摘要: 目的：探讨内皮活化与应激指数(EASIX)联合炎症因子水平对重度颅脑损伤术后患者预后的应用价值。方法：采用回顾性分析方法，分析安徽医科大学第二附属医院EICU于2023年1月至2024年12月收治的重度颅脑损伤术后患者的临床资料。收集患者住院时的年龄、性别、吸烟史、饮酒史、手术时长、基础疾病(高血压、糖尿病、高脂血症)、住院天数、30天住院死亡与生存情况等一般临床资料。检测患者术后24小时内的相关指标：生命体征一般指标(心率、呼吸、脉搏)、血电解质(血钾、血钠、血钙)、白细胞计数(WBC)、淋巴细胞计数(TLC)、血红蛋白(HB)、红细胞计数(RBC)、血清白蛋白(ALB)、血清总蛋白(TP)、TT、FIB、PT、APTT、EASIX指数、白细胞介素(IL)-6及C-反应蛋白(CRP)、乳酸、D-D二聚体、血糖、血肌酐、碱性磷酸酶、单核细胞计数(MON)、APACHEII评分、SOFA评分、LDH、GCS评分。根据住院30天是否出现死亡结局，将患者划分为生存组和死亡组，比较分析两组相关指标与预后的相关性，采用单因素和多因素logistic回归分析各种炎症因子和EASIX指数与疾病预后的关系，并进一步通过受试者工作特征曲线(receiver operating characteristic, ROC)和曲线下面积(area under the curve, AUC)评价EASIX指数与重度颅脑损伤术后患者30天死亡率的预测价值，使用最大约登指数确定EASIX指数的截断值，根据截断值将患者分为两组，采用Kaplan-Meier法绘制生存曲线，观测其在预测二组之间30天死亡率的差异。结果：两组在性别、年龄、是否患高血压、是否患糖尿病、住院天数、手术时长方面存在统计学意义(P < 0.05)，而在吸烟史、饮酒史、是否患高脂血症等临床资料方面均无显著差异(P > 0.05)。死亡组在血肌酐水平、心率、呼吸、脉搏、碱性磷酸酶、血糖、D-D二聚体水平方面显著高于生存组(P < 0.05)，而在白蛋白计数、血小板计数、淋巴细胞计数、血红蛋白计数方面显著低于生存组(P < 0.05)。生存组的EASIX指数显著低于死亡组，而死亡组的血清IL-6和CRP水平、乳酸、SOFA评分、LDH以及APACHEII评分显著高于生存组(P < 0.05)，GCS评分显著低于生存组(P < 0.05)。通过ROC曲线分析各因素单独及联合对预后的预测价值，EASIX、IL-6及CRP单独曲线下面积(AUC)分别为0.834、0.764及0.708，EASIX联合IL-6、EASIX联合CRP、EASIX联合IL-6和CRP的AUC分别为0.825、0.822及0.818。通过最大约登指数确定EASIX的截断值为44.174，并根据此截断值将患者分为两组：EASIX > 44.174组和EASIX ≤ 44.174组。Kaplan-Meier生存曲线分析显示，EASIX > 44.174组的30天生存率显著低于EASIX ≤ 44.174组，差异有统计学意义(P < 0.01)。结论表明，EASIX指数及炎症因子是评估重度颅脑损伤术后患者预后的有效指标，其中EASIX指数单独预测预后的预测价值最高。EASIX指数单独预测该类患者的临床预后具有重要价值，且对重度颅脑损伤术后患者30天死亡率具有一定的预测作用。
Abstract: Objective: This study aims to explore the prognostic value of endothelial activation and stress index (EASIX) combined with inflammatory cytokine levels in patients following severe traumatic brain injury (TBI) surgery. Methods: A retrospective analysis was conducted on clinical data from patients who underwent severe TBI surgery at the EICU of the Second Affiliated Hospital of Anhui Medical University between January 2023 and December 2024. General clinical data, including age, sex, smoking and alcohol history, duration of surgery, underlying conditions (hypertension, diabetes, hyperlipidemia), length of hospital stay, and 30-day mortality or survival status, were collected. Within 24 hours post-surgery, the following parameters were measured: vital signs (heart rate, respiration rate, pulse), blood electrolytes (serum potassium, sodium, calcium), white blood cell count (WBC), total lymphocyte count (TLC), hemoglobin (HB), red blood cell count (RBC), serum albumin (ALB), total protein (TP), thrombin time (TT), fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT), EASIX index, interleukin-6 (IL-6), C-reactive protein (CRP), lactate, D-dimer, blood glucose, serum creatinine, alkaline phosphatase, monocyte count (MON), APACHE II score, SOFA score, lactate dehydrogenase (LDH), and Glasgow Coma Scale (GCS) score. Patients were divided into survival and death groups based on 30-day mortality. Univariate and multivariate logistic regression analyses were performed to assess the relationship between inflammatory factors, EASIX index, and prognosis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive value of EASIX for 30-day mortality after surgery. The cutoff value for EASIX was determined using the maximum Youden index, and patients were classified into two groups: EASIX > 44.174 and EASIX ≤ 44.174. Kaplan-Meier survival curves were constructed to observe the differences in 30-day mortality between the two groups. Results: Significant differences were observed between the survival and death groups in terms of sex, age, hypertension, diabetes, length of hospital stay, and duration of surgery (P < 0.05). However, no significant differences were found regarding smoking history, alcohol consumption, or hyperlipidemia (P > 0.05). The death group showed significantly higher levels of serum creatinine, heart rate, respiration rate, pulse, alkaline phosphatase, blood glucose, and D-dimer, while albumin, platelet count, lymphocyte count, and hemoglobin levels were significantly lower compared to the survival group (P < 0.05). The EASIX index was significantly lower in the survival group, whereas IL-6, CRP, lactate, SOFA score, LDH, and APACHE II score were significantly higher, and GCS scores were lower in the death group (P < 0.05). ROC curve analysis revealed AUCs for EASIX, IL-6, and CRP of 0.834, 0.764, and 0.708, respectively. The combined AUCs for EASIX with IL-6, EASIX with CRP, and EASIX with both IL-6 and CRP were 0.825, 0.822, and 0.818, respectively. The EASIX cutoff value was determined to be 44.174, and Kaplan-Meier analysis showed that patients with EASIX > 44.174 had a significantly lower 30-day survival rate compared to those with EASIX ≤ 44.174 (P < 0.01). Conclusion: The EASIX index, in combination with inflammatory cytokines, is a valuable tool for assessing the prognosis of patients following severe TBI surgery. The EASIX index alone provides the highest predictive value for clinical outcomes and can significantly predict 30-day mortality in these patients.