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Abstract
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OBJECTIVE: To investigate the prognostic factors of severe traumatic brain injury (sTBI) and the predictive value of serum translocator protein (TSPO) combined with the reverse shock index multiplied by Glasgow coma scale score (rSIG).
METHODS: A total of 104 patients with sTBI treated in the Third Affiliated Hospital of Soochow University from June 2017 to June 2019 were enrolled and divided into two groups according to their 90-day prognosis evaluated by Glasgow prognosis score (GOS): 61 cases in good prognosis group, including 42 males and 19 females, the average age was (52.6±4.1) years; 43 cases in poor prognosis group, including 32 males and 11 females, the average age was (53.2±4.4) years. The clinical data, rSIG and serum TSPO levels were compared between the two groups. The prognostic factors were analyzed by the univariate analysis and logistic regression model, and the predictive value of rSIG combined with serum TSPO was evaluated by the receiver operating characteristic curve (ROC).
RESULTS: The time from injury to recovery, dilated pupils on admission, blood glucose level, serum TSPO level, CT midline shift ≥5 mm, cerebral herniation and postoperative complications were independent risk factors associated with the prognosis of sTBI patients, while the rSIG was protective factor associated with the prognosis of sTBI patients (all P<0.05). The average value of rSIG in the good prognosis group was significantly higher than that in the poor prognosis group (11.6±3.2 vs 6.6±2.0, t=9.021, P<0.05). The average serum level of TSPO in the good prognosis group was lower than that in the poor prognosis group ((1.3±0.3) vs (3.1±1.1) μg/L, t=12.350, P<0.05). The area under the curve (AUC) of the combination of rSIG value and TSPO level for predicting the poor prognosis of sTBI patients was 0.920 (95%CI: 0.808-0.978), which was significantly higher than that of rSIG or TSPO alone (both P<0.05). The overall sensitivity and the specificity of the combination were 80.0% and 92.0%, respectively. The rSIG value and serum TSPO level was significantly negatively correlated in sTBI patients (r=-0.439, P<0.05).
CONCLUSIONS: sTBI patients who show a low rSIG value and high expression of serum TSPO tend to have bad prognosis. The combined application of rSIG and serum TSPO can effectively predict the poor prognosis in sTBI patients.
Language: zh |