Abstract:Objective To explore the independent risk factors affecting the prognosis of patients with traumatic hemorrhagic shock and to evaluate the predictive value of the injury severity score（ISS）and lactate. Methods A retrospective analysis was conducted on 114 patients with traumatic hemorrhagic shock admitted to the emergency resuscitation room of Wuxi Ninth People’s Hospital from January 2023 to May 2025. Patients were divided into the survival group（n=96）and the death group（n=18）based on their survival status at 28 days after admission. The two groups were compared in terms of gender, age, ISS, injury mechanism, emergency mechanical ventilation, use of human fibrinogen, blood product transfusion, time from injury to transfusion, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen, lactate, blood calcium concentration, and extracellular fluid base excess. Multivariate logistic regression was used to identify independent risk factors, and receiver operating characteristic（ROC）curve analysis was performed to evaluate the predictive efficacy of ISS and elevated lactate individually and in combination for patient’s?? prognosis. Results Multivariate logistic regression analysis showed that ISS（OR=1.127, 95%CI：1.029-1.235）and high lactate（OR=1.575, 95%CI：1.140-2.175）were independent risk factors for the prognosis of patients with traumatic hemorrhagic shock, and emergency mechanical ventilation（OR=0.066, 95%CI：0.008-0.541）was an independent protective factor for the prognosis of patients with traumatic hemorrhagic shock（P＜0.05）. ROC curve analysis indicated that the combination of ISS and lactate had the highest predictive efficacy［area under curve（AUC）=0.904］, followed by lactate alone（AUC=0.878）and ISS alone（AUC=0.873）. Conclusion The combined detection of ISS and lactate at admission demonstrates good predictive value for patient prognosis, which aids in early identification of high risk patients and guides clinical intervention.