Estimated plasma volume status (ePVS) as a prognostic marker in polytrauma: predicting 30-day mortality and...

Estimated plasma volume status (ePVS), derived from a simple formula based on haematocrit and haemoglobin values, has been associated with an unfavourable prognosis in many cardiovascular conditions, demonstrating a correlation with volume overload and the haemodynamic status of the patient. Indeed, ePVS was demonstrated to estimate the degree of congestion and was independently associated with cardiovascular outcomes, rehospitalization, and death in patients with heart failure (HF), confirming its prognostic value also in inflammatory pathologies. Due to its easy and immediate availability even in the emergency department (ED), ePVS may be useful in trauma patients to improve their initial evaluation and management. The aim of this retrospective observational study was to evaluate the role of ePVS at ED admission in predicting mortality and blood products use, red blood cells (RBC) and fresh frozen plasma (FFP), in trauma. We included 790 patients, of whom 67.7% were male; mean age 43.9 years; median Injury Severity Score (ISS) 7.5. The 30-day mortality rate was 2.8% (22/790). The median ePVS was significantly increased in deceased as compared to survivors (5.76; 4.79-8.36 versus 4.41; 3.92-5.05; p < 0.001). Multivariable logistic regression analysis demonstrated that ePVS is an independent risk factor even after adjusting for other variables associated with 30-day mortality (odds radio, OR of 1.23; 95% confidence interval, CI 1.016-1.478, p = 0.034). Prediction of 30-day mortality for ePVS showed an AUROC of 0.776 (95% CI 0.666-0.887). Moreover, ePVS showed a positive correlation with the number of packed RBC and FFP units transfused, both during ED management, within the first 24 h, and over the entire hospital stay. The present findings suggest ePVS as a quick and easy tool to predict 30-day mortality and the need for blood resuscitation in trauma patients. Future studies may validate ePVS as a quick and easy tool for trauma victims' stratification and for predicting resource needs and mortality.