Serum cystatin C is correlated with mortality of traumatic brain injury patients partially mediated by acute kidney injury.
Serum cystatin C is correlated with mortality of traumatic brain injury patients partially mediated by acute kidney injury.
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DOI：
10.1007/s13760-023-02282-2
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发表时间：
2023-12
影响因子：
2.7
通讯作者：
Xu, Jianguo
中科院分区：
文献类型：
--
作者：
Wang, Ruoran;Chen, Hongxu;He, Min;Xu, Jianguo
早期评估创伤性脑损伤（TBI）预后不良的风险是制定治疗策略和决定是否需要重症监护的必要条件。本研究旨在验证血清胱抑素C在TBI患者中的预后价值。纳入华西医院收治的415例TBI患者。采用Logistic回归分析探讨影响死亡率的危险因素，并验证胱抑素C与死亡率的相关性。进行中介分析以测试急性肾损伤（阿基）和脑损伤严重程度是否介导胱抑素C水平与死亡率之间的关系。使用受试者工作特征曲线下面积（AUC）评估胱抑素C和结合胱抑素C构建的模型的预后价值。415例TBI患者的死亡率为48.9%。与幸存者相比，非幸存者的GCS较低（5 vs 8，p < 0.001），半胱氨酸蛋白酶抑制剂C较高（0.92 vs 0.71，p < 0.001）。校正混杂因素后，多因素Logistic回归分析显示GCS（p < 0.001）、血糖（p < 0.001）、白蛋白（p = 0.009）、胱抑素C（p < 0.001）和硬膜下血肿（p = 0.042）是死亡的独立危险因素。中介效应分析显示阿基和脑损伤严重程度对Cystatin C与TBI患者死亡率的关系具有中介效应。GCS与Cystatin C联用的AUC为0.862，明显高于单独使用GCS的AUC（Z = 1.7354，p < 0.05）。阿基和脑损伤严重程度是影响胱抑素C与TBI患者死亡率关系的中介变量。血清胱抑素C是TBI患者有效的预后指标。
Evaluating risk of poor outcome for Traumatic Brain Injury (TBI) in early stage is necessary to make treatment strategies and decide the need for intensive care. This study is designed to verify the prognostic value of serum cystatin C in TBI patients. 415 TBI patients admitted to West China hospital were included. Logistic regression was performed to explore risk factors of mortality and testify the correlation between cystatin C and mortality. Mediation analysis was conducted to test whether Acute Kidney Injury (AKI) and brain injury severity mediate the relationship between cystatin C level and mortality. Area under the receiver operating characteristic curve (AUC) was used to evaluate the prognostic value of cystatin C and the constructed model incorporating cystatin C. The mortality rate of 415 TBI patients was 48.9%. Non-survivors had lower GCS (5 vs 8, p < 0.001) and higher cystatin C (0.92 vs 0.71, p < 0.001) than survivors. After adjusting confounding effects, multivariate logistic regression indicated GCS (p < 0.001), glucose (p < 0.001), albumin (p = 0.009), cystatin C (p < 0.001) and subdural hematoma (p = 0.042) were independent risk factors of mortality. Mediation analysis showed both AKI and brain injury severity exerted mediating effects on relationship between cystatin C and mortality of included TBI patients. The AUC of combining GCS with cystatin C was 0.862, which was higher than that of GCS alone (Z = 1.7354, p < 0.05). Both AKI and brain injury severity are mediating variables influencing the relationship between cystatin C and mortality of TBI patients. Serum cystatin C is an effective prognostic marker for TBI patients.
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