Chang Lin, Lin Yu-Jun, Tsai Ching-Hua, Rau Cheng-Shyuan, Hsu Shiun-Yuan, Hsieh Ching-Hua
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Diagnostics (Basel). 2024 Aug 22;14(16):1836. doi: 10.3390/diagnostics14161836.
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients, necessitating reliable prognostic tools. The segmented neutrophil-to-monocyte (SeMo) ratio, indicative of the inflammatory response, has emerged as a valuable biomarker. This study evaluates the prognostic value of dynamic changes in the SeMo ratio in predicting outcomes for patients with moderate to severe TBI.
A retrospective analysis was conducted on data from 1118 TBI patients admitted to the surgical intensive care unit at a level I trauma center between January 2009 and December 2020. Patients were selected based on an Abbreviated Injury Scale (AIS) score ≥ 3 in the head region. Initial and follow-up SeMo ratios were calculated upon admission and 48-72 h later, respectively. The dynamic SeMo ratio was defined as the difference between the second and initial SeMo ratios. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine the optimal threshold for mortality prediction, and comparative analysis of clinical outcomes.
The study cohort included 121 deceased and 997 surviving patients. Deceased patients had significantly higher second SeMo ratios (20.9 ± 16.1 vs. 15.8 ± 17.2, = 0.001) and dynamic SeMo ratios (2.4 ± 19.8 vs. -2.1 ± 19.5, = 0.019) than those survival patients. In the multivariate analysis, the dynamic SeMo is a significant independent risk factor for in-hospital mortality (OR 1.01, 95%CI: 1.01-1.03, = 0.031). The optimal cut-off for the dynamic SeMo ratio was 5.96, above which patients exhibited higher mortality (21.4% vs. 8.5%, < 0.001), higher adjusted mortality (adjusted odds ratio: 2.98; 95% confidence interval: 1.95-4.56; = 0.005), and longer hospital stays (23.6 days vs. 19.7 days, = 0.005).
Dynamic SeMo ratio changes serve as a prognostic marker for in-hospital mortality and hospital stay duration in moderate to severe TBI patients. A higher dynamic SeMo ratio indicates increased risk, highlighting the importance of early monitoring and intervention. Future prospective studies should validate these findings and explore integration with other biomarkers for enhanced prognostication.
创伤性脑损伤（TBI）是创伤患者发病和死亡的主要原因，因此需要可靠的预后工具。作为炎症反应指标的分段中性粒细胞与单核细胞（SeMo）比值已成为一种有价值的生物标志物。本研究评估了SeMo比值动态变化在预测中重度TBI患者预后方面的价值。
对2009年1月至2020年12月期间在一级创伤中心的外科重症监护病房收治的1118例TBI患者的数据进行回顾性分析。根据头部区域的简明损伤量表（AIS）评分≥3选择患者。分别在入院时和48 - 72小时后计算初始和随访的SeMo比值。动态SeMo比值定义为第二次与初始SeMo比值的差值。统计分析包括受试者操作特征（ROC）曲线分析以确定死亡率预测的最佳阈值，以及临床结局的比较分析。
研究队列包括121例死亡患者和997例存活患者。死亡患者的第二次SeMo比值（20.9±16.1对15.8±17.2，P = 0.001）和动态SeMo比值（2.4±19.8对 - 2.1±19.5，P = 0.019）显著高于存活患者。在多变量分析中，动态SeMo是院内死亡的显著独立危险因素（OR 1.01，95%CI：1.01 - 1.03，P = 0.031）。动态SeMo比值的最佳截断值为5.96，高于该值的患者死亡率更高（21.4%对8.5%，P < 0.001），调整后死亡率更高（调整后的优势比：2.98；95%置信区间：1.95 - 4.56；P = 0.005），住院时间更长（23.6天对19.7天，P = 0.005）。
动态SeMo比值变化可作为中重度TBI患者院内死亡率和住院时间的预后标志物。较高的动态SeMo比值表明风险增加，突出了早期监测和干预的重要性。未来的前瞻性研究应验证这些发现，并探索与其他生物标志物整合以增强预后评估。
