多量表联合分析对重型创伤性颅脑出血患者短期预后的预测价值

Value of the multiscale cojoint analysis in short-term prognosis in patients with severe traumatic craniocerebral hemorrhage

  • 摘要:
    目的 分析格拉斯哥昏迷量表(GCS)评分、全面无反应性量表(FOUR) 评分以及赫尔辛基CT评分评估重型创伤性颅脑出血患者短期预后的临床价值。
    方法 选择150例重型创伤性颅脑出血患者为研究对象,根据患者2周内预后结局分为死亡组(65例)、存活组(85例)。比较2组GCS评分、FOUR评分及赫尔辛基CT评分差异。采用Pearson直线分析评估FOUR评分及赫尔辛基CT评分与GCS评分的相关性。应用多元Logistic回归分析探讨FOUR评分、赫尔辛基CT评分和GCS评分与预后的相关性。
    结果 与存活组比较,死亡组与存活组D-二聚体、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)及血小板(PLT)计数比较,差异无统计学意义(P>0.05), 而死亡组FOUR评分及赫尔辛基CT评分较存活组高, GCS评分降低,差异有统计学意义(P < 0.05)。重型创伤性颅脑出血患者FOUR评分及赫尔辛基CT评分与GCS评分呈负相关(P < 0.05)。FOUR评分以及赫尔辛基CT评分是重型创伤性颅脑出血患者入院2周预后的危险因素(OR=2.913, P=0.036; OR=2.831, P=0.041), 而GCS评分为保护性因素(OR=0.756, P=0.029)。GCS评分、FOUR评分及赫尔辛基CT评分预测患者死亡的灵敏度、特异度及曲线下面积(AUC)比较,差异无统计学意义(P>0.05)。3种评分联合预测患者死亡的灵敏度为86.8%, 特异度为94.5%, AUC为0.892(95%CI为0.863~0.946)。
    结论 GCS评分、FOUR评分及赫尔辛基CT评分联合应用能有效评估重型创伤性颅脑出血患者的短期预后。

     

    Abstract:
    Objective To analyze the predictive value of Glasgow Coma Scale (GCS) score, Full Outline of UnResponsiveness (FOUR) score, and Helsinki CT score on short-term prognosis in patients with severe traumatic craniocerebral hemorrhage (TCCH).
    Methods A total of 150 patients with TCCH were collected as study objects, and were divided into death group (65 cases) and survival group (85 cases) according to outcome of 2-week prognosis. The differences of GCS score, FOUR score and Helsinki CT score were compared between the two groups. The correlations of FOUR score and Helsinki CT score with the GCS score were analyzed by Pearson correlation analysis. Multivariate Logistic regression analysis was used to investigate the correlations of FOUR score, Helsinki CT score and GCS score with prognosis.
    Results The levels of D-dimer, prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio(INR) and platelet (PLT) count in the death group showed no significant difference compared with the survival group (P>0.05). The scores of FOUR and Helsinki CT score in the death group were higher, and the score of GCS was lower than that in the survival group (P < 0.05). The FOUR score and Helsinki CT score were negatively correlated with GCS scores (P < 0.05). FOUR score and Helsinki CT score were the risk factors to the prognosis of patients with TCCH (OR=2.913, P=0.036; OR=2.831, P=0.041), and GCS score was the protective factor to the prognosis of patients with TCCH (OR=0.756, P=0.029). The sensitivity, specificity and area under curve (AUC) in predicting death by GCS score, FOUR score and CT Score Scale score had no significant differences (P>0.05). The sensitivity, specificity and AUC of three scale scores in combination were 86.8%, 94.5% and 0.892(95%CI, 0.863 to 0.946; P < 0.05).
    Conclusion The combination of GCS, FOUR and CT Score Scale scores can effectively evaluate the short-term prognosis of patients with TCCH.

     

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