CONUT和PNI对重型颅脑损伤患者短期预后的预测价值

Predictive value of controlling nutritional status score and prognostic nutrition index for prognosis of patients with severe traumatic brain injury

目的评估控制营养状况(CONUT)评分和预后营养指数(PNI)对重型颅脑损伤(STBI)患者临床治疗6个月预后的预测价值。方法本研究为回顾性研究,选取2018年1月至2020年6月入东南大学附属中大医院溧水分院确诊STBI患者100例,采用改良Rankin量表(mRS)评价6个月临床预后,受试者操作特征曲线(ROC曲线)获得治疗前CONUT评分和PNI评估预后不良的最佳临界值;分析CONUT评分和PNI与患者临床资料间的关系,单因素和多因素Logistic回归分析筛选预后的危险因素。结果预后不良(mRS≥3分)53例(53.0%),CONUT评分最佳临界值为4,PNI最佳临界值为44。CONUT评分≥4分组比<4分组,PNI<44组比≥44组患者年龄较大、格拉斯哥昏迷量表(GCS)评分降低、脑疝和肺炎增多、血清白蛋白和总胆固醇水平降低(P<0.05)。单因素Logistic回归分析显示,年龄≥50岁、GCS评分<6分、脑疝、肺炎、白蛋白<3.8g/dl、总胆固醇<130mg/dl、CONUT评分≥4分和PNI<44是预后不良的危险因素(P<0.05)。多因素回归分析显示,GCS评分<6分、肺炎、CONUT评分≥4分和PNI<44是预后不良的独立危险因素(P<0.05)。结论治疗前CONUT评分和PNI对STBI患者临床治疗6个月预后有较好的预测价值,其中CONUT评分≥4分和PNI<944是预后不良的独立危险因素。

Objective To evaluate the predictive value of controlling nutritional status(CONUT)score and prognostic nutrition index(PNI)for 6⁃month prognosis of patients with severe traumatic brain injury(STBI).Methods A total of 100 patients with STBI into our hospital from January 2018 to June 2020 were retrospectively summarized.The modified Rankin Scale(mRS)was used to evaluate the 6⁃month clinical prognosis.The best cut⁃off value of CONUT score and PNI for poor prognosis was obtained by receiver operating curve(ROC curve).The relationship between CONUT score,PNI and clinical datas was analyzed,and univariate and multivariate Logistic regression analysis to screen the risk factors of prognosis.Results There were 53 patients(53.0%)of poor prognosis(mRS≥3).The best cut⁃off value of CONUT score was 4,and PNI was 44.The patients with CONUT score≥4 or PNI<44 were older than CONUT score<4,or PNI≥44,Glasgow Coma Scale(GCS)score was less,cerebral hernia and pneumonia were more,serum albumin and total cholesterol were lower,too(P<0.05).Univariate regression analysis showed that age≥50 years,GCS score<6,cerebral hernia,pneumonia,albumin<3.8 g/dl,total cholesterol<130 mg/dl,CONUT score≥4 and PNI<44 were associated with poor prognosis(P<0.05).Multivariate regression analysis showed that GCS score<6,pneumonia,CONUT score≥4 and PNI<44 were independent risk factors for poor prognosis(P<0.05).Conclusion CONUT score and PNI before treatment have good predictive values for 6⁃month prognosis of STBI patients.CONUT score≥4 and PNI<44 are independent risk factors for poor prognosis.