Wei Dan, Liu Xing, Gu Yanlai, Fu Qiuhong, Tang Hua
Department of Emergency, Shenzhen Longhua District Center Hospital, Shenzhen, Guangdong, 518110, P. R. China.
Department of Emergency, The Second People's Hospital of Futian District Shenzhen, Shenzhen, Guangdong, 518049, P. R. China.
Open Med (Wars). 2025 Apr 8;20(1):20251161. doi: 10.1515/med-2025-1161. eCollection 2025.
To investigate the significance of the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) and the neutrophil-lymphocyte ratio (NLR) in the prediction of prognosis in patients with multiple injuries.
The clinical data of 142 patients with multiple injuries admitted to the Emergency Department of Shenzhen Longhua District Central Hospital between January 2019 and December 2022 were retrospectively analyzed. Subjects were divided into the survival group ( = 102) and the deceased group ( = 40) based on their survival status at 28 days after injury. We subsequently analyzed the intergroup differences in blood test results, rSIG, and NLR, as well as the relationship between rSIG and NLR. The predictive value of rSIG, NLR, and both combined in determining the prognosis of patients with multiple injuries was explored by plotting the receiver operator characteristic (ROC) curve. Based on the optimal cut-point value of the ROC curves, subjects were divided into groups with rSIG ≤ 7.75 (22 patients) and rSIG > 7.75 (120 patients), as well as groups with NLR ≤ 10.36 (104 patients) and NLR > 10.36 (38 patients), and the 28-day mortality rate was compared between the groups.
A total of 142 patients were enrolled. The rSIG of the survival group ( = 102) was significantly greater (15.7 ± 4.8) than that of the deceased group ( = 40, 6.2 ± 2.9), ( = 14.307, < 0.001). The NLR of the survival group was higher than that of the deceased group, but the difference was not statistically significant ( > 0.05). The area under the curve (AUC) of the ROC of NLR was significantly greater than that of rSIG (0.922 vs 0.54) ( = -7.881, < 0.001). The AUC for NLR was also statistically greater than that of the combination of rSIG and NLR (0.963 vs 0.54) ( = -8.378, < 0.001). The AUC of the combination of rSIG and NLR was significantly greater than that of rSIG (0.844 vs 0.540) ( = 2.239, = 0.025). The 28-day mortality rate of patients in the rSIG ≤ 7.75 group was also significantly greater than that of patients in the rSIG > 7.75 group (10.0%) ( < 0.05). Finally, the 28-day mortality rate in the group with an NLR ≤ 10.36 was lower than that in the group with an NLR > 10.36 ( < 0.05). Pearson correlation analysis showed that the correlation coefficient between rSIG and NLR was = 0.13, which did not reach statistical significance ( = 0.12).
NLR, rSIG, and the combination of the two are all valuable in predicting the prognosis of patients with multiple injuries (all AUC > 0.5). However, the predictive capacity of NLR was better than either rSIG alone or both combined. These findings may serve as references in guiding the treatment of patients with multiple injuries in clinical practice.
探讨反向冲击指数乘以格拉斯哥昏迷量表评分（rSIG）及中性粒细胞与淋巴细胞比值（NLR）对多发伤患者预后预测的意义。
回顾性分析2019年1月至2022年12月深圳市龙华区中心医院急诊科收治的142例多发伤患者的临床资料。根据伤后28天的生存状况将患者分为生存组（n = 102）和死亡组（n = 40）。随后分析两组血常规结果、rSIG及NLR的组间差异，以及rSIG与NLR之间的关系。通过绘制受试者工作特征（ROC）曲线探讨rSIG、NLR及其联合应用对多发伤患者预后判断的预测价值。根据ROC曲线的最佳切点值，将受试者分为rSIG≤7.75组（22例）和rSIG>7.75组（120例），以及NLR≤10.36组（104例）和NLR>10.36组（38例），比较两组的28天死亡率。
共纳入142例患者。生存组（n = 102）的rSIG（15.7±4.8）显著高于死亡组（n = 40，6.2±2.9），（t = 14.307，P < 0.001）。生存组的NLR高于死亡组，但差异无统计学意义（P>0.05）。NLR的ROC曲线下面积（AUC）显著大于rSIG（0.922对0.54）（t = -7.881，P < 0.001）。NLR的AUC在统计学上也大于rSIG与NLR联合应用的AUC（0.963对0.54）（t = -8.378，P < 0.001）。rSIG与NLR联合应用的AUC显著大于rSIG（0.844对0.540）（t = 2.239，P = 0.025）。rSIG≤7.75组患者的28天死亡率也显著高于rSIG>7.75组（10.0%）（P < 0.05）。最后，NLR≤10.36组的28天死亡率低于NLR>10.36组（P < 0.05）。Pearson相关分析显示，rSIG与NLR的相关系数r = 0.13，未达到统计学意义（P = 0.12）。
NLR、rSIG及其二者联合应用对多发伤患者的预后预测均有价值（所有AUC>0.5）。然而，NLR的预测能力优于单独的rSIG或二者联合。这些发现可为临床实践中多发伤患者的治疗提供参考。
