基于预后营养指数联合NIHSS评分对老年重型颅脑损伤患者预后分层

Prognostic stratification of elderly patients with severe craniocerebral injury based on prognostic nutritional index and NIHSS score

摘要:

目的 在PNI、NIHSS评分以及其他临床因子中筛选老年重型颅脑损伤患者预后因子，对老年患者的预后进行分层评估。方法 回顾性分析2019年3月—2024年3月在海安市人民医院神经外科住院的老年重型颅脑损伤患者的临床资料。采用多因素Cox回归分析筛选预后影响因素。结果 多因素Cox分析表明，NIHSS是老年重型颅脑损伤患者预后不良的危险因素（HR>1, P<0.05）。PNI是老年重型颅脑损伤患者预后良好的保护因素（HR<1, P<0.05）。高NHISS评分的患者预后较低NHISS的患者预后差（P<0.05）。高PNI患者预后较低PNI的患者预后好（P<0.05）。低NHISS评分且高PNI的患者预后最好，高NHISS评分且低PNI的患者预后最差。结论 NIHSS评分和PNI是老年重型颅脑损伤患者预后不良的危险因素和预后良好的保护因素。NHISS评分和PNI可以联合用于指导老年重型颅脑损伤患者预后风险分层，有助于识别预后差的患者，并在损伤早期阶段提供个性化治疗。

Abstract:

Objective To identify the prognostic factors for elderly patients with severe craniocerebral injury among prognostic nutritional index （PNI）， NIHSS score， and other clinical factors， and to perform a stratified assessment of the prognosis of elderly patients.Methods A retrospective analysis was performed for the clinical data of elderly patients with severe craniocerebral injury who were admitted to Department of Neurosurgery， Hai’an People’s Hospital， from March 2019 to March 2024. A multivariate Cox regression analysis was used to identify the influencing factors for prognosis.Results The multivariate Cox regression analysis showed that NIHSS was a risk factor for poor prognosis in elderly patients with severe craniocerebral injury （HR >1， P <0.05）， while PNI was a protective factor for good prognosis in elderly patients with severe craniocerebral injury （HR <1， P <0.05）. The patients with a high NHISS score had a worse prognosis than those with a low NHISS score （P <0.05）， and the patients with a high PNI had a better prognosis than those with a low PNI （P <0.05）. The patients with a low NHISS score and a high PNI tended to have the best prognosis， while the patients with a high NHISS score and a low PNI tended to have the worst prognosis.Conclusions NIHSS score and PNI are risk factors for poor prognosis and protective factors for good prognosis in elderly patients with severe craniocerebral injury. The combination of NHISS score and PNI can be used to guide prognostic risk stratification in elderly patients with severe craniocerebral injury， help identify the patients with poor prognosis， and provide individualized treatment in the early stage of injury.