| BackgroundNeurological disorders are an important cause of disability and death worldwide.Neurological disorders were the main cause of diseases in the past 25 years.Neurological disorders were the second-leading cause group of deaths.Patients admitted into the neuro-intensive care unit(NICU)are in critical conditions,with high levels of disability and mortality.Inflammatory response and immune disorders play important roles in the pathogenesis of nervous system diseases.C-reactive protein(CRP)is a representative inflammatory response index.Albumin can maintain colloid pressure and transport free fatty acids,bilirubin,and drug metabolites.Recently,a novel prognostic index,namely,the CRP/ALB ratio(CAR)in combination with systemic inflammation and nutritional status,has been reported as an independent prognostic marker in cancer,severe sepsis or septic shock,and hepatitis B virus related decompensated cirrhosis and so on.In these studies,CAR showed significant significance.So far,no studies have been reported on the neuro-functional prognosis of CAR for neurocritical patients.ObjectionIn this study,by observing the changes of CAR in patients with neurocritical diseases,the evaluation value of CAR on the prognosis of 30-day neurological functional outcome was discussed.MethodsPatients who were admitted to the neurological intensive care unit of Nanfang Hospital of southern medical university from January 2013 to December 2016 were enrolled in this retrospective study.The inclusion criteria were as follows:(1)age older than 18 years;(2)The patients admitted into NICU due to primary central nervous system or peripheral nervous system disease;(3)Longer than 3 days hospitalization time of NICU.Finally,603 patients were included in the study.CRP and ALB in the serum were measured respectively after the patients admitted into NICU at 24 hours and 72 hours.CAR was calculated using the same test CRP value divided by ALB.The patients were divided into two groups according to the mRS score at 30-day.The mRS was dichotomized into values for unfavorable neuro-functional outcome(mRS 4～6)and favorable neuro-functional outcome(mRS 0～3).According to the diagnostic criteria of international sepsis in 2012,all patients were divided into three subgroups:no infection group,sepsis group,severe sepsis or septic shock,regardless of infection site and source of infection.Compare the 24 hours and 72 hours of CRP,ALB and CAR of the patients with different mRS score in 30 days.Analyze the influence.factors of mRS score at 30-day.The binary logistic regression model was used to determine whether each variable was an independent prognostic factor of outcome,and the results were presented as odds ratios with 95%confidence intervals(CIs).The evaluation value of 30-day neuro-functional prognosis was analyzed and compared with the receiver operating characteristic curve.Results1.There were significant differences in age,hospitalization time of NICU and GCS score between the two groups with different neuro-functional outcome at 30-day.There were no significant differences in the remaining baseline datas.2.The two groups with different neuro-functional outcomes at 30-day had the same diagnosis of the eight main diseases.3.Results of CRP,ALB and CAR(1)Comparisons of CRP,ALB and CAR between the two groups with different neuro-functional outcome at 30-day(mRS 0～vs 4～6)The CRP and CAR at 24-hour and 72-hour in the group of mRS 4-6 score were higher than that in the group of mRS score 0～3,but the ALB at 24-hour and 72-hour in the group of mRS 4-6 score were lower than that in the group of mRS score 0-3.There were significant differences in CRP,ALB and CAR at 24-hour and 72-hour between the two groups with different neuro-functional outcome at 30-day.(2)Comparisons of CRP,ALB and CAR between groups with different degrees of disability(mRS 0-3,4-5)and group of death(mRS 6)at 30-dayThe 24-hour and 72-hour of CRP and CAR in the group of mRS 6 was the highest,followed by the group of mRS 4～5,and the lowest in the group of mRS 0～3.The 24-hour and 72-hour of ALB in the group of mRS 6 was the lowest,followed by the group of mRS 4-5,and the highest in the group of mRS 0-3.There were multiple significant differences of CAR at 24-hour and 72-hour between three groups with different mRS.There were significant differences in CRP,ALB and CAR at 24-hour and 72-hour between the three groups with different mRS value.