中重度颅脑损伤患者28 d死亡影响因素分析及NLR联合GCS评分对其28 d死亡预测价值

目的探讨中重度颅脑损伤(traumatic brain injury,TBI)患者28 d死亡影响因素及中性粒细胞与淋巴细胞比值(neutrolphil to lymphocyte ratio,NLR)联合格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分对其28 d死亡预测价值。方法回顾性分析中重度TBI 628例的临床资料,根据28 d生存情况,将其分为病死组112例和存活组516例。采用单因素和多因素Logistic回归分析对中重度TBI患者28 d死亡影响因素进行分析,应用受试者工作特征(ROC)曲线分析NLR、GCS评分和NLR联合GCS评分对中重度TBI患者28 d死亡的预测价值。结果单因素分析结果显示,病死组入院时NLR、活化部分凝血酶原时间和C反应蛋白高于存活组,血红蛋白低于存活组;急诊手术治疗、坠落伤、瞳孔对光反应双阴、中线移位>5 mm、环池受压所占比例以及急性生理学及慢性健康状况评分系统Ⅱ评分高于存活组,GCS评分低于存活组,差异有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析结果显示,NLR>10.36、中线移位>5 mm和环池受压是中重度TBI患者28 d死亡的危险因素,GCS评分9~12分是中重度TBI患者28 d死亡的保护因素(P<0.01)。ROC曲线分析结果显示,NLR联合GCS评分预测中重度TBI 28 d死亡的曲线下面积(AUC)为0.892高于NLR、GCS评分单独预测中重度TBI 28 d死亡的AUC 0.745和0.827,且敏感度和特异度均较高。结论NLR>10.36、中线移位>5 mm和环池受压是中重度TBI患者28 d死亡的危险因素,GCS评分9~12分是中重度TBI患者28 d死亡的保护因素。NLR联合GCS评分对中重度TBI患者28 d死亡具有较高预测价值。

Influencing Factors for 28-day Mortality and Predictive Effect of Neutrophil Lymphocyte Ratio Combined with GCS Score on 28-day Mortality in Patients with Moderate to Severe Head Injury

Objective To investigate the influencing factors for 28-day mortality of patients with moderate to severe traumatic brain injury(TBI)and the predictive value of the neutrophil to lymphocyte ratio(NLR)combined with Glasgow coma scale(GCS)on 28-day mortality of these patients.Methods The clinical data of 628 patients with moderate to severe TBI were retrospectively analyzed.According to the 28-day survival,they were divided into the death group(n=112)and the survival group(n=516).Univariate and multivariate Logistic regression analysis was used to analyze the influencing factors for the 28-day mortality of moderate to severe TBI patients,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR,GCS score and NLR combined with GCS score on the 28-day mortality in patients with moderate to severe TBI.Results The results of univariate analysis showed that NLR,activated partial prothrombin time and C-reactive protein at admission in death group were higher than those of the survival group,and hemoglobin was lower than that of the survival group.The percentage of emergency surgery,fall injury,pupillary response to light(double negative),midline shift>5 mm,the proportion of ambient cistern compression,and acute physiology and chronic health scoring systemⅡ(APACHEⅡ)score were higher than those of the survival group,while GCS score was lower than that of the survival group(P<0.05 or P<0.01).The results of multivariate Logistic regression analysis showed that NLR>10.36,midline shift>5 mm,and ambient cistern compression were risk factors for 28-day mortality in patients with moderate to severe TBI,and GCS scores of 9-12 points were the protective factors for 28-day mortality in moderate to severe TBI patients(P<0.01).ROC curve analysis results showed that the area under the ROC curve(AUC)of NLR combined with GCS score for predicting the 28-day mortality in patients with moderate to severe TBI was 0.892,higher than that of NLR and the GCS score in prediction alone(0.745 and 0.827),with higher sensitivity and specificity.Conclusion NLR>10.36,midline shift>5 mm,and ambient cistern compression are risk factors for 28-day mortality in patients with moderate to severe TBI,and GCS scores of 9-12 points are protective factors for 28-day mortality in these patients.NLR combined with GCS score has a high predictive value for 28-day mortality in patients with moderate to severe TBI.