Prognostic value of hemogram derived indices in polytrauma patients

Abstract

Introduction Trauma, the leading cause of mortality in young, results in significant socio-economic costs. The rate of avoidable deaths remains high mainly due to the underestimation of the initial severity of injuries. Currently, indices derived from hemogram such as RDW, NLR, and PLR show promising prognostic potential. This study aims to evaluate these indices in polytrauma patients. Materials and methods This is a retrospective and analytical observational study conducted in the anesthesia and intensive care unit of Sahloul Teaching Hospital (Sousse, Tunisia) over a four month period. Patients admitted between January 2022 and March 2024, with an ICU stay exceeding 5 days were included. Excluding criteria were conditions interfering with leukocytes or recent transfusion. Data were collected via a pre-established form covering sociodemographic parameters, trauma mechanisms, severity assessment, management, hematological indices, and patient outcomes. Results Among the 553 polytrauma patients admitted, 384 were included in the study. The mean age was 44.9 years with a male predominance (sex ratio of 3.4). Road traffic accidents were the most frequent mechanism (78.1%). Thoracic (86.7%) and cranial injuries (57.6%) were the most common. The mortality rate was 16.9%. Upon admission, the SAPS II and APACHE II scores had the best predictive capacities for mortality (AUC of 0.819 and 0.817). Among hematological indices, RDW was the most performant with AUCs > 0.7. The SAPS II and APACHE II had AUC ≥ 0.7 for predicting infectious complications, while for thromboembolic complications; no index reached an AUC ≥ 0.7. Conclusion Hematological indices such as the RDW have prognostic value in trauma. Their integration to preexisting scores may improve the assessment of polytrauma patients.