Aims: To recognize patients who require massive transfusion at the early stage of blunt trauma, we retrospectively investigated patients with high-energy blunt injuries transferred within 1 h post-trauma. Methods:Between August 2007 and July 2011, 233 trauma patients were: (i) injured by a high-energy blunt mechanism with Injury Severity Score ≥9; (ii) not dead on arrival; (iii) older than 9 years; and (iv) at our center within 1 h after injury. The findings for 113 of those patients were analyzed, including those produced by ultrasonography, computed tomography, and arterial blood gas analyses.Results: Of 113 patients, 33 underwent massive transfusion (≥6 units) within 8 h of arrival. A logistic regression analysis revealed that an arterial lactate level ≥28 mg/dL (P < 0.001; odds ratio, 105.11; 95% confidence interval, 12.58-2,718.84) and a flat ratio of the inferior vena cava on computed tomography ≥3 (P < 0.001; odds ratio, 32.50; 95% confidence interval, 4.44-714.44) were significant independent predictors for a massive transfusion within 8 h. In a receiver operating curve analysis, the area under the curve of the need for massive transfusion was 0.956, with a sensitivity of 0.94 and a specificity of 0.90. A linear predictive formula for the probability (P) of receiving a massive transfusion was generated as P = 2 × lactate (mg/dL) + 15 × the flat ratio of inferior vena cava − 103. Using another 52 trauma patients, the formula was validated.Conclusions: An elevated level of arterial lactate and the flat ratio of inferior vena cava were significant predictors for identifying the patients who would require a massive transfusion in the early stage after high-energy blunt trauma.

BackgroundThe patients with rheumatoid arthritis (RA) are associated with high mortality caused by comorbidity and complication, and are often required the intensive treatment. Severe infections are among the most common causes of their mortality in intensive care unit (ICU)1)2).ObjectivesTo determine prognostic factors and mortality in patients with RA, including juvenile idiopathic arthritis (JIA), admitted to the ICU in Kyushu University Hospital, we examined the treatments of RA and JIA, comorbidities, complications, the reasons admitted to the ICU, intensive treatments, mortalities within 30 days, 90 days, and a year.MethodsBetween January 2008 and March 2018, 70 patients (20 males, 50 females) with RA (68) or JIA (2) staying at the ICU of our institution for 48 hours and over were included in this study. The admission to the ICU were performed total 77 of times because 5 patients were readmitted. The average of age and RA duration at the admission was 65.817.7 years (5-96) and 13.514.8 years (0-61), respectively, and the average of follow-up duration was 879.9992.0 days (3-3988).ResultsThe mortality within 30 and 90 days were 21.4% (15/70) and 27.1% (19/70), respectively, and 24 of 65 patients (36.9%), excluded 5 patients due to the change of hospital, were dead within a year. The reasons for ICU admission included cardiovascular complications (22.9%), infection (30.0%), neurological complications (7.1%), respiratory problem (15.7%), gastrointestinal problems (4.3%), endocrinological cause (2.9%), liver problems (7.1%), kidney problems (4.3%), and others (5.7%). The average of ICU length of stay was 7.27.6 days (2-39). The group of 30 days mortality was significantly higher in the amount of prednisone (8.15.8 vs 4.54.9), Charlson Comorbidity Index3) (5.12.5 vs 2.71.4), and APACHEII4) (21.79.2 vs 14.55.5) scores. The fatal outcomes within 30 days was mainly caused by infection (46.7%). In blood data, the low levels of platelet number, total protein, and albumin, and the high levels of creatinine and prothrombin time international normalize ratio at the time of admission of ICU were significantly poorer prognoses.ConclusionOur study has shown the high mortality of RA patients admitted to the ICU, and some blood data could be predicted poor prognosis.References[1] Moreels M, et al.: Intensive Care Med 2005[2] Brunnler T, et al.: Intern Med 2015[3] Quan H, et al.: Am J Epidemiol 2011[4] Knaus WA, et al.: Crit Care Med 1985Disclosure of Interests

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