Is it possible to predict mortality in patients with high-grade blunt liver injury? A single trauma center study

BACKGROUND: Blunt abdominal trauma constitutes a significant portion of trauma cases and is often associated with liver injury. Given that high-grade liver injuries remain life-threatening, identifying patients who will likely require more vigilant attention and care is crucial. This study aims to determine the parameters that increase mortality in patients with high-grade liver trauma.
METHODS: This study enrolled 38 patients with Grade III or higher liver injuries, treated by the general surgery department between 2008 and 2023. Eleven patients who died were categorized into Group 1, and 27 survivors were placed in Group 2. We evaluated their respective mechanisms of injury, imaging results, Glasgow Coma Scale scores, Base Excess, Lactate levels, pH, and Injury Severity Score findings. Receiver Operating Characteristics (ROC) analysis was performed for parameters with significant differences, and certain cutoff values were determined.
RESULTS: The grade of liver injury and additional abdominal organ injuries were significantly higher in Group 1 (p<0.05). The difference in extra-abdominal injury sites was statistically insignificant between the groups (p>0.05). Erythrocyte suspension requirements were significantly higher in Group 1 (p<0.05). Average lactate and base deficit values were also significantly higher in Group 1 (p<0.05), while leukocyte counts were significantly lower in Group 1 (p<0.05).
CONCLUSION: Base deficit, hemoglobin (Hb), lactate levels, injury severity, liver injury grade, accompanying abdominal injuries at admission, and erythrocyte suspension demands were found to be associated with increased mortality rates. Certain cutoff values for the aforementioned parameters could be established. However, further data are required to confirm these findings.

Yüksek dereceli künt karaciðer yaralanmalarýnda mortaliteyi öngörmek mümkün mü? Tek travma merkezli çalýþma

AMAÇ: Künt karýn travmalarý tüm travma vakalarýnýn önemli bir bölümünü oluþturur ve sýklýkla karaciðer yaralanmalarý ile iliþkilidir. Yüksek dereceli künt karaciðer yaralanmalarý ise günümüzde dahi hayatý tehdit eden klinik tablolara sebebiyet verebilmektedir. Bu nedenle daha yakýn takip ve tedavi gerekecek kritik hastalarýn tanýnmasý önem arz etmektedir. Bu minvalde mortaliteyi arttýran faktörlerin tespiti için bu hastalardaki deneyimimizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: 2008 ve 2023 yýllarý arasýnda acil kliniðinde künt travma sonrasý grade 3 ve üzeri karaciðer yaralanmasý tanýsý almýþ 38 hasta çalýþmaya dahil edildi. Vefat eden 11 hasta 1. gruba alýnýrken, sað kalan 27 hasta 2. gruba dahil edildi. Gruplar yaralanma mekanizmasý, görüntüleme sonuçlarý, glasgow koma skorlarý, travma þiddeti skorlarý, baþvuru esnasýndaki baz açýðý, laktat ve pH deðerleri yönünden karþýlaþtýrýldý. Anlamlý fark olan parametrelerde eþik deðeri bulmak için ROC analizi kullanýldý.
BULGULAR: Karaciðer yaralanma derecesi ve ek abdominal organ yaralanma oranlarý 1. grupta anlamlý daha yüksekti (p<0.05). Ekstraabdominal organ yaralanmasý yönünden gruplar arasýnda fark yoktu (p>0.05). Eritrosit suspansiyonu ihtiyacý 1. grupta anlamlý daha yüksekti (p<0.05). Ortalama laktat ve baz açýðý deðerleri 1. grupta anlamlý daha yüksekti (p<0.05). Lökosit deðerleri 1. grupta anlamlý daha düþük bulundu (p<0.05).
SONUÇ: Baz açýðý, hemoglobin, laktat, travma þiddeti skoru, karaciðer yaralanma derecesi, eþlik eden abdominal yaralanmalar ve eritrosit suspansiyon ihtiyacý artmýþ mortalite ile iliþkili bulunmuþtur. Yukarýda belirtilen parametreler ile alakalý net eþik deðerlerinin belirlenebilmesi için daha fazla veriye ve yayýna ihtiyaç vardýr.