BACKGROUND
Traumatic splenic rupture is the most common solid organ injury in blunt abdominal trauma, and splenectomy remains a critical intervention for patients with hemodynamic instability. The shock index (SI), a simple hemodynamic indicator, has demonstrated significant value in prognostic assessment of trauma patients. However, studies on the predictive value of SI in patients undergoing splenectomy for traumatic splenic rupture are relatively limited.
AIM
To investigate the predictive value of preoperative SI on postoperative complications, mortality, and long-term survival in patients with traumatic splenic rupture undergoing splenectomy, and to construct a prognostic prediction model based on SI.
METHODS
Clinical data of 212 patients with traumatic splenic rupture who underwent splenectomy from January 2020 to January 2025 were retrospectively analyzed. Patients were divided into low SI group (SI < 0.9, n = 78), moderate SI group (0.9 ≤ SI < 1.3, n = 89), and high SI group (SI ≥ 1.3, n = 45) based on preoperative SI (SI = heart rate/systolic blood pressure). Basic information, clinical indicators at admission, laboratory tests, imaging examinations, surgery-related indicators, and prognostic data were collected. The Clavien-Dindo grading system was used to assess postoperative complications. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for severe postoperative complications. A prognostic prediction model was constructed and its discriminative ability was evaluated using receiver operating characteristic curves. Kaplan-Meier method and Cox regression model were used for survival analysis.
RESULTS
With increasing SI, patients showed significantly decreased blood pressure, significantly increased heart rate and respiratory rate, more severe splenic injury, and significantly increased intraoperative blood loss and transfusion volume (all P < 0.001). The incidence of severe postoperative complications in the high SI group (26.7%) was significantly higher than that in the moderate SI group (12.4%) and low SI group (3.8%) (P < 0.001). Multivariate logistic regression analysis showed that SI [odds ratio (OR) = 2.34, 95% confidence interval (CI): 1.25-4.38, P = 0.008], splenic injury grade ≥ IV (OR = 2.97, 95%CI: 1.28-6.86, P = 0.011), hemoglobin ≤ 90 g/L (OR = 3.14, 95%CI: 1.40-7.07, P = 0.005), lactate level ≥ 4.0 mmol/L (OR = 3.97, 95%CI: 1.76-8.92, P = 0.001), and massive intraperitoneal hemorrhage (OR = 2.43, 95%CI: 1.02-5.78, P = 0.045) were independent risk factors for severe postoperative complications. The multivariate prediction model based on SI had an area under the curve of 0.847 (95%CI: 0.789-0.905) for predicting severe postoperative complications, which was significantly superior to SI alone (area under the curve = 0.782, P = 0.033). The optimal cutoff value of SI for predicting severe postoperative complications was 1.15, with sensitivity of 76.9% and specificity of 81.2%. Survival analysis showed that 1-year survival rates in the low, moderate, and high SI groups were 98.7%, 96.6%, and 86.7%, respectively (P = 0.015). Cox regression analysis confirmed that SI was an independent risk factor affecting patient survival (hazard ratio = 1.85, 95%CI: 1.16-2.95, P = 0.010).
CONCLUSION
Preoperative SI is an important predictor of prognosis in patients with traumatic splenic rupture undergoing splenectomy, which can effectively identify high-risk patients and guide clinical decision-making.
Core Tip: This study demonstrates that the preoperative shock index (SI), calculated as heart rate divided by systolic blood pressure, is a powerful predictor of postoperative complications and long-term survival in patients undergoing splenectomy for traumatic splenic rupture. By integrating SI with key clinical variables, we developed a prognostic model with strong discriminative performance. An SI threshold of 1.15 effectively identified high-risk patients. These findings support SI-based early risk stratification and provide evidence for optimizing surgical decision-making and perioperative management.
