Effects of hemoglobin level and blood pressure variability on prognosis of patients with traumatic brain injury_West China Medical Journal

Authors：

YE Jingwei , SHEN Niaosong , NI Haibo , SUN Jian ,  ZHANG Li

Department of Neurosurgery, the Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, Jiangsu 215600, P. R. China;

Corresponding author：

ZHANG Li, Email: zhangli_syy@163.com

Keywords：

Traumatic brain injury; hemoglobin; blood pressure variability; quality of prognosis

DOI：

10.7507/1002-0179.202206066

Video：

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Objective To analyze the influencing factors of prognosis of patients with traumatic brain injury (TBI), and explore the influence of hemoglobin (Hb) level combined with blood pressure variability (BPV) on the quality of prognosis of patients with TBI. Methods The data of 186 TBI patients who received systemic treatment in the Affiliated Zhangjiagang Hospital of Soochow University between January 2020 and December 2021 were retrospectively analyzed. According to the Glasgow Outcome Scale (GOS) 3 months after treatment, they were divided into group A (GOS 4-5, 159 cases) and group B (GOS 1-3, 27 cases). The general clinical data, BPV indexes and Hb levels of the two groups were analyzed by single factor analysis and multiple logistic regression analysis, and the predictive value of the logistic regression model was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and area under the curve (AUC). Results There was no statistical significance in gender, age, body mass index, blood urea nitrogen, prothrombin time, fasting blood glucose level, or smoking history (P>0.05); the patients’ Glasgow Coma Scale at admission in group A was higher than that in group B (P<0.05), and the constituent ratio with a history of hypertension of group A was significantly lower than that of group B (P<0.05). The between-group differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and Hb at admission, and SBP, DBP, and MAP 72 h after treatment were not statistically significant (P>0.05); the SBP-standard deviation (SD), DBP-SD, SPB-coefficient of variation (CV) and DBP-CV of group B 72 h after treatment were significantly higher than those of group A (P<0.05), and the level of Hb was significantly lower than that of group A (P<0.05). Hb [odds ratio (OR)=0.787, 95% confidence interval (CI) (0.633, 0.978), P=0.031], SBP-CV [OR=1.756, 95%CI (1.073, 2.880), P=0.023] and DBP-CV [OR=1.717, 95%CI (1.107, 2.665), P=0.016] were all independent prognostic factors of TBI patients. The ROC showed that the combined index of BPV and Hb was more valuable than that of single prediction, with an AUC of 0.896 [95%CI (0.825, 0.935), P<0.05]. Conclusions Both BPV and Hb are independent factors affecting the prognosis of TBI patients, and their combined application can more effectively predict the prognosis of TBI patients. Therefore, when treating and evaluating the prognosis of TBI patients, closely monitoring the changes in blood pressure and Hb levels can timely and effectively control the development of the disease, and provide scientific reference for subsequent treatment.

Citation： YE Jingwei, SHEN Niaosong, NI Haibo, SUN Jian, ZHANG Li. Effects of hemoglobin level and blood pressure variability on prognosis of patients with traumatic brain injury. West China Medical Journal, 2022, 37(12): 1788-1792. doi: 10.7507/1002-0179.202206066 Copy

