D-二聚体/白蛋白比值对重型创伤性脑损伤短期预后的预测价值

Predictive value of D-dimer/albumin ratio in short-term prognosis of severe traumatic brain injury

目的探究D-二聚体/白蛋白比值(DAR)在重型创伤性脑损伤(sTBI)患者短期预后评估中的价值。方法回顾性分析2020年3月—2022年2月在南京大学医学院附属鼓楼医院神经外科收治的84例sTBI患者的临床资料,包括D-二聚体,白蛋白,C反应蛋白等血清指标。根据随访出院后1个月内疾病转归分为生存组和死亡组,使用格拉斯哥昏迷评分(GCS评分)及马歇尔CT分级评估患者的严重程度。采用多元Logistic回归分析sTBI患者短期不良预后的危险因素。使用ROC的AUC来分析DAR等入院时的指标对sTBI患者短期死亡率的预测价值。结果在收住入院的84例sTBI患者中,死亡20例,病死率为23.8%,与生存组患者相比较,死亡组患者具有更高的年龄、DAR指标、D-二聚体以及更低的马歇尔CT分级,差异具有统计学意义(均P<0.05)。多因素Logistic回归分析结果表明,年龄(OR=1.096,P<0.05)、DAR(OR=1.034,P<0.01)是sTBI患者短期预后不良的独立危险因素,而死亡风险较低的马歇尔CT分级(Ⅰ、Ⅱ、Ⅴ)是sTBI的保护因素(OR=0.082,P<0.01)。ROC显示DAR、D-二聚体、血清白蛋白AUC分别为0.86、0.85、0.70,但DAR、年龄和马歇尔CT分级三者联合的预测具有更高的效能(AUC为0.90)。结论入院时高DAR是sTBI患者短期死亡的独立危险因素,具有较高的预测价值。

Objective To explore the predictive value of D-dimer/albumin ratio(DAR)in the short-term prognostic evaluation of patients with severe traumatic brain injury(sTBI).Methods The clinical data of 84 patients with sTBI admitted to Department of Neurosurgery,Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2020 to February 2022 were analyzed retrospectively,including serum indices such as D-dimer,albumin C-reactive protein(CRP)and other serum indices.Based on the disease outcome one month after discharge during the follow-up,the patients were divided into survival group and death group.The severity of the patients was assessed using the Glasgow Coma Scale(GCS)and Marshall CT grade.Multiple logistic regression analysis was used to analyze the risk factors of short-term poor prognosis in sTBI patients.The AUC of ROC was used to analyze the value of DAR and other indicators at admission to predict short-term mortality in patients with sTBI.Results Among the 84 sTBI patients,20 died(23.8%).Compared with the survival group,the patients in the death group had higher age,DAR index,D-dimer,lower Marshall CT grade and GCS score,and the differences were statistically significant(all P<0.05).Multivariate logistic regression analysis revealed that age(OR=1.096,P<0.05),DAR(OR=1.034,P<0.01)were risk factors for poor prognosis in the patients with sTBI,while Marshall CT grade with lower risk of death(Ⅰ,Ⅱ,Ⅴ)was a protective factor for sTBI(OR=0.082,P<0.01).The ROC demonstrated that the AUC of DAR,D-dimer,and serum albumin were 0.86,0.85,0.70,respectively,but the combination of DAR,age,and Marshall CT grade had a higher prediction efficiency(AUC=0.90).Conclusion High DAR at admission is an independent risk factor for poor prognosis in patients with sTBI and has a high predictive value.