Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Validity of the scoring system for traumatic liver injury: a generalized estimating equation analysis

  • Lee, Kangho (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Ryu, Dongyeon (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Kim, Hohyun (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Jeon, Chang Ho (Department of Diagnostic Radiology, The Catholic University of Korea Eunpyeong St. Mary's Hospital) ;
  • Kim, Jae Hun (Department of Trauma and Surgical Critical Care, Pusan National University Hospital) ;
  • Park, Chan Yong (Department of Trauma Surgery, Seoul National University Hospital) ;
  • Yeom, Seok Ran (Biomedical Research Institute, Pusan National University Hospital)
  • Received : 2021.01.15
  • Accepted : 2021.03.11
  • Published : 2022.03.30
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Abstract

Purpose: The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0-1 (age and Injury Severity Score) or 0-3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0-11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018-1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.

Keywords

Acknowledgement

This work was supported by a clinical research grant from Pusan National University Hospital in 2021.

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