1.	顾宇丹, 费雅雅, 秦殊, 等. 刺激性干预在老年创伤性颅脑损伤昏迷患者中的应用. 中华护理杂志, 2020, 55(2): 228-231.
2.	马仁政, 曹守明, 闫昕. 黄体酮对大鼠外伤性脑损伤后脑水肿及周围组织细胞凋亡和神经功能的影响. 临床和实验医学杂志, 2020, 19(6): 582-586.
3.	谢晨阳, 陈秀侠. 重型颅脑损伤术中血压变异性对预后的影响. 安徽医药, 2020, 24(1): 33-38.
4.	Tran C, Frederick H, Baqai H, et al. Traumatic brain injury and intraparenchymal hemorrhage progression: blood pressure variability matters. Am J Emerg Med, 2022, 52: 119-127.
5.	李彬, 熊鹏举, 艾嗣锦, 等. 血红蛋白水平对大鼠颅脑损伤后神经细胞凋亡的影响. 南昌大学学报(医学版), 2015, 55(5): 32-34.
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8.	陆黎春, 郁明惠, 李伟生, 等. 不同部位高血压脑出血术式和时机选择及其对患者术后 GOS 和 ADL 分级的影响. 中国老年学杂志, 2018, 38(8): 1874-1877.
9.	汪润华, 周炳华. 格拉斯哥昏迷评分与颅脑创伤患者手术预后及麻醉承受力的关系. 中华麻醉学杂志, 1994, 14(5): 358-359.
10.	杨彩侠. 重型颅脑损伤患者去骨瓣减压术后高压氧治疗效果及影响因素分析. 中华航海医学与高气压医学杂志, 2021, 28(6): 718-722.
11.	Downing M, Hicks A, Braaf S, et al. Factors facilitating recovery following severe traumatic brain injury: a qualitative study. Neuropsychol Rehabil, 2021, 31(6): 889-913.
12.	Stocchetti N, Colombo A, Ortolano F, et al. Time course of intracranial hypertension after traumatic brain injury. J Neurotrauma, 2007, 24(8): 1339-1346.
13.	王津津, 陈春峰, 尹志君, 等. 重型颅脑损伤患者开颅血肿清除术后迟发性颅内血肿的影响因素研究. 实用心脑肺血管病杂志, 2018, 26(9): 25-28.
14.	李科, 刘剑雄, 朱燕, 等. 原发高血压患者血压变异性与 syntax 评分评价冠脉病变严重程度的相关性. 四川医学, 2018, 39(5): 501-505.
15.	焦坤, 冯玉宝, 苏平. 血压变异性与心血管疾病的研究进展. 中国循环杂志, 2016, 31(5): 518-520.
16.	武爱萍, 马一涵, 李兴雨, 等. 长时血压变异性对动脉硬化的影响研究. 中国全科医学, 2021, 24(2): 148-153.
17.	de la Sierra A. Blood pressure variability - research or clinical applicability?. Hipertens Riesgo Vasc, 2021, 38(3): 105-108.
18.	周晓芬, 于荣国, 龚书榕, 等. 颅脑外伤患者急性期血压变异性与近期预后的关系. 创伤与急诊电子杂志, 2014, 2(2): 1-13, 23.
19.	Svedung Wettervik T, Howells T, Lewén A, et al. Blood pressure variability and optimal cerebral perfusion pressure-new therapeutic targets in traumatic brain injury. Neurosurgery, 2020, 86(3): E300-E309.
20.	朱志刚, 王大武, 胡欣虹, 等. 重型、特重型颅脑外伤性脑梗死相关危险因素分析. 中国保健营养, 2013, 23(1): 49.
21.	Morris RS, Figueroa JF, Pokrzywa CJ, et al. Predicting outcomes after traumatic brain injury: a novel hospital prediction model for a patient reported outcome. Am J Surg, 2022, 224(4): 1150-1155.
22.	Carlson AP, Schermer CR, Lu SW. Retrospective evaluation of anemia and transfusion in traumatic brain injury. J Trauma, 2006, 61(3): 567-571.
23.	张丰, 倪海滨, 吕汪洄, 等. 血红蛋白在评估创伤性脑损伤患者预后中的临床意义. 浙江医学, 2021, 43(5): 534-536.
24.	沈印, 葛剑, 李喆, 等. 人重组促红细胞生成素对大鼠创伤性颅脑损伤后神经细胞凋亡的影响及机制研究. 创伤外科杂志, 2020, 22(8): 592-595.
25.	冯华, 陈渝杰, 黄苏娜. 生物标志物在创伤性颅脑损伤救治中的应用现状及展望. 中华神经医学杂志, 2022, 21(1): 2-5.

