Xu Huajie, Wu Wei, Zhu Qi, Wang Jie, Ding Pengfei, Zhuang Zong, Li Wei, Gao Yongyue, Hang Chunhua
Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China.
Department of Radiology, Sir Run Run Shaw Hospital (SRRSH) of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
World Neurosurg. 2024 Mar;183:e22-e27. doi: 10.1016/j.wneu.2023.10.081. Epub 2023 Oct 20.
Systemic inflammation following traumatic brain injury (TBI) has been extensively studied over the past decades, as it contributes significantly to the pathophysiological injury mechanisms and subsequent poor outcomes. Systemic immune-inflammation (SII) index is a novel biomarker of systemic inflammatory response. However, its predictive value regarding TBI prognosis in clinical practice remains insufficiently investigated.
A total of 102 TBI patients admitted to Nanjing Drum Tower Hospital from July 2019 to February 2022 were enrolled. We employed various statistical analyses to evaluate the correlation between inflammatory indicators upon admission and patient prognosis, compared the predictive accuracy of these indicators, and generated receiver operating curve analysis to test their prognostic performance.
The SII index, platelet count, absolute lymphocyte count, and neutrophil/lymphocyte ratio (NLR) were capable of distinguishing TBI prognosis according to univariate logistic regression models (P < 0.05). Multivariate logistic regression models revealed that increased SII index, platelet count, and NLR upon admission were independent predictors of poor TBI prognosis (P < 0.05). Receiver operating curve analysis further demonstrated that the SII index (area under the curve = 0.845, 95% confidence interval 0.769-0.921, P = 0.000) exhibited higher predictive ability than the NLR (area under the curve = 0.694, 95% confidence interval 0.591-0.796, P = 0.001).
Our findings suggested that increased SII index during the early stages of TBI was an independent risk factor for poor prognosis with satisfactory predictive value. The SII index provides a reliable, convenient, and cost-effective prognostic model to evaluate systemic inflammation after TBI and identify patients at risk of poor outcomes, thereby offering valuable guidance for clinical practice.
在过去几十年中,创伤性脑损伤(TBI)后的全身炎症反应得到了广泛研究,因为它对病理生理损伤机制及随后的不良预后有重大影响。全身免疫炎症(SII)指数是全身炎症反应的一种新型生物标志物。然而,其在临床实践中对TBI预后的预测价值仍未得到充分研究。
纳入2019年7月至2022年2月在南京鼓楼医院收治的102例TBI患者。我们采用各种统计分析方法来评估入院时炎症指标与患者预后之间的相关性,比较这些指标的预测准确性,并生成受试者工作特征曲线分析以测试其预后性能。
根据单因素逻辑回归模型,SII指数、血小板计数、绝对淋巴细胞计数和中性粒细胞/淋巴细胞比值(NLR)能够区分TBI预后(P<0.05)。多因素逻辑回归模型显示,入院时SII指数、血小板计数和NLR升高是TBI预后不良的独立预测因素(P<0.05)。受试者工作特征曲线分析进一步表明,SII指数(曲线下面积=0.845,95%置信区间0.769-0.921,P=0.000)比NLR(曲线下面积=0.694,95%置信区间0.591-0.796,P=0.001)具有更高的预测能力。
我们的研究结果表明,TBI早期SII指数升高是预后不良的独立危险因素,具有令人满意的预测价值。SII指数提供了一种可靠、便捷且具有成本效益的预后模型,用于评估TBI后的全身炎症反应,并识别预后不良风险患者,从而为临床实践提供有价值的指导。