Alb及NLR对创伤性脑出血患者的近期预后价值

目的探讨血清白蛋白(Alb)及中性粒细胞/淋巴细胞比值(NLR)对创伤性脑出血(TICH)患者的近期预后价值。方法选取海南省第三人民医院收治的TICH患者286例,根据28d预后情况分成存活组(n=229)和死亡组(n=57)。采用美国国立卫生研究院卒中量表(NIHSS)对患者神经功能缺损分为轻度组(n=94,4分)、中度组(n=120,4~15分)、重度组(n=72, 15分)。比较各组入院第1、3、7天Alb及NLR水平变化。应用受试者工作特征(ROC)曲线分析各时间点血清Alb及NLR水平预测TICH患者死亡的价值。结果死亡组第1、3、7天血清Alb水平均明显低于存活组(33. 80±5. 74 vs 38. 26±6. 13; 28. 24±4. 62 vs 42. 35±7. 40; 21. 73±4. 15 vs 46. 28±7. 85,均P 0. 05),而死亡组第1、3、7天NLR均明显高于存活组(5. 94±2. 26 vs 4. 38±1. 36; 7. 15±2. 40 vs 3. 34±1. 27; 8. 62±3. 24 vs 2. 13±0. 91,均P 0. 05)。重度组第1、3、7天血清Alb水平均明显低于轻度组和中度组(均P 0. 05),而重度组第1、3、7天NLR均明显高于轻度组和中度组(均P 0. 05)。ROC曲线显示,第3天血清Alb及NLR水平预测TICH患者死亡的最佳截值分别为31. 52 g/L和5. 27,两项联合预测TICH患者死亡的AUC(95%CI)为0. 925(0. 861~0. 975)明显高于单项Alb0. 836(0. 780~0. 893)]及NLR0. 851(0. 782~0. 903)],其敏感度和特异度为93. 0%和87. 5%。相关分析显示,死亡组血清Alb水平与NLR、NIHSS评分呈负相关(r=-0. 827、r=-0. 724,P 0. 01),NLR与NIHSS评分呈正相关(r=0. 775,P 0. 01)。结论 Alb及NLR水平与TICH患者的病情严重程度相关,第3天两项联合预测TICH患者预后的价值较高。

The short-term prognostic value of albumin and neutrophil-to-lymphocyte ratio in patients with traumatic intracerebral hemorrhage

Objective To investigate the short-term prognostic value of serum albumin (Alb) and neutrophil-to-lymphocyte ratio (NLR) in patients with traumatic intracerebral hemorrhage (TICH).Methods A total of 286 patients with TICH who were admitted to The Third People's Hospital of Hainan Province were divided into survival group (n=229) and death group (n=57) according to the 28-day outcome. The patients were divided into mild group (n=94,<4 points), moderate group (n=120,4-15 points), and severe group (n=72,>15 points) using the National Institutes of Health Stroke Scale (NIHSS). The changes in serum Alb and NLR at 1, 3, and 7 days after admission were compared between the groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic values of serum Alb and NLR at each time point in predicting death in patients with TICH.Results Compared with the death group, the survival group had a significantly higher serum Alb level (33.80±5.74 vs 38.26±6.13,P<0.05; 28.24±4.62 vs 42.35±7.40,P<0.05; 21.73±4.15 vs 46.28±7.85,P<0.05) and a significantly lower NLR (5.94±2.26 vs 4.38±1.36,P<0.05; 7.15±2.40 vs 3.34±1.27,P<0.05; 8.62±3.24 vs 2.13±0.91,P<0.05) at 1, 3, and 7 days after admission. Compared with the mild group and moderate group, the severe group had a significantly lower serum Alb level and a significantly higher NLR at 1, 3, and 5 days after admission (all P<0.05). ROC curves showed that the optimal cut-off values of serum Alb and NLR at 3 days after admission for predicting death in patients with TICH were 31.52 g/L and 5.27, respectively. The area under the ROC curve of a combination of the two indices for predicting death in patients with TICH was 0.925 (95% confidence interval:0.861-0.975), with sensitivity and specificity of 93.0% and 87.5%, and was significantly higher than that of serum Alb0.836 (0.780-0.893)]or NLR0.851 (0.782-0.903)] alone. Correlation analysis showed that serum Alb level was negatively correlated with NLR and NIHSS score (r=-0.827, P<0.01;r=-0.724,P<0.01), and NLR was positively correlated with NIHSS score (r=0.775,P<0.01).Conclusions Serum Alb and NLR are correlated with the severity of TICH, and a combination of them at 3 days after admission has a higher predictive value for the outcome of patients with TICH.