1. 顾宇丹, 费雅雅, 秦殊, 等. 刺激性干预在老年创伤性颅脑损伤昏迷患者中的应用. 中华护理杂志, 2020, 55(2): 228-231.
2. 马仁政, 曹守明, 闫昕. 黄体酮对大鼠外伤性脑损伤后脑水肿及周围组织细胞凋亡和神经功能的影响. 临床和实验医学杂志, 2020, 19(6): 582-586.
3. 谢晨阳, 陈秀侠. 重型颅脑损伤术中血压变异性对预后的影响. 安徽医药, 2020, 24(1): 33-38.
4. Tran C, Frederick H, Baqai H, et al. Traumatic brain injury and intraparenchymal hemorrhage progression: blood pressure variability matters. Am J Emerg Med, 2022, 52: 119-127.
5. 李彬, 熊鹏举, 艾嗣锦, 等. 血红蛋白水平对大鼠颅脑损伤后神经细胞凋亡的影响. 南昌大学学报(医学版), 2015, 55(5): 32-34.
6. Luo HC, Fu YQ, You CY, et al. Comparison of admission serum albumin and hemoglobin as predictors of outcome in children with moderate to severe traumatic brain injury: a retrospective study. Medicine (Baltimore), 2019, 98(44): e17806.
7. 叶继业, 刘绍明. 创伤性颅脑损伤标志物的研究进展. 医学综述, 2012, 18(20): 3350-3352.
8. 陆黎春, 郁明惠, 李伟生, 等. 不同部位高血压脑出血术式和时机选择及其对患者术后 GOS 和 ADL 分级的影响. 中国老年学杂志, 2018, 38(8): 1874-1877.
9. 汪润华, 周炳华. 格拉斯哥昏迷评分与颅脑创伤患者手术预后及麻醉承受力的关系. 中华麻醉学杂志, 1994, 14(5): 358-359.
10. 杨彩侠. 重型颅脑损伤患者去骨瓣减压术后高压氧治疗效果及影响因素分析. 中华航海医学与高气压医学杂志, 2021, 28(6): 718-722.
11. Downing M, Hicks A, Braaf S, et al. Factors facilitating recovery following severe traumatic brain injury: a qualitative study. Neuropsychol Rehabil, 2021, 31(6): 889-913.
12. Stocchetti N, Colombo A, Ortolano F, et al. Time course of intracranial hypertension after traumatic brain injury. J Neurotrauma, 2007, 24(8): 1339-1346.
13. 王津津, 陈春峰, 尹志君, 等. 重型颅脑损伤患者开颅血肿清除术后迟发性颅内血肿的影响因素研究. 实用心脑肺血管病杂志, 2018, 26(9): 25-28.
14. 李科, 刘剑雄, 朱燕, 等. 原发高血压患者血压变异性与 syntax 评分评价冠脉病变严重程度的相关性. 四川医学, 2018, 39(5): 501-505.
15. 焦坤, 冯玉宝, 苏平. 血压变异性与心血管疾病的研究进展. 中国循环杂志, 2016, 31(5): 518-520.
16. 武爱萍, 马一涵, 李兴雨, 等. 长时血压变异性对动脉硬化的影响研究. 中国全科医学, 2021, 24(2): 148-153.
17. de la Sierra A. Blood pressure variability - research or clinical applicability?. Hipertens Riesgo Vasc, 2021, 38(3): 105-108.
18. 周晓芬, 于荣国, 龚书榕, 等. 颅脑外伤患者急性期血压变异性与近期预后的关系. 创伤与急诊电子杂志, 2014, 2(2): 1-13, 23.
19. Svedung Wettervik T, Howells T, Lewén A, et al. Blood pressure variability and optimal cerebral perfusion pressure-new therapeutic targets in traumatic brain injury. Neurosurgery, 2020, 86(3): E300-E309.
20. 朱志刚, 王大武, 胡欣虹, 等. 重型、特重型颅脑外伤性脑梗死相关危险因素分析. 中国保健营养, 2013, 23(1): 49.
21. Morris RS, Figueroa JF, Pokrzywa CJ, et al. Predicting outcomes after traumatic brain injury: a novel hospital prediction model for a patient reported outcome. Am J Surg, 2022, 224(4): 1150-1155.
22. Carlson AP, Schermer CR, Lu SW. Retrospective evaluation of anemia and transfusion in traumatic brain injury. J Trauma, 2006, 61(3): 567-571.
23. 张丰, 倪海滨, 吕汪洄, 等. 血红蛋白在评估创伤性脑损伤患者预后中的临床意义. 浙江医学, 2021, 43(5): 534-536.
24. 沈印, 葛剑, 李喆, 等. 人重组促红细胞生成素对大鼠创伤性颅脑损伤后神经细胞凋亡的影响及机制研究. 创伤外科杂志, 2020, 22(8): 592-595.
25. 冯华, 陈渝杰, 黄苏娜. 生物标志物在创伤性颅脑损伤救治中的应用现状及展望. 中华神经医学杂志, 2022, 21(1): 2-5.

West China Medical Journal

Effects of hemoglobin level and blood pressure variability on prognosis of patients with traumatic brain injury

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