Predictive value of age-adjusted BIG score for in-hospital mortality in patients with traumatic brain injury

doi:10.11958/20252826

Abstract

Abstract:

Objective To investigate the predictive value of the age-adjusted BIG score (aaBIG score) in predicting the risk of in-hospital mortality in adult patients with traumatic brain injury (TBI). Methods A retrospective cohort study was conducted, enrolling a total of 209 adult patients diagnosed with TBI. Patients were divided into the survival group and the mortality group based on in-hospital mortality status, and differences in clinical indicators were compared between the two groups. Multivariate Logistic regression analysis was performed to identify risk factors for in-hospital mortality in TBI patients. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of the BIG score and aaBIG score for in-hospital mortality in TBI patients. Results Among the 209 patients, 48 (23%) patients died in hospital. The age, respiratory rate (RR), fasting blood glucose (FBG), international normalised ratio (INR) and BIG score were higher in the mortality group than those of the survival group (P<0.05). The blood oxygen saturation (SpO₂), Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) were lower in the mortality group than those of the survival group (P<0.05). Multivariate Logistic regression analysis revealed that increasing age (OR=1.072, 95%CI: 1.013-1.133, P=0.015), decreased SpO₂ (OR = 0.626, 95%CI: 0.455-0.861, P = 0.004), elevated FBG (OR = 1.593, 95%CI: 1.049-2.419, P = 0.029), increased RR (OR = 1.162, 95%CI: 1.019-1.327, P = 0.025) and a higher BIG score (OR = 1.279, 95%CI: 1.146-1.428, P<0.001) were all significantly associated with the increased risk of in-hospital mortality. Based on this, the aaBIG score was derived as 0.3×age + BIG score. ROC analysis showed that the AUC for the BIG score in predicting in-hospital mortality was 0.775 (95%CI: 0.712-0.830), with an optimal cut-off value of 7.4 points. The AUC for the aaBIG score in predicting in-hospital mortality was 0.810 (95%CI: 0.743-0.876), with an optimal cut-off of 29.6 points. The predictive value of the two scores was similar. Conclusion The aaBIG score has some predictive value for in-hospital mortality in TBI patients, but its performance does not show a significant improvement over the BIG score.

Key words: craniocerebral trauma, hospital mortality, forecasting, age-adjusted BIG score

CLC Number:

R651.15

Figures/Tables 4

References 24

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组别		n	性别（男/女）		年龄/岁	高血压		糖尿病		冠心病		高脂血症		SBP/mmHg		DBP/mmHg		HR/（次/min）			RR/（次/min）		SpO₂/%
生存组		161	99/62		64.8±6.7	53（32.9）		52（32.3）		52（32.3）		42（26.1）		129.0±13.6		78.1±11.7		84.1±10.4			18.4±2.7		97.1±1.3
死亡组		48	27/21		68.1±8.0	17（35.4）		14（29.2）		7（14.6）		12（25.0）		128.3±13.3		77.1±10.7		82.7±9.4			19.7±3.5		96.2±1.4
χ²或t			0.424		2.930^＊＊	0.104		0.168		0.076		0.023		0.317		0.510		0.860			2.637^＊＊		4.529^＊＊
组别	Hb/ （g/L）			WBC/ （×10⁹/L）			PLT/ （×10⁹/L）		FBG/ （mmol/L）		BE/ （mmol/L）		INR		手术治疗		输血		GCS/ 分	BIG评分/ 分		RTS/ 分
生存组	122.9±13.7			7.8±2.1			179.5±44.2		7.6±0.8		0.0（-1.0，2.0）		1.1±0.2		49（30.4）		83（51.6）		11.0（8.0，13.0）	7.0（4.5，9.9）		11.0（9.0，12.0）
死亡组	125.2±14.2			7.5±1.5			182.5±39.4		8.1±0.8		0.0（-1.0，1.8）		1.2±0.3		13（27.1）		26（54.2）		7.0（6.0，9.0）	10.8（9.1，13.0）		10.0（8.0，11.0）
t或Z	0.991			1.135			0.420		3.702^＊＊		0.296		3.109^＊＊		0.199		0.101		6.196^＊＊	5.787^＊＊		2.681^＊＊

组别		n	性别（男/女）		年龄/岁	高血压		糖尿病		冠心病		高脂血症		SBP/mmHg		DBP/mmHg		HR/（次/min）			RR/（次/min）		SpO₂/%
生存组		161	99/62		64.8±6.7	53（32.9）		52（32.3）		52（32.3）		42（26.1）		129.0±13.6		78.1±11.7		84.1±10.4			18.4±2.7		97.1±1.3
死亡组		48	27/21		68.1±8.0	17（35.4）		14（29.2）		7（14.6）		12（25.0）		128.3±13.3		77.1±10.7		82.7±9.4			19.7±3.5		96.2±1.4
χ²或t			0.424		2.930^＊＊	0.104		0.168		0.076		0.023		0.317		0.510		0.860			2.637^＊＊		4.529^＊＊
组别	Hb/ （g/L）			WBC/ （×10⁹/L）			PLT/ （×10⁹/L）		FBG/ （mmol/L）		BE/ （mmol/L）		INR		手术治疗		输血		GCS/ 分	BIG评分/ 分		RTS/ 分
生存组	122.9±13.7			7.8±2.1			179.5±44.2		7.6±0.8		0.0（-1.0，2.0）		1.1±0.2		49（30.4）		83（51.6）		11.0（8.0，13.0）	7.0（4.5，9.9）		11.0（9.0，12.0）
死亡组	125.2±14.2			7.5±1.5			182.5±39.4		8.1±0.8		0.0（-1.0，1.8）		1.2±0.3		13（27.1）		26（54.2）		7.0（6.0，9.0）	10.8（9.1，13.0）		10.0（8.0，11.0）
t或Z	0.991			1.135			0.420		3.702^＊＊		0.296		3.109^＊＊		0.199		0.101		6.196^＊＊	5.787^＊＊		2.681^＊＊

变量	B	SE	Wald χ²	P	OR（95%CI）
年龄	0.069	0.028	5.896	0.015	1.072（1.013~1.133）
SpO₂	-0.469	0.163	8.313	0.004	0.626（0.455~0.861）
FBG	0.466	0.213	4.767	0.029	1.593（1.049~2.419）
RR	0.151	0.067	4.994	0.025	1.162（1.019~1.327）
BIG评分	0.246	0.056	19.349	<0.001	1.279（1.146~1.428）
常数项	30.793	16.012	3.698	0.054	2.36×10¹³

变量	B	SE	Wald χ²	P	OR（95%CI）
年龄	0.069	0.028	5.896	0.015	1.072（1.013~1.133）
SpO₂	-0.469	0.163	8.313	0.004	0.626（0.455~0.861）
FBG	0.466	0.213	4.767	0.029	1.593（1.049~2.419）
RR	0.151	0.067	4.994	0.025	1.162（1.019~1.327）
BIG评分	0.246	0.056	19.349	<0.001	1.279（1.146~1.428）
常数项	30.793	16.012	3.698	0.054	2.36×10¹³

指标	AUC（95%CI）	截断值/ 分	约登指数	敏感度/ %	特异度/ %
BIG评分	0.775（0.712~0.830）	7.4	0.505	95.8	54.7
RTS	0.625（0.533~0.710）	8.5	0.215	33.3	88.2
aaBIG评分	0.810（0.743~0.876）	29.6	0.536	72.9	80.7