, BRS may be a better option for perioperative fluid therapy in elderly patients undergoing gastrointestinal surgery.

Effect of Injury Patterns on the Development of Complications and Trauma-Induced Mortality in Patients Suffering Multiple Trauma

Patients that suffer from severe multiple trauma are highly vulnerable to the development of complications that influence their outcomes. Therefore, this study aimed to evaluate the risk factors that can facilitate an early recognition of adult patients at risk. The inclusion criteria were as follows: admission to a level 1 trauma center, injury severity score (ISS) ≥ 16 (severe injury was defined by an abbreviated injury score (AIS) ≥ 3) and ≥18 years of age. Injury- and patient-associated factors were correlated with the development of four complication clusters (surgery-related, infection, thromboembolic events and organ failure) and three mortality time points (immediate (6 h after admission), early (>6 h-72 h) and late (>72 h) mortality). Statistical analysis was performed using a Chi-square, Mann-Whitney U test, Cox hazard regression analysis and binominal logistic regression analysis. In total, 383 patients with a median ISS of 24 (interquartile range (IQR) 17-27) were included. The overall mortality rate (27.4%) peaked in the early mortality group. Lactate on admission significantly correlated with immediate and early mortality. Late mortality was significantly influenced by severe head injuries in patients with a moderate ISS (ISS 16-24). In patients with a high ISS (≥25), late mortality was influenced by a higher ISS, older age and higher rates of organ failure. Complications were observed in 47.5% of all patients, with infections being seen most often. The development of complications was significantly influenced by severe extremity injuries, the duration of mechanical ventilation and length of ICU stay. Infection remains the predominant posttraumatic complication. While immediate and early mortality is mainly influenced by the severity of the initial trauma, the rates of severe head injuries influence late mortality in moderate trauma severity, while organ failure remains a relevant factor in patients with a high injury severity.

Mortality Risk Factors of Severely Injured Polytrauma Patients (Prehospital Mortality Prediction Score)

The aim of this study was to analyze the mortality of polytrauma patients and identify prediction parameters. A further aim was to create from the results a score for the prehospital predictive evaluation of 30-day survival. The study was conducted with a retrospective, observational design and was carried out unicentrically at a Level 1 Trauma Center. During the 4-year investigation period, patients with an Injury Severity Score (ISS) ≥ 16 were examined and their demographic basic data, laboratory values, and vital parameters were recorded. The mortality data analysis was performed using Kaplan-Meier Analysis and Log-Rank tests. Cox regressions were carried out to determine influencing factors and Receiver Operating Characteristic (ROC) curves were plotted to establish limit values for potential influencing factors. All statistical tests were conducted at a significance level of p ≤ 0.05. Coronary Heart Disease (CHD), cardiopulmonary resuscitation (CPR), age at admission, sex, and Glasgow Coma Scale (GCS) had a significant impact on the survival of polytrauma patients. The identified prediction parameters were combined with the shock index (SI). The generated score showed a sensitivity of 93.1% and a specificity of 73.3% in predicting the mortality risk. The study was able to identify significant influencing prehospital risk factors on 30-day survival after polytrauma. A score created from these parameters showed higher specificity and sensitivity than other prediction scores. Further studies with a larger number of participants and the inclusion of slightly injured patients could verify these findings.

Combination of Lactate and Base Deficit Levels at Admission to Predict Mortality in Blunt Trauma Patients

INTRODUCTION

Elevated lactate levels are associated with increased mortality in both trauma and non-trauma patients. The relation between base deficit (BD) and mortality is less clear. Traumatologists debate the utility of elevated lactate (EL) versus BD in predicting mortality. We hypothesized that EL (2mmol/L to 5mmol/L) and BD (≤-2mmol/L) in combination could predict mortality in blunt trauma patients.  Methods: This is a retrospective analysis of the trauma registry from 2012 to 2021 at a level 1 trauma center. Blunt trauma patients with admission lactate and BD values were included in the analysis. Exclusion criteria were age <18, penetrating trauma, unknown mortality, and unknown lactate or BD. Logistics regression of the total 5153 charts showed 93% of the patients presented with lactate levels <5mmol/L, therefore patients with lactate >5mmol/L were excluded as outliers. The primary outcome was mortality.

