Zhang Lianyu, Zhang Fabin, Bai Huanying, Yun Huibin, Zheng Zhao, Liu Shuncai, Shenghua A, Shi Zhongshan, Hu Yuhai
Department of Critical Care Medicine, Xining Third People's Hospital, Xining 810005, Qinghai, China.
Department of Public Health, School of Medicine, Qinghai University, Xining 810016, Qinghai, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Jan;36(1):56-61. doi: 10.3760/cma.j.cn121430-20230425-00317.
To analyze the changes rule of serum procalcitonin (PCT) levels in patients with traumatic brain injury in plateau areas, and to evaluate its value in assessing the severity and prognosis of the patients.
A prospective cohort study was conducted. The patients with traumatic brain injury admitted to the critical care medicine departments of Xining Third People's Hospital (at an altitude of 2 260 metres) and Golmud City People's Hospital (at an altitude of 2 780 metres) from May 2018 to September 2022 were enrolled. According to the Glasgow coma scale (GCS) score at admission, the patients were divided into mild injury group (GCS score 13-15), severe injury group (GCS score 9-12), and critical injury group (GCS score 3-8). All patients received active treatment. Chemiluminescence immunoassay was used to measure the serum PCT levels of patients on the 1st, 3rd, 5th, and 7th day of admission. The Kendall tau-b correlation method was used to analyze the correlation between serum PCT levels at different time points and the severity of the disease. The patients were followed up until October 30, 2022. The prognosis of the patients was collected. The baseline data of patients with different prognosis were compared. The Cox regression method was used to analyze the relationship between baseline data, serum PCT levels at different time points and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of serum PCT levels at different time points for death during follow-up.
Finally, a total of 120 patients with traumatic brain injury were enrolled, including 52 cases in the mild injury group, 40 cases in the severe injury group, and 28 cases in the critical injury group. The serum PCT levels of patients in the mild injury group showed a continuous downward trend with the prolongation of admission time. The serum PCT levels in the severe injury and critical injury groups reached their peak at 3 days after admission, and were significantly higher than those in the mild injury group (μg/L: 3.53±0.68, 4.47±0.63 vs. 0.40±0.14, both P < 0.05), gradually decreasing thereafter, but still significantly higher than the mild injured group at 7 days. Kendall tau-b correlation analysis showed that there was a significant positive correlation between serum PCT levels on days 1, 3, 5, and 7 of admission and the severity of disease (r value was 0.801, 0.808, 0.766, 0.528, respectively, all P < 0.01). As of October 30, 2022, 92 out of 120 patients with traumatic brain injury survived and 28 died, with a mortality of 23.33%. Compared with the survival group, the GCS score, serum interleukin-6 (IL-6) levels, white blood cell count (WBC) in peripheral blood, and PCT levels in cerebrospinal fluid at admission in the death group were significantly increased [GCS score: 5.20±0.82 vs. 4.35±0.93, IL-6 (ng/L): 1.63±0.45 vs. 0.95±0.27, blood WBC (×10/L): 14.31±2.03 vs. 11.95±1.98, PCT in cerebrospinal fluid (μg/L): 11.30±1.21 vs. 3.02±0.68, all P < 0.01]. The serum PCT levels of patients in the survival group showed a continuous downward trend with prolonged admission time. The serum PCT level in the death group peaked at 3 days after admission and was significantly higher than that in the survival group (μg/L: 4.11±0.62 vs. 0.52±0.13, P < 0.01), gradually decreasing thereafter, but still significantly higher than the survival group at 7 days. Cox regression analysis showed that serum IL-6 levels [hazard ratio (HR) = 17.347, 95% confidence interval (95%CI) was 5.874-51.232], WBC in peripheral blood (HR = 1.383, 95%CI was 1.125-1.700), PCT levels in cerebrospinal fluid (HR = 1.952, 95%CI was 1.535-2.482) at admission and serum PCT levels on admission days 1, 3, 5, and 7 [HR (95%CI) was 6.776 (1.844-24.906), 1.840 (1.069-3.165), 3.447 (1.284-9.254), and 6.666 (1.214-36.618), respectively] were independent risk factors for death during follow-up in patients with traumatic brain injury (all P < 0.05). ROC curve analysis showed that the AUC of serum PCT levels on days 1, 3, 5, and 7 for predicting death during follow-up in patients with traumatic brain injury was all > 0.8 [AUC (95%CI) was 0.898 (0.821-0.975), 0.800 (0.701-0.899), 0.899 (0.828-0.970), 0.865 (0.773-0.958), respectively], indicating ideal predictive value. The optimal cut-off value for serum PCT level at 3 days of admission was 1.88 μg/L, with the sensitivity of 78.6% and specificity of 88.0% for predicting death during follow-up.
Abnormal expression of serum PCT levels in patients with traumatic brain injury on the 3rd day of admission was found. The serum PCT levels greater than 3 μg/L may be related to severe illness. The serum PCT levels greater than 1.88 μg/L can predict the poor prognosis of patients. Dynamic observation of changes in serum PCT levels has good evaluation value for the severity and prognosis of patients with traumatic brain injury in plateau areas.
分析高原地区创伤性脑损伤患者血清降钙素原（PCT）水平的变化规律，评估其在评估患者病情严重程度及预后中的价值。
进行一项前瞻性队列研究。纳入2018年5月至2022年9月在西宁第三人民医院（海拔2 260米）和格尔木市人民医院（海拔2 780米）重症医学科收治的创伤性脑损伤患者。根据入院时格拉斯哥昏迷量表（GCS）评分，将患者分为轻度损伤组（GCS评分13 - 15分）、重度损伤组（GCS评分9 - 12分）和极重度损伤组（GCS评分3 - 8分）。所有患者均接受积极治疗。采用化学发光免疫分析法测定患者入院第1、3、5、7天的血清PCT水平。采用Kendall tau - b相关法分析不同时间点血清PCT水平与疾病严重程度的相关性。对患者进行随访至2022年10月30日，收集患者的预后情况，比较不同预后患者的基线资料。采用Cox回归法分析基线资料、不同时间点血清PCT水平与预后的关系。绘制受试者工作特征曲线（ROC曲线）分析不同时间点血清PCT水平对随访期间死亡的预测价值。
最终共纳入120例创伤性脑损伤患者，其中轻度损伤组52例，重度损伤组40例，极重度损伤组28例。轻度损伤组患者血清PCT水平随入院时间延长呈持续下降趋势。重度损伤组和极重度损伤组患者血清PCT水平在入院后3天达到峰值，且显著高于轻度损伤组（μg/L：3.53±0.68，4.47±0.63 vs. 0.40±0.14，均P < 0.05），此后逐渐下降，但在7天时仍显著高于轻度损伤组。Kendall tau - b相关分析显示，入院第1、3、5、7天的血清PCT水平与疾病严重程度呈显著正相关（r值分别为0.801、0.808、0.766、0.528，均P < 0.01）。截至2022年10月30日，120例创伤性脑损伤患者中92例存活，28例死亡，死亡率为23.33%。与存活组相比，死亡组入院时的GCS评分、血清白细胞介素 - 6（IL - 6）水平、外周血白细胞计数（WBC）及脑脊液PCT水平均显著升高[GCS评分：5.20±0.82 vs. 4.35±0.93，IL - 6（ng/L）：1.63±0.45 vs. 0.95±0.27，血液WBC（×10/L）：14.
