Wang Xi, Hui Xiaobo, Wang Xiangyu, Huang Baosheng, Gan Xiaokui, Liu Xingdong, Shen Zhiyan, Sun Yi, Li Lixin
Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Neurosurgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China.
Front Neurosci. 2023 Jul 27;17:1222541. doi: 10.3389/fnins.2023.1222541. eCollection 2023.
Cognitive impairment is a common sequela following traumatic brain injury (TBI). This study aimed to identify risk factors for cognitive impairment after 3 and 12 months of TBI and to create nomograms to predict them.
A total of 305 mild-to-moderate TBI patients admitted to the First Affiliated Hospital with Nanjing Medical University from January 2018 to January 2022 were retrospectively recruited. Risk factors for cognitive impairment after 3 and 12 months of TBI were identified by univariable and multivariable logistic regression analyses. Based on these factors, we created two nomograms to predict cognitive impairment after 3 and 12 months of TBI, the discrimination and calibration of which were validated by plotting the receiver operating characteristic (ROC) curve and calibration curve, respectively.
Cognitive impairment was detected in 125/305 and 52/305 mild-to-moderate TBI patients after 3 and 12 months of injury, respectively. Age, the Glasgow Coma Scale (GCS) score, >12 years of education, hyperlipidemia, temporal lobe contusion, traumatic subarachnoid hemorrhage (tSAH), very early rehabilitation (VER), and intensive care unit (ICU) admission were independent risk factors for cognitive impairment after 3 months of mild-to-moderate TBI. Meanwhile, age, GCS score, diabetes mellitus, tSAH, and surgical treatment were independent risk factors for cognitive impairment after 12 months of mild-to-moderate TBI. Two nomograms were created based on the risk factors identified using logistic regression analyses. The areas under the curve (AUCs) of the two nomograms to predict cognitive impairment after 3 and 12 months of mild-to-moderate TBI were 0.852 (95% CI [0.810, 0.895]) and 0.817 (95% CI [0.762, 0.873]), respectively.
Two nomograms are created to predict cognitive impairment after 3 and 12 months of TBI. Age, GCS score, >12 years of education, hyperlipidemia, temporal lobe contusion, tSAH, VER, and ICU admission are independent risk factors for cognitive impairment after 3 months of TBI; meanwhile, age, the GCS scores, diabetes mellitus, tSAH, and surgical treatment are independent risk factors of cognitive impairment after 12 months of TBI. Two nomograms, based on both groups of factors, respectively, show strong discriminative abilities.
认知障碍是创伤性脑损伤（TBI）后的常见后遗症。本研究旨在确定TBI后3个月和12个月时认知障碍的危险因素，并创建列线图来预测这些因素。
回顾性招募了2018年1月至2022年1月在南京医科大学第一附属医院住院的305例轻度至中度TBI患者。通过单变量和多变量逻辑回归分析确定TBI后3个月和12个月时认知障碍的危险因素。基于这些因素，我们创建了两个列线图来预测TBI后3个月和12个月时的认知障碍，分别通过绘制受试者工作特征（ROC）曲线和校准曲线来验证其区分度和校准度。
在受伤后3个月和12个月时，分别在125/305例和52/305例轻度至中度TBI患者中检测到认知障碍。年龄、格拉斯哥昏迷量表（GCS）评分、受教育年限>12年、高脂血症、颞叶挫伤、创伤性蛛网膜下腔出血（tSAH）、极早期康复（VER）和入住重症监护病房（ICU）是轻度至中度TBI后3个月时认知障碍的独立危险因素。同时，年龄、GCS评分、糖尿病、tSAH和手术治疗是轻度至中度TBI后12个月时认知障碍的独立危险因素。基于逻辑回归分析确定的危险因素创建了两个列线图。预测轻度至中度TBI后3个月和12个月时认知障碍的两个列线图的曲线下面积（AUC）分别为0.852（95%CI[0.810,0.895]）和0.817（95%CI[0.762,0.873]）。
创建了两个列线图来预测TBI后3个月和12个月时的认知障碍。年龄、GCS评分、受教育年限>12年、高脂血症、颞叶挫伤、tSAH、VER和入住ICU是TBI后3个月时认知障碍的独立危险因素；同时，年龄、GCS评分、糖尿病、tSAH和手术治疗是TBI后12个月时认知障碍的独立危险因素。基于这两组因素分别创建的两个列线图显示出很强的区分能力。