RESULTS

A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of EL + BD (35.8% vs. 14.4%, p <0.001). When comparing survivors and non-survivors, EL + BD (OR 5.69), age >65 (5.17), injury severity score (ISS) >25 (8.87), Glasgow coma scale <8 (8.51), systolic blood pressure (SBP) <90 (4.2), and ICU admission (2.61) were significant predictors of mortality. Other than GCS <8 and ISS >25, EL + BD had the highest odds of predicting mortality.

CONCLUSION

Elevated lactate + BD on admission in combination represents a 5.6-fold increase in mortality in blunt trauma patients and can be used to predict a patient's outcome on admission. This combination variable provides an additional early data point to identify patients at elevated risk of mortality at the moment of admission.

Biochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility

PURPOSE OF REVIEW

With advances in resuscitative techniques, trauma patients are surviving increasingly severe injuries and physiological insult. Timely recognition of futility remains important in terms of patient dignity and resource preservation yet is increasingly challenging in the face of these advances. The understanding of biochemical derangement from pathophysiological processes of trauma and iatrogenic effects of resuscitation has expanded recently.

RECENT FINDINGS

Acidosis and hypocalcaemia have been recognized as important contributors to mortality among trauma patients. Although less well recognized and studied, critical injury and high blood product volume resuscitation render patients vulnerable to life-threatening hyperkalaemia. The methods of correcting disruptions to acid-base and electrolyte homeostasis during damage control resuscitation have changed little recently and often rely on evidence from undifferentiated populations. Biochemical disturbances have value as ancillary predictors of futility in trauma resuscitation.

SUMMARY

These findings will contribute to a greater understanding among anaesthesiologists of the causative mechanisms and effects of biochemical derangement after severe injury and aid them in the delivery of well tolerated and effective damage control resuscitation. Gaps in the evidence base are highlighted to encourage future work.

Acute Kidney Injury: Iterative Development of an Audit Tool for Trauma Patients

BACKGROUND

Acute kidney injury is a low-volume, high-risk complication in trauma patients and is associated with prolonged hospital length of stay and increased mortality. Yet, no audit tools exist to evaluate acute kidney injury in trauma patients.

OBJECTIVE

This study aimed to describe the iterative development of an audit tool to evaluate acute kidney injury following trauma.

METHODS

Our performance improvement nurses developed an audit tool to evaluate acute kidney injury in trauma patients using an iterative, multiphase process conducted from 2017 to 2021, which included a review of our Trauma Quality Improvement Program data, trauma registry data, literature review, multidisciplinary consensus approach, retrospective and concurrent review, and continuous audit and feedback for piloted and finalized versions of the tool.

RESULTS

The final acute kidney injury audit tool can be completed within 30 min using data obtained from the electronic medical record and consists of six sections, including identification criteria, source potential causes, source treatment, acute kidney injury treatment, dialysis indications, and outcome status.

CONCLUSION

The iterative development and testing of an acute kidney injury audit tool improved the uniform data collection, documentation, audit, and feedback of best practices to positively impact patient outcomes.

Routine laboratory parameters predict intensive care unit admission and hospitalization in patients suffering stab injuries

Background

Knife crime has increased considerably in recent years in Northern Europe. Affected patients often require immediate surgical care due to traumatic organ injury. Yet, little is known about clinically relevant routine laboratory parameters in stab injury patients and how these are associated with intensive care unit (ICU) admission, hospitalization and number of surgeries.

