全身免疫炎症指数（SII）与血小板-淋巴细胞比值（PLR）对创伤性脑损伤患者凝血功能障碍及预后的影响
The Association of Systemic Immune Inflammation Index (SII) and Platelet-to-Lymphocyte Ratio (PLR) on Coagulopathy and Prognosis in Patients with Traumatic Brain Injury.
作者信息
Chen Jiali, Fu Jiahui, Liu Jiazhuo, Lu Yin, Han Dong, Zeng Jiaxuan, Zou Zhimin, Li Qin, Zhang Kun, Wei Xiucai, Li Li, Gu Zhengtao
机构信息
Department of Treatment Center For Traumatic Injuries, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Academy of Orthopedics, Guangdong Province, Orthopedic Hospital of Guangdong Province, Guangdong Provincial Key Laboratory of Bone and Joint Degenerative Diseases, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
出版信息
J Inflamm Res. 2025 Apr 25;18:5637-5653. doi: 10.2147/JIR.S512018. eCollection 2025.
OBJECTIVE
We aimed to investigate the associations between inflammatory immune indicators, specifically systemic immune inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and the coagulopathy and prognosis of traumatic brain injury (TBI) patients in ICU.
METHODS
One hundred sixty-one TBI patients were grouped into four groups. The outcomes included TBI-related coagulopathy and prognosis at six months after discharge. The association between SII, PLR and coagulopathy, and prognosis in TBI patients was elucidated by applying trend analysis, sensibility analysis, spearman correlation, restricted cubic splines and so on.
RESULTS
Sixty-four (39.75%) of 161 TBI patients were diagnosed with coagulopathy. In the unadjusted model, TBI patients in the lowest quarter of SII (≤966.60) and PLR levels (≤97.99) had a higher risk of coagulopathy than those in the highest quarter of SII (≥3096.16) [OR 0.169 (95% CI 0.052-0.547)] and PLR (≥255.39) [OR 0.098 (95% CI 0.028-0.340)]. After adjusting for covariates, the significant negative associations of results remained consistent in the sensitivity analyses. Restricted cubic splines revealed that an almost linear relationship between SII, PLR and coagulopathy risk and poor prognosis ( for all nonlinearities > 0.05). Finally, receiver operating characteristic (ROC) curves indicated that the SII and PLR had certain diagnostic and predictive values for TBI-related coagulopathy [AUC = 0.666 (95% CI 0.566-0.766), AUC = 0.752 (95% CI 0.662-0.842)] and prognosis [AUC = 0.657 (95% CI 0.548-0.766), AUC = 0.700 (95% CI 0.596-0.805)]. The stratification of isolated TBI and TBI with multi-trauma does not affect SII and PLR in predicting TBI-related coagulopathy and poor prognosis in the subgroup analysis (P > 0.05).
CONCLUSION
This study demonstrated that the SII and PLR had a significant correlation with coagulopathy risk and prognosis at 6 months after discharge. SII and PLR were predictive of coagulopathy and poor prognosis, specifically PLR value. It suggests that the SII and PLR might be promising biomarkers for predicting TBI-related coagulopathy and prognosis.
TRIAL REGISTRATION
The study was registered in the ethics committee of the Third Affiliated Hospital of Southern Medical University (2024-ER-005).
目的
我们旨在研究炎症免疫指标，特别是全身免疫炎症指数（SII）、血小板与淋巴细胞比值（PLR）与重症监护病房（ICU）中创伤性脑损伤（TBI）患者凝血病及预后之间的关联。
方法
161例TBI患者被分为四组。观察指标包括TBI相关凝血病及出院后6个月的预后情况。通过趋势分析、敏感性分析、Spearman相关性分析、限制立方样条等方法阐明SII、PLR与TBI患者凝血病及预后之间的关联。
结果
161例TBI患者中有64例（39.75%）被诊断为凝血病。在未调整模型中，SII水平处于最低四分位数（≤966.60）和PLR水平处于最低四分位数（≤97.99）的TBI患者发生凝血病的风险高于SII水平处于最高四分位数（≥3096.16）的患者[比值比（OR）0.169（95%置信区间0.052 - 0.547）]以及PLR水平处于最高四分位数（≥255.39）的患者[OR 0.098（95%置信区间0.028 - 0.340）]。在对协变量进行调整后，敏感性分析结果显示显著的负相关关系仍然一致。限制立方样条显示SII、PLR与凝血病风险及不良预后之间几乎呈线性关系（所有非线性关系>0.05）。最后，受试者工作特征（ROC）曲线表明，SII和PLR对TBI相关凝血病[AUC = 0.666（95%置信区间0.566 - 0.766），AUC = 0.752（95%置信区间0.662 - 0.842）]和预后[AUC = 0.657（95%置信区间0.548 - 0.766），AUC = 0.700（95%置信区间0.596 - 0.805）]具有一定的诊断和预测价值。在亚组分析中，单纯TBI和合并多发伤的TBI分层并不影响SII和PLR对TBI相关凝血病及不良预后的预测（P>0.05）。
结论
本研究表明，SII和PLR与出院后6个月的凝血病风险及预后显著相关。SII和PLR可预测凝血病及不良预后，特别是PLR值。这表明SII和PLR可能是预测TBI相关凝血病及预后的有前景的生物标志物。
试验注册
本研究已在南方医科大学第三附属医院伦理委员会注册（2024 - ER - 005）。
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