联合LIPS和APACHEⅡ评分对重症创伤性脑损伤患者合并急性肺损伤的预测价值

Predictive value of combined LIPS and APACHEⅡscores in patients with severe traumatic brain injury complicated with acute lung injury

目的探讨肺损伤预测评分(lung injury prediction score,LIPS)联合急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对重症创伤性脑损伤(severe traumatic brain injury,sTBI)患者合并急性肺损伤(acute lung injury,ALI)的预测价值。方法回顾性选取2019年1月至2021年12月安徽医科大学附属省立医院收治的75例sTBI患者,根据是否合并ALI,将其分为ALI组(n=24)和非ALI组(n=51)。收集患者入院时的基本资料、实验室指标、APACHEⅡ评分、LIPS评分、格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分;采用Logistic回归分析sTBI患者合并ALI的危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价指标对sTBI合并ALI的预测价值。结果ALI组患者的APACHEⅡ评分、LIPS评分均显著高于非ALI组,GCS评分、红细胞体积分布宽度显著低于非ALI组(P<0.05)。Logistic回归分析显示,APACHEⅡ评分和LIPS评分升高及GCS评分降低均是sTBI合并ALI的独立危险因素(P<0.05)。ROC曲线分析显示,LIPS评分、APACHEⅡ评分诊断sTBI合并ALI的曲线下面积(area under the curve,AUC)分别为0.869和0.754;二者联合检测的AUC为0.916(95%CI:0.855~0.976),敏感度和特异性分别为83.4%和84.3%。结论LIPS评分联合APACHEⅡ评分可有效预测sTBI合并ALI的风险。

Objective To investigate predictive value of combined lung injury prediction score(LIPS)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores in patients with severe traumatic brain injury(sTBI)complicated with acute lung injury(ALI).Methods Seventy-five sTBI patients admitted to Provincial Hospital of Anhui Medical University from January 2019 to December 2021 were retrospectively selected and divided into ALI group(n=24)and non-ALI group(n=51)according to whether they were complicated with ALI.Basic data,laboratory indicators,APACHEⅡscore,LIPS score and Glasgow coma scale(GCS)score were collected.Logistic regression was used to analyze the risk factors of patients with sTBI complicated with ALI,and predictive value of the evaluation index of the receiver operating characteristic(ROC)curve for sTBI complicated with ALI was drawn.Results APACHEⅡscore and LIPS score in ALI group were significantly higher than those in non-ALI group,GCS score and red cell volume distribution width were significantly lower than those in non-ALI group(P<0.05).Logistic regression analysis showed that APACHEⅡscore,LIPS score and GCS score were independent risk factors for sTBI complicated with ALI(P<0.05).ROC curve analysis showed that area under the curve(AUC)of LIPS score and APACHEⅡscore in the diagnosis of sTBI complicated with ALI were 0.869 and 0.754,respectively.The AUC was 0.916(95%CI:0.855-0.976),and the sensitivity and specificity were 83.4%and 84.3%,respectively.Conclusion LIPS score combined with APACHEⅡscore can effectively predict the risk of sTBI complicated with ALI.