Methods

We retrospectively analyzed 258 stab injury cases between July 2015 and December 2021 at an urban Level I Trauma Center. Annual and seasonal incidences, injury site, injury mechanism, Injury Severity Score (ISS), and surgical management were evaluated. First, correlations between routine laboratory parameters for hematology, coagulation, and serum biochemistry (peak, and Δ (change from admission to peak within 3 days following admission)) and length of hospital stay, ICU stay, and number of surgeries were assessed using Spearman's rank correlation coefficients. Second, multivariable Least Absolute Shrinkage and Selection Operator (LASSO) regression analyses were conducted to identify parameters predictive of clinical outcomes. Third, longitudinal developments of routine laboratory parameters were assessed during hospital admission.

Results

In 2021, significantly more stab injuries were recorded compared with previous years and occurred less during winter compared with other seasons. Mean ISS was 8.3 ± 7.3, and ISS was positively correlated with length of hospital and ICU stay (r = 0.5-0.8, p < 0.001). Aspartate transaminase (AST) (Δ) (r = 0.690), peak C-reactive protein (CrP) (r = 0.573), and erythrocyte count (Δ) (r = 0.526) showed the strongest positive correlations for length of ICU stay for penetrating, thoracoabdominal, and organ injuries, respectively. No correlations were observed between routine laboratory parameters and number of surgeries. For patients with penetrating injuries, LASSO-selected predictors of ICU admission included ISS, pH and lactate at admission, and Δ values for activated partial thromboplastin time (aPTT), K+, and erythrocyte count. CrP levels on day 3 were significantly higher in patients with penetrating (p = 0.005), thoracoabdominal (p = 0.041), and organ injuries (p < 0.001) compared with those without.

Conclusion

Our data demonstrate an increase in stab injury cases in 2021 and an important link between changes in routine laboratory parameters and ICU admission and hospitalization. Monitoring ISS and changes in AST, CrP, erythrocyte count, pH, lactate, aPTT, and K+ may be useful to identify patients at risk and adjust surgical and ICU algorithms early on.

Lactate acid level and prognosis of neonatal necrotizing enterocolitis: a retrospective cohort study based on pediatric-specific critical care database

OBJECTIVE

To investigate the relationship between lactate acid level and hospitalization mortality in neonatal necrotizing enterocolitis (NEC).

METHOD

Paediatric-specific critical care database collected clinical data from the intensive care unit of Children's Hospital Affiliated to Zhejiang University Medical College from 2010 to 2018. Clinical and laboratory examination information of NEC patients was collected and divided into the death group and discharge group to find out the risk factors affecting the prognosis through univariate and multivariate analysis.

RESULTS

Among 104 NEC neonates, the admission age was 7.5 days and the weight was 2.03 kg. Comparing the death group with the discharge group, there were significant differences in therapeutic regimen, pH, serum albumin, total protein, creatinine and lactate acid. Multivariate and threshold effect analysis showed that lactate acid had a linear correlation with hospital mortality, and newborns who died in the hospital had much higher lactate levels than those who were discharged. The mortality of NEC newborns increased by 40-45% for every 1 mmol/L increase in lactate acid level.

CONCLUSIONS

There was a correlation between lactate acid level and hospital mortality in newborns with NEC, and lactate acid level was an important index to evaluate the prognosis of NEC.

The Association Between Serum Lactate Concentration, Base Deficit, and Mortality in Polytrauma Patients as a Prognostic Factor: An Observational Study

Introduction

In polytrauma patients, it is crucial to identify the severity of the injuries to ensure patient safety and survival. Polytrauma leads to hypotension and hypoperfusion, which results in an anaerobic metabolism with acidosis and a decrease in base excess. Thus, blood lactate levels above a certain threshold indicate the existence of global tissue hypoxia, which is a precursor to shock and multiple organ dysfunction syndrome (MODS). The serum lactate and base deficit (BD) levels are used in polytrauma patients as measures of damage severity and resuscitation endpoints and as a way to evaluate therapy efficacy and to predict outcomes. Thus, arterial blood gas analysis is of great value in assessing the status and prognosis of patients with polytrauma. There are few comparative studies on the predictive values of these markers in trauma patients. To determine which measure can more accurately predict the prognosis of polytrauma patients, the present study investigated the predictive values of mortality of these indicators for mortality within 48 hours of admission to the emergency room (ER) in patients with polytrauma.

