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    Analysis of the Early Posttraumatic Period Pathophysiology in Case of the Severe Combined Thoracic Trauma Using Multivariate Logistic Regression
    (Rwth Aachen, 2019) Stupnytskyi, Myroslav; Zhukov, Viktor; Gorbach, Tatyana; Biletskii, Oleksii; Kutucu, Hakan
    Severely injured patients are always challenging, even more so when they have suffered critical trauma to the chest. The aim of this study is to create a prognostic tool for outcome prediction for patients with combined thoracic trauma based on the determination of main homeostasis parameters on the 1st and 2nd day after injury. Multivariate logistic regression analysis with forward elimination of the variables was used for modeling the dependence of outcome on clinical and laboratory parameters that reflects main pathophysiological mechanisms developed on the 1st and 2nd day after combined thoracic trauma. 73 Male patients with combined thoracic trauma were included in the study. The results of fitting a logistic regression model show the relationship between mortality and six independent variables: transferrin saturation, percentage of eosinophils, TNF-a concentration, total iron binding capacity, inspiratory fraction of oxygen and albumin concentration. Besides that, forward elimination of the variables into the logistic regression equation helps to recognize relatively independent pathophysiological mechanisms involved to progression of wound dystrophy. The likelihood ratio tests can reflect the contribution degree of each pathogenesis rout responsible for the negative outcomes of the severe combined thoracic trauma. The study contributes to our understanding of interaction between pathophysiological mechanisms that make harmful effects and are involved in the progression of wound dystrophy and compensatory reactions directed on stabilization of vital function disturbances and maintenance of homeostasis during this type of wound dystrophy.
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    ROC Analysis of the Outcome Predictive Markers for Multiple Trauma Patients during Early Posttraumatic Period
    (Rwth Aachen, 2021) Stupnytskyi, Myroslav; Zhukov, Viktor; Gorbach, Tatyana; Biletskii, Oleksii; Kutucu, Hakan
    Receiver operating characteristic analysis is widely used in biomedical studies for evaluating the diagnostic accuracy of continuous markers. Continuous status severity evaluation and the accurate prediction of mortality risk for the polytrauma patients is crucial for triage, quality management, assessment of mortality prediction and the scientific study of trauma. The aim of this study is to investigate the possibility of the receiver operating characteristic analysis for determination of lethal outcome predictive markers for multiple trauma patients with severe thoracic trauma during early posttraumatic period. A single-center prospective observational cohort study involved 73 male patients. Patients' examinations were performed on the 1st-2nd, 3rd-4th and 5th-6th days after trauma. A biochemical assay was conducted for estimation of biomarkers dynamics during observed posttraumatic period. Receiver operating characteristic analyses with the areas under receiver operating characteristic curves estimation was performed for the investigated biomarkers with the most significant differences between survivors and non-survivors for each of the time periods. According to Youden's index the cut-off values of investigated biomarkers with contingency table statistics were calculated as possible predictive tests for negative outcomes during the first 5-6 days after trauma. This study demonstrates that receiver operating characteristic analysis is a useful tool for decision-making in clinical medicine. The clinical example suggests that the same biomarkers and cut-off values cannot be equally useful for lethal outcome prediction for several days in patients with multiple trauma with severe thoracic trauma. These additional biomarkers for each of the investigated time periods can serve as criteria for the clinical course monitoring of polytraumatized patients via recognizing of those with a high risk of lethal outcome for improving the quality of patient care.