入院时全身炎症反应指数预测基底节区自发性脑出血患者术后转归

Systemic inflammatory response index at admission predicts postoperative outcome in patients with spontaneous intracerebral hemorrhage in basal ganglia region

目的探讨术前全身炎症反应指数(systemic inflammatory response index,SIRI)对基底节区自发性脑出血(intracerebral hemorrhage,ICH)患者术后临床转归的预测价值。方法回顾性纳入2015年1月至2021年12月在青岛大学附属医院神经外科接受手术治疗的基底节区ICH患者。在术后3个月时采用改良Rankin量表进行临床转归评价,0~2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归分析确定SIRI与ICH患者转归不良的独立相关性。通过受试者工作特征(receiver operating characteristic,ROC)曲线分析确定SIRI的预测价值。结果共纳入258例接受手术治疗的基底节区ICH患者,其中男性176例(68.22%),中位年龄57.00岁(四分位数间距:49.00~65.25岁);中位血肿体积50.00 ml(四分位数间距:40.00~70.00 ml),中位SIRI 4.12(四分位数间距:2.28~7.30);143例(55.43%)转归不良。多变量logistic回归分析显示,年龄较高[优势比(odds ratio,OR)1.070,95%置信区间(confidence interval,CI)1.030~1.111;P<0.001]、格拉斯哥昏迷量表评分较低(OR 0.669,95%CI 0.575~0.779;P<0.001)、血小板计数较高(OR 1.010,95%CI 1.003~1.017;P=0.004)以及SIRI较高(OR 1.434,95%CI 1.255~1.638;P<0.001)是患者转归不良的独立预测因素。ROC曲线分析显示,SIRI预测转归不良的曲线下面积为0.791(95%CI 0.737~0.845;P<0.001),最佳截断值为4.53,预测敏感性和特异性分别为67.8%和81.7%。结论术前SIRI可有效预测基底节区ICH患者术后3个月时的临床转归,SIRI>4.53提示转归不良。

ObjectiveTo the investigate the predictive value of preoperative systemic inflammatory response index(SIRI)for postoperative clinical outcome in patients with spontaneous intracerebral hemorrhage(ICH)in basal ganglia region.MethodsPatients with ICH in basal ganglia region underwent surgical treatment at the Department of Neurosurgery,the Affiliated Hospital of Qingdao University from January 2015 to December 2021 were retrospectively included.At 3 months after surgery,the modified Rankin Scale was used to evaluate the clinical outcome,with a score of 0-2 defined as good outcome and>2 defined as poor outcome.Multivariate logistic regression analysis was used to identify the independent correlation between SIRI and poor outcome in patients with ICH.Receiver operating characteristic(ROC)curve analysis was used to identify the predictive value of SIRI.ResultsA total of 258 patients with ICH in basal ganglia region underwent surgical treatment were enrolled,including 176 males(68.22%),aged 57.00 years(interquartile range,49.00-65.25 years);median hematoma volume was 50.00 ml(interquartile range,40.00-70.00 ml),and median SIRI was 4.12(interquartile range,2.28-7.30);143 patients(55.43%)had poor outcome.Multivariate logistic regression analysis showed that older age(odds ratio[OR]1.070,95%confidence interval[CI]1.030-1.111;P<0.001),lower Glasgow Coma Scale score(OR 0.669,95%CI 0.575-0.779;P<0.001),higher platelet count(OR 1.010,95%CI 1.003-1.017;P=0.004),and higher SIRI(OR 1.434,95%CI 1.255-1.638;P<0.001)were the independent predictors of poor outcome.ROC curve analysis showed that the area under the curve for predicting poor outcome by SIRI was 0.791(95%CI 0.737-0.845;P<0.001),with an optimal cutoff value of 4.53.The predictive sensitivity and specificity were 67.8%and 81.7%,respectively.ConclusionPreoperative SIRI can effectively predict the clinical outcome of patients with ICH in basal ganglia area at 3 months after surgery,and SIRI>4.53 indicates poor outcome.