纤维蛋白原与白蛋白比值百分比：抗N-甲基-D-天冬氨酸受体脑炎疾病严重程度和预后的独立预测指标。
Fibrinogen-to-albumin ratio percentage: An independent predictor of disease severity and prognosis in anti-N-methyl-D-aspartate receptor encephalitis.
作者信息
Du Juan, Shao Yingzhe, Song Yajun, Wang Kaixin, Yang Xuan, Li Yanfei, Yao Yaobing, Gong Zhe, Jia Yanjie
机构信息
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Neurol. 2023 Feb 24;14:1083752. doi: 10.3389/fneur.2023.1083752. eCollection 2023.
PURPOSE
This retrospective study aimed to investigate the relationship between fibrinogen-to-albumin ratio percentage (FARP) and disease severity and prognosis in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.
METHODS
Medical records and clinical characteristics from 181 patients with anti-NMDAR encephalitis were included. The modified Rankin Scale (mRS) was used to analyze disease severity and prognosis at admission and discharge, and correlations between FARP, disease severity, and prognosis were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the efficiency of FARP in assessing disease severity and prognosis.
RESULTS
Compared to the control group, patients with anti-NMDAR encephalitis had higher fibrinogen (Fib) levels ( < 0.001), neutrophil counts ( < 0.001), and FARP levels ( < 0.001) but had lower albumin levels (P = 0.003). The enrolled patients were divided into mild-to-moderate and severe groups according to their mRS scores both at admission and discharge. FARP levels were significantly elevated in the severe group compared to the mild-to-moderate group among patients with anti-NMDAR encephalitis both at admission and discharge (admission 6.0 vs. 7.40, < 0.001; discharge 6.43 vs. 8.18, P<0.001). Indeed, the mRS scores at admission (56 vs. 26%, < 0.001) and discharge (26 vs. 11%, = 0.006) in the high FARP group were significantly higher than those in the low FARP group. Furthermore, FARP was positively correlated with the mRS scores at admission ( = 0.383, < 0.001) and discharge (r =0.312, P < 0.001). In the multivariate analysis, FARP was significantly associated with disease severity (odds ratio [OR] = 1.416, 95% confidence interval [CI] = 1.117-1.795, = 0.004) and prognosis (OR = 1.252, 95% CI = 1.010-1.552, = 0.040). FARP-based ROC curves predicted disease severity, with a sensitivity of 0.756, a specificity of 0.626, and an area under the ROC curve of 0.722 (95% CI = 0.648-0.796, < 0.001). The ROC curve predicted the disease prognosis with a sensitivity of 0.703, a specificity of 0.667, and an area under the ROC curve of 0.723 (95% CI = 0.629-0.817, < 0.001).
CONCLUSION
Our results indicate that FARP is a novel predictive marker for disease severity and prognosis of anti-NMDAR encephalitis.
目的
本回顾性研究旨在探讨纤维蛋白原与白蛋白比值百分比（FARP）与抗N-甲基-D-天冬氨酸受体（抗NMDAR）脑炎患者疾病严重程度及预后的关系。
方法
纳入181例抗NMDAR脑炎患者的病历及临床特征。采用改良Rankin量表（mRS）分析入院及出院时的疾病严重程度及预后，并分析FARP、疾病严重程度及预后之间的相关性。采用受试者工作特征（ROC）曲线评估FARP在评估疾病严重程度及预后方面的效能。
结果
与对照组相比，抗NMDAR脑炎患者的纤维蛋白原（Fib）水平更高（P<0.001）、中性粒细胞计数更高（P<0.001）、FARP水平更高（P<0.001），但白蛋白水平更低（P = 0.003）。根据入院及出院时的mRS评分，将纳入患者分为轻至中度组和重度组。在抗NMDAR脑炎患者中，无论是入院时还是出院时，重度组的FARP水平均显著高于轻至中度组（入院时：6.0 vs. 7.40，P<0.001；出院时：6.43 vs. 8.18，P<0.001）。实际上，高FARP组入院时（56% vs. 26%，P<0.001）及出院时（26% vs. 11%，P = 0.006）的mRS评分显著高于低FARP组。此外，FARP与入院时（r = 0.383，P<0.001）及出院时（r = 0.312，P<0.001）的mRS评分呈正相关。在多因素分析中，FARP与疾病严重程度显著相关（比值比[OR] = 1.416，95%置信区间[CI] = 1.117 - 1.795，P = 0.004）及预后相关（OR = 1.252，95% CI = 1.010 - 1.552，P = 0.040）。基于FARP的ROC曲线预测疾病严重程度，敏感性为0.756，特异性为0.626，ROC曲线下面积为0.722（95% CI = 0.648 - 0.796，P<0.001）。ROC曲线预测疾病预后，敏感性为0.703，特异性为0.667，ROC曲线下面积为0.723（95% CI = 0.629 - 0.817，P<0.001）。
结论
我们的结果表明，FARP是抗NMDAR脑炎疾病严重程度及预后的一种新型预测标志物。
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