摘要
目的系统评价反向休克指数与格拉斯哥昏迷评分乘积指数(rSIG)对创伤患者死亡的预测价值。方法检索中国知网、万方数据、中国生物医学文献服务系统、PubMed、Cochrane Library、Web of Science、Embase数据库建库至2025年4月收录的关于rSIG预测创伤患者死亡价值的文献,由2名研究者按照纳入和排除标准独立进行文献筛选、数据提取和质量评价。采用诊断准确性研究质量评价工具-2(QUADAS-2)评估纳入研究的偏倚风险。应用Stata 17.0统计软件并采用双变量混合效应模型进行Meta分析。评估rSIG预测创伤患者死亡的灵敏度、特异度、阳性似然比(PLR)、阴性似然比(NLR)、诊断比值比(DOR)及综合受试者工作特征(SROC)曲线下面积(AUC),探讨不同损伤类型、研究类型、地区、样本量、截断值、rSIG测量时间及结局指标等因素对rSIG预测效能的影响,并通过敏感性分析、Fagan图及Deeks漏斗图评估结果稳定性、临床应用价值和发表偏倚。结果纳入15项研究,共710612例创伤患者,其中死亡26105例。Meta分析结果显示,rSIG预测创伤患者死亡的合并灵敏度为0.78(95%CI 0.71,0.84),合并特异度为0.78(95%CI 0.68,0.86),合并PLR为3.60(95%CI 2.46,5.27),合并NLR为0.28(95%CI 0.22,0.36),合并DOR为12.70(95%CI 8.10,19.91),AUC为0.85(95%CI 0.81,0.87)。亚组分析结果显示,损伤类型是异质性的主要来源之一,rSIG对多发伤患者的预测特异度(0.82)明显优于颅脑损伤患者(0.65)(P<0.05)。敏感性分析表明,结果具有良好稳定性。Fagan图显示,当验前概率为7%时,低rSIG创伤患者的验后概率上升至21%,高rSIG创伤患者的验后概率下降至2%。Deeks漏斗图提示,纳入的研究无明显发表偏倚(P>0.05)。结论低rSIG对创伤患者死亡具有良好的预测价值,可作为早期快速评估创伤患者预后的有效工具,且对多发伤患者的预测效能优于颅脑损伤患者。
Objective To systematically evaluate the predictive value of the reverse shock index multiplied by the Glasgow coma scale score(rSIG)for mortality of trauma patients.Methods A comprehensive literature search was conducted to identify studies on the predictive value of rSIG for mortality of trauma patients in the following databases from inception to April 2025,including CNKI,Wanfang Data,SinoMed,PubMed,Cochrane Library,Web of Science,and Embase.Two investigators independently screened the literature,extracted data,and assessed study quality according to predefined inclusion and exclusion criteria.The Quality assessment of diagnostic accuracy studies-2(QUADAS-2)tool was used to evaluate the risk of bias in the included studies.Meta analysis was performed using Stata 17.0 software with a bivariate mixed-effects model.The following metrics were used to assess the predictive value of rSIG for mortality in trauma patients,including sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),diagnostic odds ratio(DOR),and area under the summary receiver operating characteristic(SROC)curve(AUC).The influence of various factors on the predictive performance of rSIG was examined,including injury type,study design,region,sample size,cut-off value,rSIG measurement time,and outcome measures.Additionally,sensitivity analysis,Fagan's nomogram,and Deeks'funnel plot were employed to assess the robustness of the findings,clinical applicability,and publication bias.Results A total of 15 studies involving 710612 trauma patients were included,26105 of whom were deceased.Meta analysis results showed that rSIG had a pooled sensitivity of 0.78(95%CI 0.71,0.84),a pooled specificity of 0.78(95%CI 0.68,0.86),a pooled PLR of 3.60(95%CI 2.46,5.27),a pooled NLR of 0.28(95%CI 0.22,0.36),a pooled DOR of 12.70(95%CI 8.10,19.91),and an AUC of 0.85(95%CI 0.81,0.87)for predicting mortality of trauma patients.Subgroup analysis identified injury type as one of the major sources of heterogeneity,and the predictive specificity of rSIG was significantly higher in patients with multiple trauma(0.82)than in those with isolated traumatic brain injury(0.65)(P<0.05).Sensitivity analysis indicated that the findings were robust and stable.Fagan's nomogram showed that when the pre-test probability was 7%,the post-test probability of death increased to 21%in patients with low rSIG and decreased to 2% in those with high rSIG.Deeks'funnel plots suggested no significant publication bias among the included studies(P>0.05).Conclusion Low rSIG has good predictive performance for mortality of trauma patients and can serve as an effective tool for early and rapid prognosis assessment with superior predictive performance in patients with multiple trauma compared to those with traumatic brain injury.
作者
刘冰
贾国洪
卜晓沛
宋创业
张江华
贾志芳
李晓武
苗建军
Liu Bing;Jia Guohong;Bu Xiaopei;Song Chuangye;Zhang Jianghua;Jia Zhifang;Li Xiaowu;Miao Jianjun(Department of General Surgery,Hospital of 81st Group Army of PLA,Zhangjiakou 075000,China)
出处
《中华创伤杂志》
北大核心
2025年第11期1094-1102,共9页
Chinese Journal of Trauma