Methods

This prospective study was designed for a single tertiary care center in northern India. We included 90 patients with polytrauma who were between the ages of 18 and 70 years, with the exception of pregnant women, who presented to the ER within six hours of injury with an injury severity score (ISS) >16, serum lactate level >2.0 mmol/L, and BD -4.0 mEq/L at the time of admission. If the patient's ISS was >16 at the time of ER presentation, arterial blood samples were drawn to determine the serum lactate and BD level at the time of admission and at 12, 24, and 48 hours intervals after ER admission. The primary outcome was the change in serum lactate and BD level in polytrauma. The secondary outcomes were an association of serum lactate and BD with mortality and the correlation between serum lactate with the BD and ISS with mortality of polytrauma patients. The timing of all outcome assessments was at 48 hours after each patient's ER admission.

Results

Lactate clearance from 0-12 hours (t = 2.28, p <0.05), 0-24 hours (t = 6.01, p <0.001), and 0-48 hours (t = 7.98, p <0.001) and a correction in BD from 0-24 (t = 2.68, p <0.01 ) and 0-48 hours (t = 5.46, p <0.001) were significantly higher in nonsurvivors as compared with survivors. In survivors and nonsurvivors, mean serum lactate levels (2.46 ± 1.46 versus 4.15 ± 2.99, t = 3.31, p <0.001, 95%Cl) and mean BD (-3.17 ± 2.58 versus -6.5 ± 4.91, t = 3.86, p <0.001, 95%CI) had a statistically significant difference. The serum lactate and BD levels at time of ER admission (r L0, BD0 = -0.765, p <0.01) and 48 hours after ER admission (r L48, BD 48 = -0.652, p <0.001) were highly negatively correlated.

Conclusion

In polytrauma patients, serum lactate and BD are simple, quick, and independent biochemical predictors of 48-hour mortality, and this single arterial blood test would thereby improve decision-making for resuscitation effectiveness. Prolonged lactate and BD normalization time were associated with higher mortality. Serum lactate and BD are negatively correlated. A higher ISS at admission was associated with a higher incidence of mortality in polytrauma patients.

A Novel Strategy for Predicting 72-h Mortality After Admission in Patients With Polytrauma: A Study on the Development and Validation of a Web-Based Calculator

Background

Early and accessible screening of patients with polytrauma at a high risk of hospital death is essential. The purpose of this research was to seek an accurate and convenient solution to predict deaths occurring within 72 h after admission of these patients.

Methods

A secondary analysis was conducted on 3,075 patients with polytrauma from the Dryad database. We imputed missing values in eligible individuals with the k-nearest neighbor algorithm and then randomly stratified them into the training group (n = 2,461) and the validation group (n = 614) based on a proportion of 8:2. The restricted cubic spline, univariate, backward stepwise, and multivariate logistic regression methods were employed to determine the suitable predictors. Calibration and receiver operating characteristic (ROC) curves were applied to assess the calibration and discrimination of the obtained model. The decision curve analysis was then chosen as the measure to examine the clinical usage.

Results

Age, the Glasgow Coma Scale score, the Injury Severity Score, base excess, and the initial lactate level were inferred as independent prognostic factors related to mortality. These factors were then integrated and applied to construct a model. The performance of calibration plots, ROC curves, and decision curve analysis indicated that the model had satisfactory predictive power for 72-h mortality after admission of patients with polytrauma. Moreover, we developed a nomogram for visualization and a web-based calculator for convenient application (https://songandwen.shinyapps.io/DynNomapp/).

Conclusions

A convenient web-based calculator was constructed to robustly estimate the risk of death in patients with polytrauma within 72 h after admission, which may aid in further rationalization of clinical decision-making and accurate individual treatment.