To investigate the clinical significance of pulmonary CT imaging morphological features combined with coagulation function indicators in predicting the prognosis of patients with chest trauma.

A total of 104 patients with closed chest trauma admitted to our hospital from June 2020 to June 2025 were selected and divided into an observation group 41 cases and a control group 63 cases based on prognosis. Clinical data, laboratory indicators, and chest CT images were collected. Pulmonary involvement extent (≥50% or <50%) and injury pattern (ground-glass opacity or consolidation) were assessed using a visual semi-quantitative method. Multivariate logistic regression was used to analyze prognostic factors, and receiver operating characteristic (ROC) curves were drawn to evaluate the predictive performance of individual and combined indicators.

Compared with the control group, the observation group had significantly higher neutrophil count [7.05(6.59, 7.55) ×10⁹/L vs. 5.02(4.56, 5.46)×10⁹/L], lymphocyte count [1.01(0.87, 1.85)×10⁹/L vs. 0.80(0.77, 0.81)×10⁹/L], NLR[10.40(10.39, 10.98) vs. 7.99(7.68, 8.22)], CRP[80.94 (76.87, 85.95)mg/L vs. 49.43(44.88, 52.46)mg/L], ferritin [902.25 (791.01, 996.27) mcg/dl vs. 661.18(620.57, 700.66)mcg/dl], and D-dimer [2.17(2.09, 2.22)mg/L vs. 1.05(1.04, 1.08)mg/L], as well as a higher proportion of pulmonary involvement ≥50% (41.5% vs. 20.6%) and consolidation pattern (48.8% vs. 23.8%) (P<0.05). Multivariate logistic regression analysis revealed that NLR (OR=9.304, 95%CI: 1.328~65.186, P=0.025), D-dimer (OR=1.250, 95%CI: 1.099~1.422, P=0.001), pulmonary involvement extent ≥50% (OR=3.048, 95%CI: 1.311~7.083, P=0.010), and consolidation-type lung injury (OR=2.724, 95%CI: 1.140~6.508, P=0.024) were independent risk factors for poor prognosis. ROC curve analysis showed that the combined prediction of D-dimer, NLR, pulmonary involvement extent, and lung injury pattern yielded an area under the curve (AUC) of 0.863 (95%CI: 0.785~0.940), with a sensitivity of 85.4% and a specificity of 79.4%. Among the 104 patients, 95 survived (91.35%) and 9 died (8.65%). Causes of death included sepsis complicated by multiple organ dysfunction syndrome in 4 cases, acute respiratory distress syndrome in 3 cases, and pulmonary embolism due to venous thromboembolism in 2 cases.

Pulmonary CT imaging morphological features combined with coagulation function indicators can effectively predict the prognosis of chest trauma, facilitating early identification of high-risk patients.