中性粒细胞淋巴细胞比值联合胆碱酯酶对重型颅脑损伤患者28天病死率的预测价值

Predictive Value of Neutrophil Lymphocyte Ratio Combined with Cholinesterase in 28-day Mortality in Patients with Severe Brain Injury

目的探讨中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、胆碱酯酶以及NLR联合胆碱酯酶在预测重型颅脑损伤(severe traumatic brain injury,sTBI)患者28天病死率的临床价值。方法回顾性分析2018年5月~2021年4月在徐州医科大学附属医院重症医学科住院治疗的sTBI患者的临床资料。根据28天预后将sTBI分为存活组和死亡组,比较组间患者各指标的差异。探究NLR联合胆碱酯酶对患者28天病死率的预测价值。结果共入组234例sTBI患者,其中28天内死亡92例,存活142例。与存活组比较,中性粒细胞计数、NLR、血肌酐、血糖、降钙素原(PCT)、乳酸等更高,胆碱酯酶、淋巴细胞计数、GCS评分等更低,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,NLR、胆碱酯酶、Scr、血糖、乳酸、GCS评分是sTBI患者死亡的独立危险因素。ROC曲线分析显示,NLR联合胆碱酯酶可以预测sTBI患者28天病死率,ROC曲线下面积(AUC)为0.824。Kaplan-Meier生存曲线分析显示,NLR与胆碱酯酶联合指标低于临界值组患者28天累积生存率显著高于高于临界值组。结论NLR联合胆碱酯酶对sTBI患者28天病死率具有良好的预测价值。

Objective To investigate the clinical value of neutrophil lymphocyte ratio(neutrophil to Lymphocyte ratio NLR),cholinesterase and NLR combined with cholinesterase in predicting 28-day mortality of severe traumatic brain injury(sTBI)patients.Methods The clinical data of sTBI patients hospitalized in ICU of Xuzhou Medical University Hospital from May 2018 to April 2021 were retrospectively analyzed.sTBI was divided into the survival group and the death group according to the 28-day prognosis,and the differences of various indicators between the groups were compared.To explore the predictive value of NLR combined with cholinesterase on 28day mortality.Results A total of 234 sTBI patients were enrolled,of whom 92 died and 142 survived after 28 days.Compared with the survival group,neutrophils,NLR,serum creatinine,blood glucose,procalcitonin(PCT)and Lac were higher,and cholinesterase,lymphocyte count and GCS score were lower,with statistical significance(all P<0.05).Multivariate Logistic regression analysis showed that NLR,cholinesterase,Scr,blood glucose,Lac and GCS scores were independent risk factors for death in sTBI patients.ROC curve analysis showed that NLR combined with cholinesterase and GCS score had good predictive value for 28-day mortality.Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate of patients with NLR and cholinesterase combination index below critical value was significantly higher than that of patients with NLR and cholinesterase combination index above critical value.Conclusion NLR combined with cholinesterase has good predictive value for 28-day mortality of sTBI patients.