Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Brain Behav. 2018 Dec;8(12):e01163. doi: 10.1002/brb3.1163. Epub 2018 Nov 19.
Iron, an essential mineral for human body, has the potential to cause toxicity at high levels. Previous studies have shown inconsistent predictive value of iron parameters in critically ill patients. Thus, we aimed to evaluate the performance of iron parameters in outcome prediction of neurocritically ill patients.
Retrospective data were collected from patients admitted to the neurocritical care unit (NCU) of a tertiary teaching hospital between August 2016 and January 2017. The iron parameters were obtained at NCU admission. Primary endpoints were short-term (30-day) mortality and long-term (6-month) poor outcome, with the latter defined as modified Rankin Scale of 4-6. The predictive value of variables was determined with univariate and multivariate logistic analysis. A further subanalysis was conducted in patients stratified by the level of estimated glomerular filtration rate (eGFR).
Of 103 eligible patients, the etiology included stroke (58.2%, N = 60), central nervous system infection (13.6%, N = 14), and other neurologic disorders (28.2%, N = 29). The correlation analysis showed that the increase in ferritin, as well as the reduction in transferrin and total iron-binding capacity, had strong correlation with C-reactive protein, procalcitonin, duration of NCU stay, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score. In a further subanalysis of 75 patients with eGFR ≥ 60 ml/min/1.73 m , twelve (16.0%) patients died within 30 days and 39 (52.0%) patients achieved good follow-up outcome data. In the multivariate logistic regression analysis, we identified baseline ferritin level as an independent predictor of short-term mortality (OR: 1.002; 95% CI: 1.000-1.003; p = 0.008) and long-term functional outcome (OR: 1.002; 95% CI: 1.000-1.004; p = 0.031).
Serum ferritin level at admission could be used as an independent predictor of short-term mortality and long-term functional outcome in neurocritically ill patients with eGFR ≥ 60 ml/min/1.73 m .
铁是人体必需的矿物质，在高水平下有潜在的毒性。先前的研究表明，铁参数在危重症患者中的预测价值不一致。因此，我们旨在评估铁参数在神经危重症患者预后预测中的表现。
本研究回顾性收集了 2016 年 8 月至 2017 年 1 月期间在一家三级教学医院神经重症监护病房（NCU）住院的患者数据。铁参数在 NCU 入院时获得。主要终点是短期（30 天）死亡率和长期（6 个月）不良预后，后者定义为改良 Rankin 量表 4-6 分。采用单因素和多因素逻辑分析确定变量的预测价值。进一步在按估计肾小球滤过率（eGFR）分层的患者中进行了亚组分析。
在 103 名符合条件的患者中，病因包括中风（58.2%，N=60）、中枢神经系统感染（13.6%，N=14）和其他神经疾病（28.2%，N=29）。相关性分析表明，铁蛋白的增加以及转铁蛋白和总铁结合能力的降低与 C 反应蛋白、降钙素原、NCU 住院时间、急性生理学和慢性健康评估 II 评分和序贯器官衰竭评估评分呈强相关。在对 eGFR≥60ml/min/1.73m2的 75 名患者进行的进一步亚组分析中，12 名（16.0%）患者在 30 天内死亡，39 名（52.0%）患者获得了良好的随访结果。在多因素逻辑回归分析中，我们发现基线铁蛋白水平是短期死亡率（OR：1.002；95%CI：1.000-1.003；p=0.008）和长期功能结局（OR：1.002；95%CI：1.000-1.004；p=0.031）的独立预测因素。
在 eGFR≥60ml/min/1.73m2的神经危重症患者中，入院时的血清铁蛋白水平可作为短期死亡率和长期功能结局的独立预测因素。
