rSIG combined with NLR in the prognostic assessment of patients with multiple injuries

TL;DR

This study examines how rSIG and NLR can predict outcomes for patients with multiple injuries, finding that NLR is more effective than rSIG or their combination.

Contribution

The study introduces the combined use of rSIG and NLR for prognosis in multiple injury patients and compares their predictive values.

Findings

NLR had a higher predictive accuracy (AUC = 0.922) than rSIG (AUC = 0.54) for 28-day mortality.

The combination of rSIG and NLR improved prediction over rSIG alone but not over NLR alone.

Patients with lower rSIG had significantly higher 28-day mortality rates.

Abstract

To investigate the significance of the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) and the neutrophil–lymphocyte ratio (NLR) in the prediction of prognosis in patients with multiple injuries.

The clinical data of 142 patients with multiple injuries admitted to the Emergency Department of Shenzhen Longhua District Central Hospital between January 2019 and December 2022 were retrospectively analyzed. Subjects were divided into the survival group (n = 102) and the deceased group (n = 40) based on their survival status at 28 days after injury. We subsequently analyzed the intergroup differences in blood test results, rSIG, and NLR, as well as the relationship between rSIG and NLR. The predictive value of rSIG, NLR, and both combined in determining the prognosis of patients with multiple injuries was explored by plotting the receiver operator characteristic (ROC) curve. Based on the optimal cut-point value of the ROC curves, subjects were divided into groups with rSIG ≤ 7.75 (22 patients) and rSIG > 7.75 (120 patients), as well as groups with NLR ≤ 10.36 (104 patients) and NLR > 10.36 (38 patients), and the 28-day mortality rate was compared between the groups.

A total of 142 patients were enrolled. The rSIG of the survival group (n = 102) was significantly greater (15.7 ± 4.8) than that of the deceased group (n = 40, 6.2 ± 2.9), (t = 14.307, p < 0.001). The NLR of the survival group was higher than that of the deceased group, but the difference was not statistically significant (p > 0.05). The area under the curve (AUC) of the ROC of NLR was significantly greater than that of rSIG (0.922 vs 0.54) (Z = −7.881, p < 0.001). The AUC for NLR was also statistically greater than that of the combination of rSIG and NLR (0.963 vs 0.54) (Z = −8.378, p < 0.001). The AUC of the combination of rSIG and NLR was significantly greater than that of rSIG (0.844 vs 0.540) (Z = 2.239, p = 0.025). The 28-day mortality rate of patients in the rSIG ≤ 7.75 group was also significantly greater than that of patients in the rSIG > 7.75 group (10.0%) (p < 0.05). Finally, the 28-day mortality rate in the group with an NLR ≤ 10.36 was lower than that in the group with an NLR > 10.36 (p < 0.05). Pearson correlation analysis showed that the correlation coefficient between rSIG and NLR was r = 0.13, which did not reach statistical significance (p = 0.12).

NLR, rSIG, and the combination of the two are all valuable in predicting the prognosis of patients with multiple injuries (all AUC > 0.5). However, the predictive capacity of NLR was better than either rSIG alone or both combined. These findings may serve as references in guiding the treatment of patients with multiple injuries in clinical practice.

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