A Mortality Prediction Model for Cirrhotic Patients With Blunt Abdominal Trauma: A Single-Center Retrospective Study.

Abstract

Owing to its impaired production of coagulation factors and immunosuppressed state, liver cirrhosis is recognized as a detrimental factor in patients with blunt abdominal trauma (BAT). The aim of this study was to evaluate cirrhosis-associated factors contributing to mortality in patients suffering from BAT with preexisting cirrhosis and develop a corresponding prediction model. A retrospective observational study of patients with BAT from May 2008 to December 2022 in a level-I trauma center was conducted. Propensity score matching (PSM) was performed at a 1:2 ratio to compare mortality, hemorrhage-related complications, length of stay (LOS), and intensive care unit (ICU) LOS among patients with and without preexisting cirrhosis. A subset analysis using multivariate logistic regression (MLR) was conducted to identify independent cirrhosis-associated factors of mortality among cirrhotic patients. Out of 5705 patients suffering from BAT, 88 (1.5%) had preexisting cirrhosis. A well-balanced PSM revealed that patients with cirrhosis had significantly higher mortality (21.6% vs. 6.8%, p < 0.001) and hemorrhage-related complication (31.8% vs. 19.9%, p = 0.032) rates. Among patients suffering from BAT with preexisting cirrhosis (N = 88), the MLR analysis demonstrated that the prothrombin time-international normalized ratio (PT-INR) and creatinine level were independent factors of mortality. A 0.1 unit increase in the PT-INR increased the odds of mortality by 58.2% (odds ratio = 1.582, 95% CI: 1.244-2.012, and p < 0.001), whereas a 1 mg/dL increase in the creatinine level increased the odds of mortality by 90.3% (odds ratio = 1.903, 95% CI: 1.082-3.347, and p = 0.026). Compared with noncirrhotic patients, cirrhotic patients had significantly higher mortality and hemorrhage-related complication rates. The PT-INR and creatinine level are identified as predictors of mortality for patients suffering from BAT with preexisting cirrhosis. In the management of patients with BAT, early and routine examinations of PT-INR and creatinine are encouraged, especially for patients with preexisting cirrhosis.