血清生长停滞特异性蛋白6作为重度创伤性脑损伤后严重程度和预后生物标志物的效用：一项前瞻性观察研究。
Utility of Serum Growth Arrest-Specific Protein 6 as a Biomarker of Severity and Prognosis After Severe Traumatic Brain Injury: A Prospective Observational Study.
作者信息
Ni Bu-Kao, Cai Jian-Yong, Wang Xiao-Bo, Lin Qun, Zhang Xue-Na, Wu Jian-Hua
机构信息
Intensive Care Unit, The Wenzhou Central Hospital, Wenzhou, People's Republic of China.
Department of Neurosurgery, The Wenzhou Central Hospital, Wenzhou, People's Republic of China.
出版信息
Neuropsychiatr Dis Treat. 2022 Jul 14;18:1441-1453. doi: 10.2147/NDT.S372904. eCollection 2022.
OBJECTIVE
Growth arrest-specific protein 6 (Gas6) may harbor protective effects in acute brain injury. This study was designed to determine the relation of serum Gas6 levels to severity and prognosis after traumatic brain injury (TBI).
METHODS
In this prospective cohort study of 114 controls and 114 patients with severe TBI, multivariate analysis was used to assess relationships between serum Gas6 levels, Glasgow coma scale (GCS) score, Rotterdam computed tomography (CT) score, postinjury 180-day mortality, overall survival and poor prognosis (Extended Glasgow outcome scale score 1-4).
RESULTS
Significantly increased serum Gas6 levels of patients (median, 10.3 ng/mL versus 32.5 ng/mL; P < 0.001), as compared with controls, were independently correlated with Rotterdam CT score (t = 3.629, P < 0.001) and GCS score (t=-3.393, P = 0.001), and independently predicted 180-day mortality (odds ratio, 1.078; 95% confidence interval (CI), 1.007-1.154), overall survival (hazard ratio, 1.074; 95% CI, 1.012-1.139) and poor prognosis (odds ratio, 1.129; 95% CI, 1.059-1.205). Areas under receiver operating characteristic curve (AUCs) of serum Gas6 levels for discriminating risks of 180-day mortality and poor prognosis were 0.785 (95% CI, 0.699-0.857) and 0.793 (95% CI, 0.707-0.863), respectively; and serum Gas6 levels above 30.9 ng/mL and 28.3 ng/mL predicted 180-day mortality and poor prognosis with maximum Youden indices of 0.451 and 0.468, respectively. The predictive ability of serum Gas6 levels for mortality was similar to those of GCS score (AUC, 0.833; 95% CI, 0.751-0.896; P = 0.286) and Rotterdam CT score (AUC, 0.823; 95% CI, 0.740-0.888; P = 0.432). The discriminatory capability of serum Gas6 levels for the risk of poor prognosis was in the range of GCS score (AUC, 0.846; 95% CI, 0.766-0.906; P = 0.178) and Rotterdam CT score (AUC, 0.831; 95% CI, 0.750-0.895; P = 0.368).
CONCLUSION
Serum Gas6 may appear as a promising biochemical parameter for aiding in the assessment of trauma severity and prediction of prognosis among patients with severe TBI.
目的
生长停滞特异性蛋白6（Gas6）可能对急性脑损伤具有保护作用。本研究旨在确定血清Gas6水平与创伤性脑损伤（TBI）严重程度及预后的关系。
方法
在这项针对114名对照者和114名重度TBI患者的前瞻性队列研究中，采用多变量分析评估血清Gas6水平、格拉斯哥昏迷量表（GCS）评分、鹿特丹计算机断层扫描（CT）评分、伤后180天死亡率、总体生存率和不良预后（扩展格拉斯哥预后量表评分1 - 4）之间的关系。
结果
与对照组相比，患者血清Gas6水平显著升高（中位数，10.3 ng/mL对32.5 ng/mL；P < 0.001），与鹿特丹CT评分（t = 3.629，P < 0.001）和GCS评分（t = -3.393，P = 0.001）独立相关，并独立预测180天死亡率（比值比，1.078；95%置信区间（CI），1.007 - 1.154）、总体生存率（风险比，1.074；95% CI，1.012 - 1.139）和不良预后（比值比，1.129；95% CI，1.059 - 1.205）。血清Gas6水平用于区分180天死亡率和不良预后风险的受试者工作特征曲线（AUC）下面积分别为0.785（95% CI，0.699 - 0.857）和0.793（95% CI，0.707 - 0.863）；血清Gas6水平高于30.9 ng/mL和28.3 ng/mL分别预测180天死亡率和不良预后，最大约登指数分别为0.451和0.468。血清Gas6水平对死亡率的预测能力与GCS评分（AUC，0.833；95% CI，0.751 - 0.896；P = 0.286）和鹿特丹CT评分（AUC，0.823；95% CI，0.740 - 0.888；P = 0.432）相似。血清Gas6水平对不良预后风险的判别能力在GCS评分（AUC，0.846；95% CI，0.766 - 0.906；P = 0.178）和鹿特丹CT评分（AUC，0.831；95% CI，0.750 - 0.895；P = 0.368）范围内。
结论
血清Gas6可能是有助于评估重度TBI患者创伤严重程度和预测预后的一个有前景的生化参数。
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