Incidence, prognosis and risk factors of jaundice in polytrauma patients

Liangsheng Tang; Liming Dong; Deng Chen; Cong Zhang; Jialiu Luo; Shunyao Chen; Zhiqiang Lin; Peidong Zhang; Teding Chang; Zhaohui Tang

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Incidence, prognosis and risk factors of jaundice in polytrauma patients

VernacularTitle:多发性创伤后黄疸的发生、预后及危险因素分析
Author: Liangsheng TANG ¹ ; Liming DONG ; Deng CHEN ; Cong ZHANG ; Jialiu LUO ; Shunyao CHEN ; Zhiqiang LIN ; Peidong ZHANG ; Teding CHANG ; Zhaohui TANG
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1. 监利市创伤中心，监利市人民医院骨外科，监利　433300
Keywords: Polytrauma; Jaundice; Prospective study; Incidence; Risk Factor
From: Chinese Journal of Emergency Medicine 2024;33(5):630-635
CountryChina
Language:Chinese
Abstract: Objective:To assess the occurrence, prognosis and possible early risk factors of jaundice in polytrauma patients.Methods:This study was a single-center, prospective study. Polytrauma patients (age>18 years) admitted to Tongji Trauma Center from October 2020 to January 2023 were enrolled. The patients with liver, biliary tract or pancreatic traumatic injury, previously suffered from chronic liver disease were excluded. The clinical characteristics of patients, laboratory test results, imaging examination results, Injury Severity Score (ISS), Glasgow Coma Score and APACHEⅡ score were collected. The incidence of jaundice, the classification of jaundice or the severity of jaundice after multiple injuries, the mortality rate of polytrauma patients with jaundice, and the early independent risk factors of jaundice in polytrauma were analyzed. The differences between the groups were compared by Student’s t test or χ2 test. The independent risk factors of jaundice were analyzed by Logistic regression analyzed. Results:A total of 742 polytrauma patients were included, 34.09% polytrauma patients were accompanied by jaundice, and the ratio of both moderate and severe jaundice were as high as 32.41%. The main type of jaundice was intrahepatic cholestatic jaundice (47.03%). The mortality rate of polytrauma patients accompanied by jaundice was significantly higher than that of polytrauma patients without jaundice (12.25% vs. 3.47%, P<0.001). Logistic regression analysis showed that ISS score ( OR=3.405, 95% CI: 1.962-7.438, P=0.026), plasma lactate ( OR=2.216, 95% CI: 1.203-4.862, P=0.017), interleukin-6 levels ( OR=2.431, 95% CI: 1.424-3.793, P=0.007), the overall duration of parenteral nutrition ( OR=3.011, 95% CI: 1.624-5.041, P=0.022), and the total duration of mechanical ventilation ( OR=3.572, 95% CI: 1.497-4.601, P=0.031) were the early independent risk factors for jaundice in patients after polytrauma. Conclusions:Polytrauma patients are prone to developing jaundice after injury, which is more harmful, especially for intrahepatic cholestatic jaundice after injury. Early identification and early intervention of risk factors associated with jaundice after injury should be strengthened.