全身免疫炎症指数对急性脑出血患者发生卒中相关性肺炎的预测价值

Predictive value of systemic inflammation response index for stroke-associated pneumonia in patients with acute intracerebral hemorrhage

目的 探讨全身免疫炎症指数(SII)对脑出血(ICH)患者发生卒中相关性肺炎(SAP)的预测价值。方法 回顾性分析2019年5月至2020年5月广州中医药大学第二附属医院的241例急性脑出血患者,依据是否发生SAP将患者分为SAP组(83例)及非SAP组(158例)。收集患者的人口学特征、既往史及全血分析结果等,计算SII值,采用单及多因素logistic回归分析确定SII与SAP的独立相关性,通过受试者工作特征(ROC)曲线中的AUC、敏感度、特异度等指标评价SII的预测价值。结果 241例脑出血患者中83例(34.4%)发生肺炎。单因素分析显示SAP组患者出血量、入院NHISS、入院GCS、洼田饮水试验分级、SII均高于非SAP组,神经外科手术治疗患者比例高于非SAP组,组间比较差异有统计学意义(P<0.05)。多因素分析结果示SII第三、四分位数组与第一分位数组相比,SAP患病风险的OR值(95%CI)分别为3.40(1.18~9.78)、5.20(1.81~14.95),差异均有统计学意义(P均<0.05)。ROC曲线分析显示,曲线下面积为0.708(P<0.001),SII最佳截断点为2 071.95×10~9时,其预测ICH患者发生SAP的敏感度为54.2%,特异度为77.8%。结论 SII是ICH患者发生SAP的独立危险因素,且与不良结局相关。

Objective To evaluate the predictive value of the systemic immune-inflammation Index(SII)for the occurrence of stroke-associated pneumonia(SAP)in patients with intracerebral hemorrhage(ICH).Methods A retrospective analysis was conducted on 241 patients with acute intracerebral hemorrhage admitted to the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2019 to May 2020.Patients were divided into the SAP group(83 cases)and non-SAP group(158 cases)based on the occurrence of SAP.Demographic characteristics,medical history,and complete blood count results were collected.The SII value was calculated,and logistic regression analysis,both univariate and multivariate,was employed to determine the independent correlation between SII and SAP.The predictive value of SII was evaluated using indicators such as area under the curve(AUC),sensitivity,and specificity in the ROC curve.Results Among the 241 patients with intracerebral hemorrhage,83(34.4%)developed pneumonia.Univariate analysis showed that patients in the SAP group had higher bleeding volume,admission National Institutes of Health Stroke Scale(NHISS),admission Glasgow Coma Scale(GCS),Watada water swallow test grade,and SII compared to the non-SAP group.The proportion of patients undergoing neurosurgical treatment was higher in the SAP group,and the differences between the groups were statistically significant(P<0.05).Multivariate analysis results showed that compared to the first quartile of SII,the odds ratios(ORs)(95%CI)for SAP risk in the third and fourth quartiles were 3.40(1.18-9.78)and 5.20(1.81-14.95),respectively,with statistically significant differences(P<0.05).ROC curve analysis demonstrated an area under the curve of 0.708(P<0.001).The optimal cutoff point for SII was 2071.95×109,with a sensitivity of 54.2%and specificity of 77.8%for predicting SAP in ICH patients.Conclusion SII is an independent risk factor for the occurrence of SAP in ICH patients and is associated with adverse outcomes.