Travmatik beyin hasar�nda hastane i�i mortaliteyi tahmin etmek i�in C-reaktif protein alb�min oran� m� yoksa n�trofil-lenfosit oran� m� daha iyi bir g�stergedir?

�zeren, Ersin

Cilt : 28 Say� : 10 Y�l : 2024

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Turkish Journal of Trauma and Emergency Surgery Travmatik beyin hasar�nda hastane i�i mortaliteyi tahmin etmek i�in C-reaktif protein alb�min oran� m� yoksa n�trofil-lenfosit oran� m� daha iyi bir g�stergedir? [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2022; 28(10): 1482-1487 | DOI: 10.14744/tjtes.2022.00794

Travmatik beyin hasar�nda hastane i�i mortaliteyi tahmin etmek i�in C-reaktif protein alb�min oran� m� yoksa n�trofil-lenfosit oran� m� daha iyi bir g�stergedir?

Ersin �zeren
Aksaray �niversitesi T�p Fak�ltesi, Beyin ve Sinir Cerrahisi Anabilim Dal�, Aksaray

AMA�: N�trofil-lenfosit oran� (NLR) ve C-reaktif protein alb�min oran� (CAR) enflamatuvar yan�t�n basit ve nesnel bir belirtecidir. Ancak, bu iki belirte� travmatik beyin hasar�nda birlikte �al��lmam��t�r. Bu y�zden �al��mada TBH�li hastalarda NLR ve CAR�nin hastane i�i mortaliteyi �ng�rmede hangisinin daha iyi bir biyobelirte� oldu�u �al��ld�.
GERE� VE Y�NTEM: �al��maya Ocak 2016 ile Aral�k 2021 y�llar� aras�nda hastaneye kabul edilen ard��k 257 hasta dahil edildi. T�m travmatik beyin hasarl� 18 ya� �st� hastalar�n dosyalar� geriye d�n�k olarak incelendi. Hastanede kald�klar� s�re i�indeki verileri kaydedildi. Klinik �zellikleri glaskow koma skorlar� (GKS) kaydedildi. Bilgisayarl� beyin tomografisi (BBT) ile tan�lar� s�n�fland�r�ld�. Hastalar�n ilk 12�24 saat aras�ndaki rutin kan incelemeleri kaydedildi. Hastanede kald�klar� s�rece �lenlerle �lmeyenlerin laboratuvar sonu�lar� kar��la�t�r�larak analiz edildi.
BULGULAR: Mann-Whitney U testine g�re hastanede kald�klar� s�rede �len hastalarda ortanca CRP, CAR, NLR, WBC, monosit, n�trofil, RDW-CV, RDW-SD ve trombosit de�erleri anlaml� derecede y�ksek, ortanca alb�min ve RBC de�erleri �lmeyen hastalara g�re anlaml� olarak daha d��kt�. Student t-testi, �len hastalarda ortalama hemoglobinin �lmeyen hastalara g�re anlaml� derecede d��k oldu�unu g�sterdi. Tek de�i�kenli lojistik regresyon modelinde ya�, alb�min, CRP, CAR, NLR, WBC, monosit, n�trofil, RBC, RDW-CV, RDW-SD ve hemoglobin mortaliteyi �ng�ren fakt�rlerdi. Bununla birlikte, �ok de�i�kenli lojistik regresyon modelinde yaln�zca ya�, alb�min, CAR ve WBC�nin mortaliteyi �ng�ren fakt�rler oldu�u bulundu. E�ri alt�nda kalan alanlar; CAR 0.891 (%95 GA, 0.847�0.935), WBC 0.759 (%95GA, 0.696�0.823) ve NLR 0.671 (%95 GA, 0.598�0.744).
TARTI�MA: Bu �al��ma, TBH�de hastane i�i mortaliteyi �n g�rmede CAR�nin NLR ye g�re daha iyi prognostik de�ere sahip oldu�unu g�stermi�tir.

Anahtar Kelimeler: C-reaktif protein alb�min oran�, hastane i�i mortalite, n�trofil-lenfosit oran�, travmatik beyin hasar�.

Is C-reactive protein-albumin ratio or neutrophil-lymphocyte ratio a better indicator to predict in-hospital mortality in traumatic brain injury?

Ersin �zeren
Department of Neurosurgery, Aksaray University Faculty of Medicine, Aksaray-T�rkiye

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and C-reactive protein-albumin ratio (CAR) are simple and objective markers of inflammatory responses. However, there are no studies in the literature evaluating these two markers together in traumatic brain injury (TBI). Therefore, this study aimed to examine whether CAR or NLR is a better biomarker for predicting in-hospital mortality in patients with TBI.
METHODS: A total of 257 consecutive patients admitted to the hospital between January 2016 and December 2021 were included in the study. The files of all patients aged >18 years with TBI were retrospectively reviewed. Clinical characteristics, Glasgow Coma Scale, and patient data during hospital stay were recorded. Definitive diagnosis was made using computed brain tomography. Routine blood tests were performed in the first 12�24 h of hospitalization. Laboratory results of patients with and without in-hospital mortality were comparatively analyzed.
RESULTS: According to the Mann�Whitney U-test, median CRP, CAR, NLR, WBC, monocyte, neutrophil, RDW-CV, RDW-SD, and platelet values were significantly higher, whereas median albumin and RBC values were significantly lower in patients with in-hospital mortality. Student�s t-test showed that the mean hemoglobin level was significantly lower in patients with in-hospital mortality compared to other patients. Univariate logistics regression model revealed that age, albumin, CRP, CAR, NLR, WBC, monocyte, neutrophil, RBC, RDW-CV, RDW-SD, and hemoglobin were the factors predicting mortality. However, in the multivariate logistic regression model, only age, albumin, CAR, and WBC were the factors predicting mortality. Areas under the curve were 0.891 for CAR (95% GA, 0.847�0.935), 0.759 for WBC (95% GA, 0.696�0.823), and 0.671 for NLR (95% GA, 0.598�0.744).
CONCLUSION: The results of this study showed that CAR has better prognostic value than NLR in predicting in-hospital mortality in patients with TBI.

Keywords: C-reactive protein-albumin ratio, in-hospital mortality, neutrophil-lymphocyte ratio, traumatic brain injury.

Sorumlu Yazar: Ersin �zeren, T�rkiye
Makale Dili: �ngilizce

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