Department of Emergency Care, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
Department of Neurosurgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
J Clin Lab Anal. 2022 Oct;36(10):e24679. doi: 10.1002/jcla.24679. Epub 2022 Aug 31.
Gastrointestinal bleeding (GIB) is a potential contributing factor for poor prognosis of spontaneous basal ganglia hemorrhage (BGH). This study aimed to investigate the predictive value of new inflammatory biomarkers including neutrophil to lymphocytes (NLR) on admission and construct a nomogram for rapidly predicting GIB in acute BGH.
The retrospective study included all patients with acute BGH admitted from the emergency department in Huashan Hospital from July 2017 to January 2019. Multivariate analysis was conducted to evaluate the correlation between factors within 24 h and the occurrence of GIB within 7 days after BGH. The receiver operating characteristic (ROC) curve was performed to estimate the prediction ability of inflammatory biomarkers. A nomogram based on significant predictors was validated by ROC curve and calibration curve.
A total of 122 patients were enrolled in this study, and the incidence of GIB was 23.0%. Patients with GIB had larger hematoma volume (≥30 ml), lower Glasgow Coma Scale (GCS) score (≤8) and increased inflammatory biomarkers on admission. ROC curve revealed that NLR had a high predictive value to the complication (area under the curve = 0.87). According to multivariate analysis, NLR, GCS score, and hematoma volume were main factors for nomogram, with good calibration and discrimination.
Neutrophil-to-lymphocyte ratio and GCS score within 24 h after the onset of acute BGH are the independent risk factors for GIB. The nomogram developed by these predictors may assist surgeons in rapidly assessing and preventing of GIB for BGH patients in earlier stage.
胃肠道出血（GIB）是自发性基底节出血（BGH）预后不良的潜在因素。本研究旨在探讨包括入院时中性粒细胞与淋巴细胞比值（NLR）在内的新炎症生物标志物对急性 BGH 患者发生 GIB 的预测价值，并构建预测 GIB 的列线图。
本回顾性研究纳入了 2017 年 7 月至 2019 年 1 月华山医院急诊科收治的所有急性 BGH 患者。采用多变量分析评估 24 小时内各因素与 BGH 后 7 天内发生 GIB 的相关性。通过受试者工作特征（ROC）曲线评估炎症生物标志物的预测能力。基于有意义的预测因素构建列线图，并通过 ROC 曲线和校准曲线进行验证。
本研究共纳入 122 例患者，GIB 发生率为 23.0%。发生 GIB 的患者血肿量较大（≥30ml）、格拉斯哥昏迷量表（GCS）评分较低（≤8），入院时炎症标志物水平升高。ROC 曲线显示 NLR 对并发症具有较高的预测价值（曲线下面积为 0.87）。多变量分析显示，NLR、GCS 评分和血肿量是列线图的主要因素，具有良好的校准度和区分度。
急性 BGH 发病后 24 小时内 NLR 和 GCS 评分是 GIB 的独立危险因素。基于这些预测因素构建的列线图可帮助外科医生早期快速评估和预防 BGH 患者的 GIB。
