Tao Erxing, Liu Zhixin, Liu Yihao, Wang Chengyun, Huang Genbo, Xu Chunhua, Ding Zihan
Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Department of Neurosurgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
World Neurosurg. 2025 Feb;194:123546. doi: 10.1016/j.wneu.2024.12.005. Epub 2025 Jan 8.
To evaluate the effects of admission serum C-reactive protein-to-albumin ratio (CAR) in traumatic spinal cord injury (TSCI) severity evaluation and prognosis.
We included 402 TSCI patients from 2 hospitals and collected relevant clinical and laboratory data. The effects of CAR on the prognosis of TSCI were explored using univariate and multivariate logistic regression analyses. The predictive values of different indicators were compared by evaluating the areas under the receiver operating characteristic curve.
We classified 224 (55.7%) patients as severe TSCI (American spinal injury association Impairment Scale [AIS] grades A-B) and 178 (44.3%) patients as nonsevere TSCI (AIS grades C-E) according to the American Spinal Cord Injury Society Impairment Scale (AIS). Further investigation into the correlation among C-reactive protein (CRP), CAR, and serum albumin with the AIS grade showed that the admission CRP and CAR decreased in an AIS grade-dependent manner, while serum albumin increased in an AIS grade-dependent manner. Of the total patients, 226 (56.2%) were categorized as having a good clinical outcome based on AIS grade at the 1-year follow-up. Serum CAR decreased as follow-up AIS grade decreased. Serum CAR was more strongly correlated with follow-up AIS grade than serum CRP and serum albumin alone. Multivariate logistic regression analyses showed that injury severity and CAR were independent risk factors for poor prognosis. The area under the curve (AUC) of serum CAR was 0.749 higher than that of serum CRP (AUC = 0.736) and serum albumin (AUC = 0.719).
Serum CAR is a readily available biomarker for assessing the severity of TSCI and predicting prognosis, which is clinically relevant for the functional recovery of patients with TSCI.
评估入院时血清C反应蛋白与白蛋白比值（CAR）在外伤性脊髓损伤（TSCI）严重程度评估及预后中的作用。
我们纳入了来自两家医院的402例TSCI患者，并收集了相关临床和实验室数据。采用单因素和多因素逻辑回归分析探讨CAR对TSCI预后的影响。通过评估受试者工作特征曲线下面积比较不同指标的预测价值。
根据美国脊髓损伤协会损伤量表（AIS），我们将224例（55.7%）患者分类为重度TSCI（美国脊髓损伤协会损伤量表[AIS]分级为A - B级），178例（44.3%）患者分类为非重度TSCI（AIS分级为C - E级）。进一步研究C反应蛋白（CRP）、CAR和血清白蛋白与AIS分级之间的相关性表明，入院时CRP和CAR随AIS分级降低而降低，而血清白蛋白随AIS分级升高而升高。在所有患者中，根据1年随访时的AIS分级，226例（56.2%）患者临床结局良好。血清CAR随随访AIS分级降低而降低。血清CAR与随访AIS分级的相关性比单独的血清CRP和血清白蛋白更强。多因素逻辑回归分析显示，损伤严重程度和CAR是预后不良的独立危险因素。血清CAR的曲线下面积（AUC）比血清CRP（AUC = 0.736）和血清白蛋白（AUC = 0.719）高0.749。
血清CAR是一种易于获得的生物标志物，可用于评估TSCI的严重程度并预测预后，这对TSCI患者的功能恢复具有临床意义。
