背景:纤维蛋白(原)降解产物(FDP)和钾与动脉瘤性蛛网膜下腔出血(aSAH)患者功能预后的关系仍不确定。本研究旨在评估一种新型组合生物标志物的预测价值,FDP与钾之比(FPR),aSAH患者的不良功能结局。
方法:本研究回顾性地纳入了单中心的425例aSAH患者。不良结局定义为出院后3个月的改良Rankin量表(mRS)评分为3-6分。对入院时记录的基线信息和实验室参数进行单变量分析和多变量逻辑回归。此外,绘制了接收器工作特性曲线,基于FPR进行倾向评分匹配。
结果:根据mRS等级,301例患者被归类为具有良好的结果,124例患者被评估为不良结局.FPR水平与mRS分级显著相关(r[Spearman]=0.410;P<0.001)。多因素logistic回归分析显示年龄(比值比[OR]1.043,95%置信区间[CI]1.016~1.071;P=0.002),白细胞计数(OR1.150,95%CI1.044-1.267;P=0.005),钾(OR0.526,95%CI0.291-0.949;P=0.033),世界神经外科学会联合会等级(OR1.276,95%CI1.055-1.544;P=0.012),入院时的FPR(OR1.219,95%CI1.102-1.349;P<0.001)与不良功能结局独立相关。DeLong检验表明,FPR的受试者工作特征曲线下面积高于年龄,白细胞计数,钾,世界神经外科学会联合会年级,或FDP单独,表明FPR比其他变量具有更好的预测潜力。1:1倾向评分匹配后(FPR≥1.45vs.FPR<1.45),高FPR组的不良预后率仍然显着增加(48/121[39.7%]vs.16/121[13.2%],P<0.001)。
结论:纤维蛋白(原)降解产物与钾的比值是aSAH患者预后不良的独立预测因子,可能是临床医生评估患者功能预后的一个有前景的工具。
BACKGROUND: The relationship of fibrin(ogen) degradation products (FDPs) and potassium with the functional outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) is still uncertain. This study aims to evaluate the predictive value of a novel combination biomarker, the FDP-to-potassium ratio (FPR), for poor functional outcomes in patients with aSAH.
METHODS: A total of 425 consecutive patients with aSAH at a single center were retrospectively enrolled in our study. An unfavorable outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 3 months after discharge. Univariate analysis and multivariable logistic regression were performed for baseline information and laboratory parameters recorded at admission. In addition, the receiver operating characteristic curve was plotted, and propensity score matching was performed based on the FPR.
RESULTS: On the basis of mRS grade, 301 patients were classified as having favorable outcomes, and 124 patients were assessed as having unfavorable outcomes. FPR levels were significantly correlated with mRS grade (r[Spearman] = 0.410; P < 0.001). Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.016-1.071; P = 0.002), white blood cell count (OR 1.150, 95% CI 1.044-1.267; P = 0.005), potassium (OR 0.526, 95% CI 0.291-0.949; P = 0.033), World Federation of Neurosurgical Societies grade (OR 1.276, 95% CI 1.055-1.544; P = 0.012), and FPR (OR 1.219, 95% CI 1.102-1.349; P < 0.001) at admission were independently associated with poor functional outcomes. The DeLong test showed that the area under the receiver operating characteristic curve of FPR was higher than that of age, white blood cell count, potassium, World Federation of Neurosurgical Societies grade, or FDP alone, indicating that FPR had better predictive potential than these other variables. After 1:1 propensity score matching (FPR ≥ 1.45 vs. FPR < 1.45), the rate of poor prognosis was still significantly increased in the high-FPR group (48/121 [39.7%] vs. 16/121 [13.2%], P < 0.001).
CONCLUSIONS: Fibrin(ogen) degradation product-to-potassium ratio is an independent predictor of poor outcomes for patients with aSAH and may be a promising tool for clinicians to evaluate patients\' functional prognosis.