血清Del-1联合NISS评分对创伤患者近期预后的预测价值分析

Predictive value of serum Del-1 combined with NISS score for short-term prognosis in trauma patients

摘要:

目的 探讨血清内皮发育调节基因-1（Del-1）联合新损伤严重程度评分（NISS）对创伤患者近期预后的预测价值。方法 选取2021年6月—2024年5月青岛市市立医院收治的204例创伤患者为研究对象，根据随访28 d的预后情况分为存活组183例和死亡组21例。比较两组患者的临床资料、血清Del-1水平及NISS评分；绘制受试者工作特性（ROC）曲线评估血清Del-1、NISS评分对创伤患者近期预后的预测价值；采用多因素Logistic逐步回归模型分析创伤患者近期预后的影响因素。结果 死亡组年龄≥60岁占比、受伤至入院时间、呼吸机辅助通气率、创伤严重程度均高于存活组，收缩压、舒张压、平均动脉压、GCS评分、NE水平和D-二聚体水平均高于存活组（P <0.05）。死亡组血清Del-1水平低于存活组，NISS评分高于存活组（P <0.05）。血清Del-1、NISS评分及二者联合预测创伤患者近期预后的曲线下面积分别为0.859、0.746和0.906，特异性分别为63.71%、58.15%和85.02%，敏感性分别为93.41%、93.41%和87.11%。多因素Logistic逐步回归分析显示，受伤至入院时间长［O^R =1.958（95% CI：1.414，2.711）］、有呼吸机辅助通气［O^R =2.106（95% CI：1.474，3.009）］、GCS评分高［O^R =2.502（95% CI：1.651，3.791）］、创伤严重程度重［O^R =2.385（95% CI：1.589，3.578）］、Del-1水平降低［O^R =0.299（95% CI：0.184，0.484）］、NISS评分高［O^R =2.866（95% CI：1.848，4.446）］是创伤患者死亡的独立危险因素（P <0.05）。结论 血清Del-1、NISS评分可作为创伤患者近期预后的预测因子，且二者联合预测价值更高。

Abstract:

Objective To explore the predictive value of serum developmental endothelial locus-1 (Del-1) combined with the New Injury Severity Score (NISS) for short-term prognosis in trauma patients.Methods A total of 204 trauma patients admitted to Qingdao Municipal Hospital from June 2021 to May 2024 were enrolled. Based on 28-day follow-up outcomes, patients were divided into a survival group (n =1 83) and a death group (n = 21). Clinical data, serum Del-1 levels, and NISS scores were compared between the two groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of serum Del-1 and NISS scores for short-term prognosis. Multivariate stepwise logistic regression was used to identify independent risk factors for prognosis.Results The death group had a higher proportion of patients aged ≥ 60 years, longer injury-to-admission time, higher rates of ventilator assistance, and greater trauma severity compared to the survival group. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), Glasgow Coma Scale (GCS) scores, neutrophil elastase (NE) levels, and D-dimer levels were significantly higher in the death group (all P < 0.05). Serum Del-1 levels were lower (P < 0.05) and NISS scores were higher (P <0.05) in the death group. The areas under the ROC curve (AUCs) for Del-1, NISS, and their combination were 0.859, 0.746, and 0.906, respectively, with specificities of 63.71%, 58.15%, and 85.02%, and sensitivities of 93.41%, 93.41%, and 87.11%. Multivariate analysis identified independent risk factors for mortality: prolonged injury-to-admission time [O^R = 1.958 (95% CI: 1.414, 2.711) ], ventilator assistance [O^R = 2.106 (95% CI: 1.474, 3.009) ], higher GCS score [O^R = 2.502 (95% CI: 1.651, 3.791) ], severe trauma [O^R = 2.385 (95% CI: 1.589, 3.578) ], reduced Del-1 [O^R = 0.299 (95% CI: 0.184, 0.484) ], and elevated NISS score [O^R = 2.866 (95% CI: 1.848, 4.446) ] (all P < 0.05).Conclusion Serum Del-1 and NISS scores are effective predictors of short-term prognosis in trauma patients, with enhanced predictive power when combined.