| Objective: Traumatic brain injury(TBI)refers to damage that occurs when the brain is subjected to external force.As one of the common diseases of neurosurgery,its high death and disability rate has caused serious economic burden to individuals and society.Appropriate predictive indicators can guide the clinical treatment of traumatic brain injury,so as to reduce unnecessary expenditure in the course of clinical treatment.Bilirubin,as one of the metabolites of red blood cells,can directly damage deoxyribonucleic acid and cause neuronal damage and apoptosis in high concentration.Bilirubin mainly binds with serum albumin and is transported to liver for postmetabolism.By detecting the levels of total bilirubin,direct bilirubin,indirect bilirubin,albumin and total bilirubin/albumin ratio(TBAR)of TBI patients in the acute stage,we explored the value of total bilirubin/albumin ratio for the clinical prognosis of TBI patients,so as to provide guidance for clinical work.Methods: We retrospectively collected partial clinical data of patients who met the inclusion and exclusion criteria admitted to the Department of Neurosurgery,Affiliated Hospital of Southwest Medical University from September 2018 to September 2021.They included the patient’s basic information,previous history,personal history,type of diagnosis during hospitalization and site of injury,as well as whether surgical treatment had been performed at admission,complications,laboratory results of bound bilirubin,unbound bilirubin,total bilirubin,albumin levels,alanine aminotransferase,and aspartate aminotransferase within 24 hours of onset.According to the total bilirubin/albumin ratio of patients in the low-ratio group and the high-ratio group.The primary outcome was the Glasgow outcome score(GOS)at 6months after discharge,with a poor outcome defined as a GOS score of 1-3 and a good outcome defined as a GOS score of 4-5.Binary logistic regression model was used to determine the correlation between total bilirubin/albumin ratio and clinical prognosis of patients,and to explore the value of TBAR for clinical prognosis of patients with TBI.Results: From September 2018 to September 2021,a total of 1361 patients with a primary diagnosis of traumatic brain injury were admitted,including 324 patients who met all the inclusion and exclusion criteria,and 271 patients with less than 24 hours of onset time to admission.There were 225 cases in the low-ratio group(TBAR<0.31)and 46 cases in the high-ratio group(TBAR=0.31 and TBAR>0.31).The results showed that 26 patients in the low-ratio group had GOS score less than 4 at 6 months after discharge,accounting for 11.6%,and 25 patients died at 6 months after discharge,accounting for 11.1%.In the high ratio group,12 patients with GOS score less than 4 points 6 months after discharge,accounting for 26.1%,and 12 patients died 6 months after discharge,accounting for 26.1%.Both at discharge and 6months after discharge,the low-ratio group had better prognosis and lower mortality,and the difference in data outcomes between the two groups was statistically significant.The receiver operating characteristic curve(ROC curve)was analyzed to predict adverse outcomes.The results showed that the area under the curve of GCS score was 0.879,and the 95% confidence interval was0.825--0.932.The total bilirubin/albumin ratio had an area under the curve of0.614 and a 95% confidence interval of 0.516-0.711,both of which were associated with poor prognosis.When TBAR was greater than or equal to 0.31,the sensitivity and specificity of TBAR for poor prognosis at 6 months were37.5% and 85.4%.Conclusion: For patients with TBAR more than 0.31,the clinical prognosis is worse and the mortality is higher.Especially for patients with severe TBI,TBAR is more sensitive to the prediction of adverse prognosis outcome,and can be used as a prognostic indicator to assist GCS score to predict the prognosis of patients with TBI. |
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