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中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (06) : 356 -360. doi: 10.3877/cma.j.issn.2095-9141.2022.06.008

临床研究

全身免疫炎症指数对急性颅脑损伤患者早期预后的预测价值
闫肃1, 卢博1,†(), 李茂琴1   
  1. 1. 221009　江苏徐州，徐州市中心医院重症医学科
  • 收稿日期:2022-07-22 出版日期:2022-12-15
  • 通信作者: 卢博

Predictive value of systemic immune-inflammation index on early prognosis of patients with acute traumatic brain injury

Su Yan1, Bo Lu1,†(), Maoqin Li1   

  1. 1. Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou 221009, China
  • Received:2022-07-22 Published:2022-12-15
  • Corresponding author: Bo Lu
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闫肃, 卢博, 李茂琴. 全身免疫炎症指数对急性颅脑损伤患者早期预后的预测价值[J]. 中华神经创伤外科电子杂志, 2022, 08(06): 356-360.

Su Yan, Bo Lu, Maoqin Li. Predictive value of systemic immune-inflammation index on early prognosis of patients with acute traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(06): 356-360.

目的

探讨全身免疫炎症指数（SII）对急性颅脑损伤（TBI）患者早期预后的预测价值。

方法

选取徐州市中心医院重症医学科自2018年1月至2021年12月收治的急性TBI患者为研究对象，收集所有患者的临床资料、血液检测指标，计算SII。随访30 d，根据GOS评分将患者分为预后良好组（GOS 4~5分）和预后不良组（GOS 1~3分）。采用单因素和多因素Logistic回归分析急性TBI患者预后不良的独立危险因素，绘制受试者工作特征（ROC）曲线计算曲线下面积（AUC），分析SII对急性TBI患者预后的预测价值，计算SII的最佳截断值，将患者分为高数值组和低数值组，并评估30 d的死亡风险。

结果

共纳入164例急性TBI患者，预后良好组84例（51.2%），预后不良组80例（48.8%）。2组患者的年龄、性别、平均动脉压、心率、血红蛋白、白细胞计数、中性粒细胞计数、单核细胞计数、血小板计数和单核细胞/淋巴细胞比值比较差异均无统计学意义（均P>0.05）；淋巴细胞计数、中性粒细胞/淋巴细胞比值（NLR）、血小板与淋巴细胞比值、系统性炎症反应指数（SIRI）、SII比较差异具有统计学意义（均P<0.05）。预后不良组SII值明显高于预后良好组，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，NLR和SII是急性TBI患者预后不良的独立危险因素（P<0.05）。ROC曲线分析结果显示SII预测预后不良的AUC为0.925（95%CI：0.874~0.960），敏感度87.50%、特异度82.14%，预测价值优于NLR。SII的最佳截断值为15.95，SII>15.95组的死亡率（39.5%）高于SII≤15.95组（6.4%），差异具有统计学意义（相对危险度为1.547，95%CI：1.292~1.854）。

结论

SII与急性TBI患者的早期不良预后和死亡风险密切相关，SII水平越高，患者短期预后越差，死亡风险越高，SII对急性TBI患者短期不良结局有较高的预测价值。

关键词: 急性颅脑损伤, 全身免疫炎症指数, 早期预后
Objective

To investigate the predictive value of systemic immune-inflammation index (SII) on the early prognosis of patients with acute traumatic brain injury (TBI).

Methods

Patients with acute TBI admitted to Critical Care Medicine Department of Xuzhou Central Hospital from January 2018 to December 2021 were selected as the research objects, and the clinical data, blood test indexes were collected and SII was calculated. Patients were followed up for 30 d and divided into good prognosis group (GOS 4-5) and poor prognosis group (GOS 1-3) according to GOS score. Independent risk factors for poor prognosis in patients with acute TBI were analysed using univariate and multi-factor Logistic regression, and the area under the curve (AUC) was calculated by plotting the subject operating characteristic (ROC) curve. The predictive value of SII on the prognosis of patients with acute TBI was analyzed. The optimal cut-off value of SII was calculated and divided into high and low value groups to assess the 30 d risk of death in both groups.

