Impact of comorbidities on the prognoses of trauma patients: Analysis of a hospital-based trauma registry database

Abstract

Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included. We measured the hospital mortality of blunt traumatized patients using alive discharge as a competing risk. To investigate conditional independence of mortality and ICED scores given Injury Severity Score (ISS), we used log-linear models for modeling independence structures. Overall, we included 4997 patients (median age [IQR], 59 years old (44–75 years); 55.3% male). The mortality rate of blunt traumatized patients was higher in the higher ICED scores group compared to lower ICED scores group (4.7% vs 1.8%, p < 0.001). Meanwhile, the higher ICED scores group were associated with older age, higher ISS, and longer hospital stay than lower ICED scores group. Higher ICED group had higher probability of transition-to-death and lower probability of transition-to-discharge under the competing risk model. In the multivariable analysis of transition-specific Cox models, higher ICED group were associated with higher risk for hospital mortality compared to lower ICED group (HR 1.60; [95% CI 1.04–2.47]; p = 0.032). Also, higher ICED group were associated with lower probability of transition-to-discharge (HR 0.79; [95%CI 0.73–0.86]; p < 0.001). Additionally, higher ICED scores accounted for hospital mortality among patients with ISS < 25. In conclusion, our study suggested that severity of comorbidity was associated with higher hospital mortality among traumatized patients, particularly lower ISS.

Comorbidities in Trauma Injury Severity Scoring System: Refining Current Trauma Scoring System

“…The study concluded that comorbidities have an important influence on long-term outcomes after major trauma. In addition, Wang et al 11 analyzed their hospital trauma registry database at the Chang Gung Memorial Hospital, Keelung, a single Level I trauma center in North Taiwan, between 2011 and 2015. Patients with penetrating injuries, burns, out-of-hospital cardiac arrest, incomplete medical history, age younger than 20 years, and discharge or death within 24 hours of admission were excluded.…”

“…In addition, higher comorbid scores accounted for mortality among traumatized patients with ISS < 25, particularly among patients with ISS < 16. 11 Interestingly, a study carried out by Shoko and his associates asked the question whether preexisting medical conditions (PMCs) may play a role in hospital mortality. 12 The study involved a retrospective analysis using 20,257 cases recorded in the Japan Trauma Data Bank from 2004 to 2007.…”

ΔMST and the Regulation of Cardiac CSE and OTR Expression in Trauma and Hemorrhage

“…Furthermore, naive CSE knock out (ko) mice had lower levels of OTR [1], and similarly, naive mice with a genetic deletion of OTR presented with a reduction of CSE expression [14]. Psychological stress can reportedly dysregulate OTR expression [16], and trauma leads to cardiovascular co-morbidities, which increase morbidity and mortality in intensive care patients [1,17,18]. Trauma can be a result of either (or both) a deep emotional pain, and/or a life-threatening event (psychological) or a physiological injury or impact against the body (physical).…”

The Interaction of the Endogenous Hydrogen Sulfide and Oxytocin Systems in Fluid Regulation and the Cardiovascular System

“…The gasotransmitter hydrogen sulfide (H 2 S) (endogenously produced by cystathionine γ-lyase (CSE), cystathionine β-synthase (CBS) and 3-mercaptopyruvate-sulfurtransferase (3MST) (as depicted in Figure 1 )) and the neuroendocrine oxytocin (OT) system have been recently shown to not only possibly play parallel roles in the heart and the brain in response to trauma, but also to influence one another. Trauma can lead to cardiovascular impairments and disease which worsens the outcomes of intensive care patients and increases morbidity and mortality [ 1 , 2 ]. Trauma is either a consequence of a deep emotional pain or a physical injury.…”