Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China 450052.
Department of Critical Care Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, First Affiliated Hospital of Zhengzhou University, China 450001.
J Immunol Res. 2022 Jul 26;2022:3876805. doi: 10.1155/2022/3876805. eCollection 2022.
To assess the effect of adding coagulation indices to the currently existing prognostic prediction models of traumatic brain injury (TBI) in the prediction of outcome.
A total of 210 TBI patients from 2017 to 2019 and 131 TBI patients in 2020 were selected for development and internal verification of the new model. The primary outcomes include death at 14 days and Glasgow Outcome Score (GOS) at 6 months. The performance of each model is evaluated by means of discrimination (area under the curve (AUC)), calibration (Hosmer-Lemeshow (H-L) goodness-of-fit test), and precision (Brier score).
The IMPACT Core model showed better prediction ability than the CRASH Basic model. Adding one coagulation index at a time to the IMPACT Core model, the new combined models IMPACT Core+FIB and IMPACT Core+APTT are optimal for the 6-month unfavorable outcome and 6-month mortality, respectively (AUC, 0.830 and 0.878). The new models were built based on the regression coefficients of the models. Internal verification indicated that for the prediction of 6-month unfavorable outcome and 6-month mortality, both the IMPACT Core+FIB model and the IMPACT Core+APTT model show better discrimination (AUC, 0.823 vs. 0.818 and 0.853 vs. 0.837), better calibration (HL, = 0.114 and = 0.317) and higher precision (Brier score, 0.148 vs. 0.141 and 0.147 vs. 0.164), respectively, than the original models.
Our research shows that the combination of the traumatic brain injury prognostic models and coagulation indices can improve the 6-month outcome prediction of patients with TBI.
评估在创伤性脑损伤（TBI）预后预测模型中加入凝血指标对结局预测的影响。
选择 2017 年至 2019 年的 210 例 TBI 患者和 2020 年的 131 例 TBI 患者进行新模型的开发和内部验证。主要结局包括 14 天死亡和 6 个月格拉斯哥结局评分（GOS）。通过区分度（曲线下面积（AUC））、校准（Hosmer-Lemeshow（H-L）拟合优度检验）和精度（Brier 评分）评估每个模型的性能。
IMPACT Core 模型的预测能力优于 CRASH Basic 模型。向 IMPACT Core 模型中依次添加一个凝血指标，新的组合模型 IMPACT Core+FIB 和 IMPACT Core+APTT 分别是 6 个月不良结局和 6 个月死亡率的最佳模型（AUC，0.830 和 0.878）。新模型是基于模型的回归系数构建的。内部验证表明，对于 6 个月不良结局和 6 个月死亡率的预测，IMPACT Core+FIB 模型和 IMPACT Core+APTT 模型的区分度（AUC，0.823 与 0.818 和 0.853 与 0.837）、校准（HL， = 0.114 和 = 0.317）和精度（Brier 评分，0.148 与 0.141 和 0.147 与 0.164）均优于原模型。
本研究表明，将创伤性脑损伤预后预测模型与凝血指标相结合可以提高 TBI 患者 6 个月的预后预测能力。
