格拉斯哥-全面无反应量表评分联合动脉乳酸对老年自发性脑出血患者预后的预测价值

Predictive value of GCS-F score combined with arterial lactate for prognosis of elderly patients with spontaneous cerebral hemorrhage

目的 研究格拉斯哥-全面无反应量表(Glasgow coma scale-full outline of unresponsiveness scale,GCS-F)评分联合动脉乳酸水平对老年自发性脑出血(intracerebral hemorrhage,ICH)患者预后的预测价值。方法 采用筛选入组方式回顾性选取2022年1月至2024年1月华北理工大学附属医院神经外科重症监护室收治的老年ICH患者278例,根据发病后90 d格拉斯哥预后评分分为预后良好组95例和预后不良组183例,比较2组基本资料、入院生命体征、瞳孔、实验室指标、格拉斯哥昏迷评分(Glasgow coma scale,GCS)等临床资料。采用二元logistic回归分析影响老年ICH患者预后不良的危险因素;绘制ROC曲线分析GCS-F评分联合动脉乳酸水平对老年ICH患者预后的预测价值。结果 预后不良组入院高血压、血糖、肌酐、动脉乳酸、出血部位(小脑幕下)及出血量显著高于预后良好组,小腿围、GCS评分及GCS-F评分显著低于预后良好组(P<0.05,P<0.01);针对ICH患者各层级预后不良率进行分析,GCS-F重度患者不良预后率显著高于GCS评分同层级患者(P<0.05)。二元logistic回归分析显示,GCS-F评分(OR=1.762,95%CI:1.507~2.061,P=0.000)、动脉乳酸(OR=0.536,95%CI:0.385~0.746,P=0.000)为老年ICH患者90 d预后不良的危险因素;ROC曲线分析显示,动脉乳酸、GCS评分、GCS-F评分预测老年ICH患者90 d预后不良的曲线下面积(area under curve,AUC)分别为0.713(95%CI:0.650~0.775)、0.827(95%CI:0.774~0.880)、0.876(95%CI:0.828~0.925),GCS-F评分联合动脉乳酸预测ICH患者90 d预后不良的AUC为0.919(95%CI:0.886~0.953),显著优于GCS评分、GCS-F评分、动脉乳酸单独预测(P<0.01)。结论GCS-F评分对老年ICH患者90 d不良预后的预测效果优于GCS评分,尤其在重症患者中。且GCS-F评分联合动脉乳酸水平预测老年ICH患者的预后情况效果最佳。

Objective To investigate the predictive value of Glasgow coma scale(GCS)-Full Outline of UnResponsiveness(FOUR) scale(GCS-F) score and arterial lactate level for prognosis of intracerebral hemorrhage(ICH) in elderly patients.Methods A total of 278 elderly ICH patients admitted to Neurosurgical Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from January 2022 to January 2024 were retrospectively recruited.According score at 90 d after onset,95 of them were assigned into good prognosis group and 183 into poor prognosis group.Basic information,vital signs at admission,pupils,laboratory indicators,GCS score and other clinical data were compared between the two groups.Binary logistic regression analysis was used to analyze the risk factors of poor prognosis in elderly ICH patients.ROC curve was drawn to analyze the prognostic value of GCS-F score(including eye opening response and limb movement in GCS,and brainstem response in FOUR scale) combined with lactate level in elderly ICH patients.Results Significantly higher blood pressure,elevated levels of blood glucose,creatinine and arterial lactic acid,increased percentages of supratentorial and subtentorial bleeding,and larger blood loss,while obviously lower GCS score and GCS-F score were observed in the poor prognosis group than the good prognosis group(P<0.05,P<0.01).In the analyses for poor prognosis rate of ICH patients at different levels,the poor prognosis rate of severe GCS-F patients was significantly higher than that of patients with same level of GCS score(P<0.05).Binary logistic regression analysis showed that GPS-F score(OR=1.762,95%CI:1.507-2.061,P=0.000) and arterial lactate level(OR=0.536,95%CI:0.385-0.746,P=0.000) were risk factors for 90-day poor prognosis in elderly ICH patients.ROC curve analysis indicated that the AUC value of arterial lactate,GCS score and GCS-F score in predicting 90-day poor prognosis in elderly ICH patients was 0.713(95%CI:0.650-0.775),0.827(95%CI:0.774-0.880) and 0.876(95%CI:0.828-0.925),respectively,and the AUC value of GCS-F score combined with arterial lactic acid was 0.919(95%CI:0.886-0.953),which was significantly higher than that of GCS score,GCS-F score and arterial lactic acid alone(P<0.01).Conclusion GCS-F score has better performance than GCS score in predicting 90-day poor prognosis in elderly ICH patients,especially for severe patients.The GPS-F score combined with arterial lactate level shows the best predictive effectiveness for elderly ICH patients.