Braden评分与老年自发性脑出血患者28天死亡风险的关联

Association between Braden Score and 28-Day All-Cause Mortality in Older Adults with Spontaneous Intracerebral Hemorrhage

摘要: 目的：探讨Braden评分与老年自发性脑出血(Spontaneous intracerebral hemorrhage, SICH)患者28天死亡率之间的关联。方法：本研究基于重症监护医疗信息数据库(Medical Information Mart for Intensive Care-IV, MIMIC-IV)，纳入老年SICH患者，并以28天死亡为主要结局。采用Cox比例风险回归模型评估Braden评分与28天死亡风险的关联。使用Kaplan-Meier生存分析比较不同风险组的生存差异；利用限制性三次样条(RCS)分析评估Braden评分与死亡风险之间潜在的非线性关系，并采用ROC曲线下面积(AUC)评价其预测性能；最后进行亚组分析与敏感性分析以验证结果稳健性。结果：共纳入971例患者。Cox回归显示，高风险组(Braden ≤ 14.5分)是28天全因死亡率的独立危险因素(调整HR = 1.81，P < 0.001)。Kaplan-Meier分析提示高风险组生存率更低。RCS分析显示Braden评分与28天死亡风险呈线性关联。此外，ROC分析显示，Braden量表预测性能优于部分疾病严重程度评分，但略低于GCS评分；敏感性分析结果与主要分析结果一致。结论：Braden量表可用于预测老年SICH患者28天死亡风险，有助于早期风险分层与临床决策。

Abstract: Objective: To investigate the association between the Braden score and 28-day mortality in elderly patients with spontaneous intracerebral hemorrhage (SICH). Methods: This study was based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and included elderly SICH patients, with 28-day mortality as the primary outcome. Cox proportional hazards regression models were used to evaluate the association between Braden scores and 28-day mortality. Kaplan-Meier survival analysis was performed to compare survival differences between groups. Restricted cubic spline (RCS) analysis was conducted to assess the potential nonlinear relationship between Braden scores and mortality risk, and the area under the receiver operating characteristic curve (AUC) was calculated to evaluate predictive performance. Subgroup and sensitivity analyses were performed to verify the robustness of the findings. Results: A total of 971 patients were included. Cox regression analysis confirmed that the high-risk group (Braden ≤ 14.5) was an independent risk factor for 28-day all-cause mortality (adjusted HR = 1.81, P < 0.001). Kaplan-Meier survival curves demonstrated significantly lower survival rates in the high-risk group. RCS analysis indicated a linear association between Braden scores and mortality risk. Furthermore, ROC curve analysis showed that the Braden scale outperformed some existing disease severity scores in predicting mortality, but its predictive performance was slightly lower than that of the GCS score. Sensitivity analyses were consistent with the primary findings. Conclusion: The Braden scale can predict 28-day mortality in elderly patients with SICH, supporting early risk stratification and clinical decision-making.