Results

A total of 164 patients with acute TBI were included, 84 (51.2%) in the good prognosis group and 80 (48.8%) in the poor prognosis group. There were no significant differences in age, sex, mean arterial pressure, heart rate, hemoglobin, leukocyte count, neutrophil count, monocyte count, platelet count and MLR between the good prognosis group and the poor prognosis group (all P>0.05); There were significant differences in lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet to lymphocyteratio ratio, systemic inflammation response index (SIRI) and SII among the groups (all P<0.05).The SII values were significantly higher in the poor prognosis group than in the good prognosis group, with a statistically significant difference (P<0.01). Multi-factor Logistic regression analysis showed that SII was an independent risk factor for poor prognosis in patients with acute TBI (OR=1.275, 95%CI: 1.123-1.448, P<0.01). ROC curve analysis showed that SII predicted poor prognosis with an AUC of 0.925 (95%CI: 0.874-0.960) , sensitivity 87.50% and specificity 82.14%, and its predictive value was better than that of NLR. The optimal cut-off value for SII was 15.95, with a statistically significant higher mortality in SII>15.95 group (39.5%) than in SII≤15.95 group (6.4%) (relative risk 1.547, 95%CI: 1.292-1.854).

Conclusion

SII is closely associated with early poor prognosis and mortality risk in patients with acute TBI. The higher the level of SII, the worse the short-term prognosis of patients and the higher the risk of death, and SII has a high predictive value for short-term adverse outcomes in patients with acute TBI.

Key words: Acute traumatic brain injury, Systemic immune-inflammatory index, Early prognosis
表1 预后良好组与预后不良组患者的临床资料比较
项目 预后良好组（n=84） 预后不良组（n=80） t/χ2/Z值 P值
年龄（岁，±s） 56±16 58±14 0.938 0.563
男性[例（%）] 65（77） 65（81） 0.373 0.540
MAP（mmHg，±s） 99±14 101±18 2.115 0.091
HR（次/min，±s） 76±14 78±15 0.698 0.568
血红蛋白（g/dL，±s） 12.41±1.32 12.32±1.70 0.875 0.482
白细胞计数（×109/L，±s） 13.77±6.00 16.26±6.03 0.544 0.684
中性粒细胞计数（×109/L，±s） 10.81±4.89 13.86±5.32 0.512 0.717
淋巴细胞计数[×109/L，M（Q1，Q3）] 1.81（0.98，2.38） 0.89（0.59，1.45） 7.812 <0.010
单核细胞计数[×109/L，M（Q1，Q3）] 0.64（0.45，0.94） 0.74（0.44，1.23） 1.746 0.142
血小板计数（×109/L，±s） 171.49±72.95 213.84±76.74 0.563 0.608
NLR[M（Q1，Q3）] 5.62（3.74，9.22） 13.55（10.29，19.62） 9.593 <0.010
PLR[M（Q1，Q3）] 96.55（53.93，133.15） 222.49（127.61，303.88） 12.372 <0.010
MLR（±s） 0.54±0.37 0.85±0.43 1.086 0.228
SIRI[×109/L，M（Q1，Q3）] 3.57（2.42，5.74） 10.06（6.52，17.08） 9.805 <0.010
SII[×109/L，M（Q1，Q3）] 10.42（6.54，14.86） 27.64（18.86，42.92） 10.791 <0.010
表2 急性颅脑损伤患者预后影响因素的多因素Logistic回归分析
变量 β值 SE值 Wald χ2值 P值 OR值（95%CI）
淋巴细胞计数 -1.111 0.393 0.079 0.778 0.895（0.414~1.933）
NLR 0.161 0.074 4.694 0.030 1.174（1.015~1.358）
PLR -0.005 0.005 0.984 0.321 0.995（0.984~1.005）
SIRI -0.048 0.056 0.740 0.390 0.953（0.855~1.063）
SII 0.243 0.065 14.123 <0.001 1.275（1.123~1.448）
图1 NLR与SII预测急性颅脑损伤患者预后的受试者工作特征曲线比较NLR：中性粒细胞/淋巴细胞比值；SII：全身免疫炎症指数
表3 NLR、SII对颅脑外伤患者预后的预测价值
指标 截断值 AUC（95%CI） Youde指数 敏感度（%） 特异度（%） 标准误
NLR >9.29 0.867（0.805-0.915） 0.598 81.25 78.57 0.029
SII >15.95 0.925（0.874-0.960） 0.696 87.50 82.14 0.020
表4 SII截断值分组对急性颅脑损伤患者30 d死亡风险评估
组别 例数 死亡率[例（%）] 相对危险度 95%CI
SII>15.95组 86 34（39.5） 1.548 1.292~1.854
SII≤15.95组 78 5（6.4）
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