基于MIMIC-Ⅳ数据库对外周血NLR在创伤性脑损伤患者院内病死率评估中的价值分析  

Analysis of the value of the ratio of peripheral blood neutrophils to lymphocytes in the assessment of in-hospital mortality in patients with traumatic brain injury based on the MIMIC-Ⅳdatabase

作　　者：张国栋[1] 韩冠哲 何锋[1] 李远超 路贵 王运刚[1] 李树利 郭锋杰 程振国[1] Zhang Guodong;Han Guanzhe;He Feng;Li Yuanchao;Lu Gui;Wang Yungang;Li Shuli;Guo Fengjie;Cheng Zhenguo(Department of Neurosurgery,Xinxiang Central Hospital,Xinxiang 453000,China;Department of Emergency,Xinxiang Central Hospital,Xinxiang 453000,China)

机构地区：[1]新乡市中心医院神经外科,新乡453000 [2]新乡市中心医院急诊科,新乡453000

出　　处：《中华神经外科杂志》2025年第3期280-285,共6页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210897)。

摘　　要：目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)在创伤性脑损伤(TBI)患者院内病死率评估中的价值,并分析影响TBI患者病死率的临床因素。方法从MIMIC-Ⅳ(2.0)数据库中提取2008—2009年间首次入住重症监护病房的1602例TBI患者数据,收集并分析院内存活组(1425例)和院内病死组(177例)患者的临床特征。采用单因素和多因素logistic回归分析筛选影响TBI患者院内病死率的相关因素。通过患者院内病死率的受试者工作特征(ROC)曲线和曲线下面积(AUC)评估外周血NLR的预测效能并与患者序贯性器官功能衰竭评估(SOFA)评分的预测效能进行比较。结果与院内存活组相比,院内病死组患者年龄较大、女性占比高;出现充血性心力衰竭、肾脏疾病合并症的占比高;平均动脉压较低,而心率则较高(均P<0.05)。实验室检查方面,与院内存活组相比,院内病死组患者外周血NLR升高、白细胞计数升高、血红蛋白水平降低、血小板计数降低、阴离子间隙升高、尿素氮水平升高、血钠和血钾水平均升高、凝血功能相关的国际标准化比值上升、凝血酶原时间(PT)和活化部分凝血活酶时间均延长(均P<0.05)。与院内存活组相比,院内病死组患者的SOFA评分较高、格拉斯哥昏迷量表评分≤12分者占比高(均P<0.05)。另外,院内病死组较院内存活组患者抗生素使用者占比高(P<0.05)。多因素logistic回归分析显示,年龄、心率、外周血NLR、血钠、血钾、PT、SOFA评分及GCS评分均为患者院内病死率的独立危险因素(均P<0.05)。ROC曲线分析显示,院内外周血NLR、SOFA评分的AUC值分别为0.78、0.76,差异无统计学意义(P>0.05)。进一步分析显示,外周血NLR预测TBI患者院内病死率的截断值为12.14。结论外周血NLR与SOFA评分效能相似,可用于评估TBI患者的院内病死率;外周血NLR结合其他临床因素可更全面地评估TBI患者的院内病死率。ObjectiveTo investigate the value of the neutrophil-to-lymphocyte ratio(NLR)in peripheral blood for assessing mortality in patients with traumatic brain injury(TBI)and to analyze the clinical factors influencing in-hospital mortality in TBI patients.MethodsData from 1602 TBI patients who were first admitted to the intensive care unit(ICU)between 2008 and 2019 were extracted from the MIMIC-Ⅳ(2.0)database.Clinical characteristics of patients in the in-hospital survival group(1425 patients)and the in-hospital mortality group(177 patients)were collected and analyzed.Univariate and multivariate logistic regression analyses were conducted to screen for independent factors influencing in-hospital mortality of TBI patients.The predictive performance of NLR was assessed using the receiver operating characteristic(ROC)curve and area under the curve(AUC)for in-hospital mortality and compared with the sequential organ failure assessment(SOFA)score.ResultsCompared with those in the in-hospital survival group,patients in the in-hospital mortality group were older,had a higher proportion of female,a higher incidence of congestive heart failure and renal disease complications,lower mean arterial pressure,and higher heart rates(all P<0.05).Laboratory indicators showed that patients in the in-hospital mortality group had increased NLR and white blood cell count,decreased hemoglobin and platelet counts,increased anion gap,elevated urea nitrogen levels,increased sodium and potassium levels,prolonged international normalized ratio related to coagulation function,and prolonged prothrombin time(PT)and activated partial thromboplastin time(all P<0.05).Compared with those in the in-hospital survival group,patients in the in-hospital mortality group had higher SOFA scores and a higher proportion of patients with a Glasgow Coma Scale(GCS)score≤12(both P<0.05).Additionally,a higher proportion of patients in the in-hospital mortality group received antibiotics compared with those in the in-hospital survival group(P<0.05).Multivariate log

关 键 词：脑损伤 创伤性 中性白细胞 淋巴细胞 病死率 序贯性器官功能衰竭评分 

分 类 号：R651.1[医药卫生—外科学]