Value of early peripheral blood lymphocyte level in patients with severe trauma in poor prognosis.

Objective: To explore influencing factors of poor prognosis in patients with severe trauma, and to analyze distribution characteristics of adverse prognostic factors in patients with different early peripheral blood lymphocyte levels based on potential categories. Methods: A total of 174 patients with severe trauma treated in Mianyang Central Hospital from September 2020 to September 2022 were selected. According to condition of massive blood transfusion or death within 24 hours after admission, patients were divided into: good prognosis group (n=136) and poor prognosis group (n=38). Clinical data of two groups were compared, multivariate Logistic regression analysis was used to analyze factors affecting poor prognosis, and cluster analysis and potential classification were used to analyze distribution characteristics of adverse prognostic factors in patients with different early peripheral blood lymphocyte levels. Results: Multivariate Logistic regression analysis results showed decrease of Glasgow coma scale (GCS), prolongation of activated partial thromboplastin time (APTT), increase of D-dimer (D-D), decrease of fibrinogen (Fib), increase of fibrinogen degradation products (FDP), increase of neutrophil/lymphocyte ratio (NLR) and decrease of lymphocyte level were factors influencing poor prognosis (P<0.05). Cluster analysis results showed that risk of poor prognosis was obviously clustered, and patients could be divided into poor prognosis high risk group (lymphocyte level≤0.90x109 L-1, n=72) and low risk group (lymphocyte level>0.90x109 L-1, n=102). Incidence of poor prognosis in high risk group [33.33%(24/72) ] was significantly higher than that in low risk group [13.73% (14/102)] (P<0.05). Potential category analysis results showed that there were three potential category distribution patterns in poor prognosis high risk group and low risk group. Proportion of "unelevated distribution of D-D in patients with low GCS score" in high risk group was significantly higher than that in low risk group, and proportion of "distribution of less risk factors" in high risk group was significantly lower than that in low risk group (P<0.05). There was no significant difference in proportion of elevated D-D distribution in patients with low GCS score between two groups (P>0.05). Conclusion:Decrease of GCS score, prolongation of APTT and increase of D-D are all associated with poor prognosis in patients with severe trauma. Patients with lymphocyte level ≤0.90x109 L-1 have a higher risk of poor prognosis, and main influencing factors are "non-elevated distribution of D-D in patients with low GCS score". [ABSTRACT FROM AUTHOR]