基于营养学指标筛选老年重型颅脑损伤预后的影响因素

Screening of influencing factors for prognosis in elderly patients with severe traumatic brain injury based on nutritional indicators

中文关键词: 老年  重型颅脑损伤  预后营养指数  预后

英文关键词: elderly  severe traumatic brain injury  prognostic nutritional index  prognosis

中文摘要:

      目的 基于营养学指标筛选重型颅脑损伤老年患者预后不良危险因素,并构建列线图模型.方法 选取2019年3月1日-2023年6月1日于海安市人民医院治疗的重型颅脑损伤患者作为研究对象,并在术后6个月对患者进行格拉斯哥昏迷评分(GCS)评分,GCS评分≤3分或死亡为预后不良(设为预后不良组),GCS评分≥3分为预后良好(设为预后良好组).比较预后良好组和预后不良组患者一般临床资料、营养学和代谢血清标志物,采用多因素Logistic回归分析筛选独立预后因子,建立列线图模型.结果 多因素Logistic回归分析显示,术前GCS评分和预后营养指数(PNI)是重型颅脑损伤老年患者预后良好的独立保护因素(OR＜1,P＜0.05).受伤至手术时间、血清LAC水平、年龄是重型颅脑损伤老年患者预后不良的独立危险因素(OR＞1,P＜0.05).基于上述筛选的独立预后因子构建的列线图模型具有较好的预测效能.模型曲线和理想曲线之间的最大偏移值为0.063,ROC曲线下面积为0.934.结论 术前GCS评分和PNI可能是重型颅脑损伤老年患者预后良好的独立保护因素,受伤至手术时间、血清LAC水平、年龄可能是预后不良的独立危险因素;基于上述预后预测因子,建立的列线图模型可能具有较好的预测效能.

英文摘要:

      Objective To screen risk factors for poor prognosis in elderly patients with severe traumatic brain injury(STBI)based on nutritional indicators and construct a nomogram prediction model.Methods Patients with STBI treated in People's Hospital of Hai'an City from March 1,2019 to June 1,2023 were enrolled.At 6 months after surgery,the patients were evaluated using Glasgow Coma Scale(GCS).Those with a GCS score of ≤ 3 or death were defined as poor prognosis(set as the poor prognosis group),and those with a GCS score of ≥3 were defined as good prognosis(set as the good progno-sis group).The general clinical data,nutritional indicators,and metabolic serum markers were compared between the two groups.Multivariate Logistic regression analysis was performed to identify independent prognostic factors,and a nomogram model was established.Results Multivariate Logistic regression analysis revealed that preoperative GCS score and the Prog-nostic Nutritional Index(PNI)were independent protective factors for good prognosis in elderly STBI patients(OR＜1,P＜0.05),while time from injury to surgery,serum lactate(LAC)level,and age were independent risk factors for poor prognosis(OR＞1,P＜0.05).The nomogram model constructed based on these factors demonstrated strong predictive performance,with a maximum deviation of 0.063 between the calibration curve and ideal curve,and an area under the ROC curve(AUC)of 0.934.Conclusion Preoperative GCS score and PNI are independent protective factors for good prognosis in elderly STBI pa-tients,while time from injury to surgery,serum LAC level,and age are independent risk factors for poor prognosis.The no-mogram model established based on these prognostic factors may have good predictive performance.