(3)Comparisons of CRP,ALB and CAR in patients with different infection status between the two groups with different neuro-functional outcome at 30-day(mRS 0-3 vs mRS 4～6)In the subgroup that did not have concurrent infection,significant differences of CRP,ALB,CAR at 24-hour and the 72-hour could not be found between two groups with different neuro-functional outcome at 30-day.In the subgroup with co-infected sepsis,significant differences of CRP,ALB,C-AR at 24-hour and 72-hour could not be found between two groups with different neuro-functional outcome at 30-day.In the subgroup co-infected with severe sepsis or septic shock,significant differences of CRP,CAR at 24-hour and the 72-hour could be found between two groups with different neuro-fnctional outcome at 30-day.Significant differences of ALB at 24-hour could be found,but significant differences of ALB at 72-hour could not be found between two groups with different neuro-functional outcome at 30-day.4.The influence factors of neuro-functional outcome at 30-day in neurocritical patients(1)There were significant correlations between CRP,ALB,CAR at 24-hour and 72-hour,age,hospitalization time of NICU,GCS score with 30-day neuro-functional outcome.(2)Correlation analysis between age,hospitalization time of NICU,GCS score,CRP,ALB,CAR and mRS score at 30-day in patients with different infection statusIn the subgroup that did not have concurrent infection,correlation was found respectively between CRP,ALB,CAR at the 24-hour and 72-hour,GCS score,age with 30-day neuro-functional outcome.In the subgroup co-infected with sepsis,correlation was found between age,GCS score with 30-day neuro-functional outcome.In the subgroup co-infected with severe sepsis or septic shock,correlation was found respectively between CRP,ALB,CAR at the 24-hour and 72-hour,GCS score,age with 30-day neuro-functional outcome.5.Independent risk factors for unfavorable neuro-functional outcome in neurocritical patients(1)Age,GCS score,CAR at 24-hour(OR 1.206,95%CI 1.074-1.355)were the independent risk factors for the 30-day unfavorable neurological function outcome in all enrolled patients.(2)Independent risk factors for unfavorable neuro-functional outcome in neurocritical patients with different infection status GCS score was the independent risk factor for the 30-day unfavorable neurological function outcome in the subgroup that did not have concurrent infection.Age and GCS score were the independent risk factors for the 30-day unfavorable neurological function outcome in the subgroup co-infected with sepsis.Age,GCS score,CAR at 24-hour(OR 1.196,95%CI 1.008-1.420,P<0.05)were the independent risk factors for the 30-day unfavorable neuro-functional outcome in the subgroup co-infected with severe sepsis or septic shock.Conclusions1.As the duration of the disease prolonged CRP and CAR showed an upward trend,but ALB showed a downward trend.2.There were significant differences in CRP,ALB and CAR at 24-hour and 72-hour between the patients with 30-day different neurological outcomes.There was a significant correlation between CRP,ALB and CAR at 24-hour and 72-hour with 30-day neurological outcome.3.CAR at 24-hour(OR 1.206,95%CI 1.074-1.355,P<0.001)could be used to predict the 30-day neuro-functional outcome in all neurocritical patients enrolled in this study.4.The predictive value of CAR in patients with different infection status In the subgroups that did not have concurrent infection or co-infected with sepsis,both 24-hour and 72-hour of CAR have no predictive value.In the subgroup co-infected with severe sepsis or septic shock,CAR at 24-hour(OR 1.196,95%CI 1.008-1.420,P<0.001)could be used to predict the 30-day neuro-functional outcome in neurocritical patients.5.The combination of various clinical indicators can improve the accuracy of prognosis.The prediction model combined with age,GCS score,CAR at 24-hour had the best evaluation ability of the 30-day neurological outcome,and showed the best AUC(0.799),diagnostic odds ratio(8.87)and accuracy(78.3%)to predict the 30-day neuro-functional outcome in all neurocritical patients enrolled in this study.Similar manifestation was observed in the subgroup co-infected with severe sepsis or septic shock. |
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