Prediction of long-term quality of life after severe traumatic brain injury based on variables at hospital admission

<b>Objectives</b>: Variables collected early after severe traumatic brain injury (sTBI) could predict health-related quality of life (HRQoL). Our aim was to determine the prevalence of patients with a low HRQoL 4 years after sTBI and to develop a prediction model including early variables. <b>Methods</b>: Adult patients with both sTBI [abbreviated injury score of the head region (HAIS) &gt;3] and disease-specific HRQoL assessments using the ‘Quality of Life after Brain Injury’ (QOLIBRI) were included. The outcome was the total score (TS) of QOLIBRI; cutoff for low HRQoL: &lt;60 points. A multivariate logistic regression model and prediction model were performed. <b>Results</b>: One hundred-sixteen patients [median age 50.8 years (IQR 25.9–62.8; 21.6% &gt;65 years)] were included; 68 (58.6%) with HAIS = 4, 48 (41.4%) with HAIS = 5. Median Glasgow Coma Scale (GCS) was 13 (IQR 3–15). Median TS was 77 (IQR 60–88). Low HRQoL was observed in 28 patients (24.1%). Two variables were associated with low HRQoL: GCS &lt;13, working situation other than employed or retired. The prediction model had an AUROC of 0.765; calibration was moderate (Hosmer Lemeshow Chi2 6.82, <i>p</i> = .556). <b>Conclusion</b>: One in four patients had a low HRQoL after 4 years. A lower GCS and working situations were associated with low HRQoL.

<b>研究目标</b>：重型颅脑创伤（severe traumatic brain injury, sTBI）后早期采集的相关变量可用于预测健康相关生命质量（health-related quality of life, HRQoL）。本研究旨在明确重型颅脑创伤患者创伤后4年时低健康相关生命质量的患病率，并基于早期临床变量构建预测模型。<b>研究方法</b>：本研究纳入同时满足两项条件的成年患者：其一为确诊重型颅脑创伤，即头部简明损伤评分（abbreviated injury score of the head region, HAIS）＞3；其二为采用《脑损伤后生命质量量表》（Quality of Life after Brain Injury, QOLIBRI）完成疾病特异性健康相关生命质量评估。本研究的结局指标为QOLIBRI总分（total score, TS），低健康相关生命质量的截断值设定为＜60分。本研究采用多因素logistic回归分析构建预测模型。<b>研究结果</b>：本研究共纳入116例患者，年龄中位数为50.8岁（四分位数间距25.9~62.8；其中21.6%的患者年龄＞65岁）；其中68例（58.6%）HAIS评分为4分，48例（41.4%）HAIS评分为5分。患者的格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）中位数为13分（四分位数间距3~15），QOLIBRI总分中位数为77分（四分位数间距60~88）。共计28例患者（24.1%）存在低健康相关生命质量。分析显示两项变量与低健康相关生命质量显著相关：GCS＜13分，以及非在职或非退休的工作状态。本研究所构建的预测模型受试者工作特征曲线下面积（AUROC）为0.765，校准度中等（霍斯默-莱梅肖卡方值为6.82，P=0.556）。<b>研究结论</b>：每4例重型颅脑创伤患者中即有1例在创伤后4年时存在低健康相关生命质量。较低的GCS评分与不良工作状态与低健康相关生命质量显著相关。