Luo Song, Wang Xiao-Rui, Yang Li-Juan, Zou Liang-Yu
Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, China.
Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, China.
Transl Neurosci. 2024 May 3;15(1):20220340. doi: 10.1515/tnsci-2022-0340. eCollection 2024 Jan 1.
The FT4-to-FT3 ratio (FFR) variations in patients with subacute combined spinal cord degeneration (SCSD) as a potentially useful prognostic indicator are still unknown. This study aimed to investigate the changes of FFR as a potentially valuable prognostic predictor in patients with SCSD.
This study included 144 consecutive SCSD patients who received standard diagnostic and therapeutic procedures between January 2015 and December 2021 and were admitted to the Department of Neurology at the First Affiliated Hospital of Bengbu Medical University. At the time of admission, we gathered data on all patients' demographics, daily routines, previous chronic conditions, medication histories, and other clinical details. For the purpose of measuring FFR, blood samples were specifically taken within 48 h of admission. The degree of neurological impairment of patients was assessed using the functional disability scale at the time of admission. At 6 months following discharge, the Modified Rankin Scale (mRS) was used to evaluate the clinical prognosis. To evaluate the relationship between the FFR and the risks of a poor outcome (mRS > 2), univariate and multivariate logistic regression analysis was utilized. The significance of the FT4/FT3 ratio in predicting the clinical outcomes in SCSD patients 6 months after discharge was assessed using the area under curve-receiver operating characteristic (AUC-ROC).
About 90 patients (62.5%) of the 144 patients had poor outcomes, while 54 (37.5%) had favorable outcomes. Higher FFR at admission was independently linked to higher odds of a poor outcome, according to a logistic analysis. With an optimized cutoff value of >2.843, the FFR exhibited the maximum accuracy for predicting a poor outcome, according to the AUC‒ROC curve (AUC 0.731, < 0.001; sensitivity, 77.8%; specificity, 83.3%). FFR was identified as an independent predictor of poor outcomes by multivariate logistic regression (OR, 2.244; 95% CI, 1.74-2.90; < 0.001).
We discovered that in patients who had a bad result 6 months after discharge, the FFR had dramatically increased at the time of admission, providing a unique prognostic marker in patients with SCSD.
亚急性联合变性（SCSD）患者血清游离甲状腺素（FT4）与血清游离三碘甲状腺原氨酸（FT3）比值（FFR）的变化作为一种潜在有用的预后指标仍不清楚。本研究旨在探讨FFR作为SCSD患者潜在有价值的预后预测指标的变化情况。
本研究纳入了2015年1月至2021年12月期间在蚌埠医学院第一附属医院神经内科住院，接受标准诊断和治疗程序的144例连续性SCSD患者。入院时，我们收集了所有患者的人口统计学资料、日常生活习惯、既往慢性病、用药史及其他临床细节。为测定FFR，在入院48小时内专门采集血样。入院时使用功能残疾量表评估患者神经功能损害程度。出院后6个月，采用改良Rankin量表（mRS）评估临床预后。采用单因素和多因素逻辑回归分析评估FFR与不良预后风险（mRS>2）之间的关系。使用曲线下面积-受试者操作特征曲线（AUC-ROC）评估FT4/FT3比值对SCSD患者出院后6个月临床结局的预测意义。
144例患者中约90例（62.5%）预后不良，54例（37.5%）预后良好。逻辑分析显示，入院时较高的FFR与不良预后的较高几率独立相关。根据AUC-ROC曲线，当最佳截断值>2.843时，FFR对不良预后的预测准确性最高（AUC 0.731，P<0.001；敏感性77.8%；特异性83.3%）。多因素逻辑回归分析确定FFR是不良预后的独立预测因素（OR，2.244；95%CI，1.74-2.90；P<0.001）。
我们发现，出院后6个月预后不良的患者，入院时FFR显著升高，为SCSD患者提供了一个独特的预后标志物。
