Department of Anesthesiology and Reanimation, Specialist, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.
Medicine (Baltimore). 2024 Jul 19;103(29):e39007. doi: 10.1097/MD.0000000000039007.
Traumatic brain injury (TBI) is a significant health problem with a high mortality rate. Inflammatory markers can predict the prognosis of TBI where neuroinflammation is essential. In this study, the prognostic value of the systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) at admission in patients with critical TBI was investigated. Patients with moderately severe TBI in the intensive care unit (ICU) of a tertiary center between June 2020 and June 2022 were retrospectively reviewed. Patients were classified into survivor and mortality groups. The predictive performance of SII, PLR, and NLR levels calculated from blood results at admission and 28-day mortality and patient outcomes were analyzed. One hundred sixty-one patients were included in this study. The median age of the entire population was 41 (18-90) years, and 80.7% (n = 130) of the patients were male. Falls (42.2%) and traffic accidents (40.4%) were the most common causes of TBI. The most common primary diagnoses in patients with TBI were acute subdural hematoma (30.4%) and subarachnoid hemorrhage (26.1%). The SII and NLR levels were significantly higher in the mortality group, and PLR levels were significantly lower (P = .004, P < .001, P < .001, respectively). In multivariate regression analysis, SII and PLR were independent predictors of mortality (P = .031 and P < .001, respectively). In the receiver operating characteristics (ROC) curve analysis, the cutoff value for SII was ≥ 2951, and the area under the curve (AUC) was 0.662 (95% CI, 0.540-0.784). The cutoff value for NLR was ≥ 9.85, AUC was 0.717 (95% CI, 0.600-0.834), and the cutoff value for PLR was ≤ 130.4, AUC was 0.871 (95% CI, 0.796-0.947). 28-day mortality was 21.1%. Neuroinflammation is essential in patients with critical TBI, and inflammatory markers SII, NLR, and PLR have prognostic importance. SII and PLR are independent predictors of mortality. Early detection of those with a poor prognosis in critically ill TBI patients and planning aggressive treatments may contribute to reducing mortality.
创伤性脑损伤 (TBI) 是一种死亡率较高的重大健康问题。炎症标志物可以预测 TBI 的预后，其中神经炎症至关重要。在这项研究中，研究了入院时系统免疫炎症指数 (SII)、中性粒细胞-淋巴细胞比值 (NLR) 和血小板-淋巴细胞比值 (PLR) 在重症 TBI 患者中的预后价值。回顾性分析了 2020 年 6 月至 2022 年 6 月期间在一家三级中心重症监护病房 (ICU) 中度严重 TBI 的患者。将患者分为存活组和死亡组。分析了入院时和 28 天死亡率以及患者结局计算的 SII、PLR 和 NLR 水平的预测性能。本研究纳入了 161 名患者。整个人群的中位年龄为 41 (18-90) 岁，80.7% (n=130) 的患者为男性。跌倒 (42.2%) 和交通事故 (40.4%) 是 TBI 的最常见原因。TBI 患者最常见的主要诊断是急性硬膜下血肿 (30.4%) 和蛛网膜下腔出血 (26.1%)。死亡组的 SII 和 NLR 水平明显较高，PLR 水平明显较低 (P=.004，P<.001，P<.001，分别)。在多变量回归分析中，SII 和 PLR 是死亡率的独立预测因素 (P=.031 和 P<.001，分别)。在接受者操作特征 (ROC) 曲线分析中，SII 的截断值为≥2951，曲线下面积 (AUC) 为 0.662 (95%CI，0.540-0.784)。NLR 的截断值为≥9.85，AUC 为 0.717 (95%CI，0.600-0.834)，PLR 的截断值为≤130.4，AUC 为 0.871 (95%CI，0.796-0.947)。28 天死亡率为 21.1%。神经炎症在重症 TBI 患者中至关重要，炎症标志物 SII、NLR 和 PLR 具有预后意义。SII 和 PLR 是死亡率的独立预测因素。早期发现重症 TBI 患者预后不良者并计划积极治疗，可能有助于降低死亡率。
