A novel scoring system to predict the outcomes of adult patients with hypoxic-ischemic encephalopathy

<b>Background:</b> Adult patients with hypoxic-ischemic encephalopathy (HIE) often incur large costs, but their outcomes are poor. Currently, there is lack of a comprehensive quantitative approach to predict patient prognoses. <b>Methods</b>: A total of 73 adult patients with HIE participated in this prospective, observational study. Clinical assessments, laboratory tests, and electrophysiological examinations were conducted within 3 days after HIE occurred. Logistic regression model was used to identify independent factors associated with patient outcomes. <b>Results</b>: After a 6-month follow-up, 44 (61.1%) patients survived, 28 (38.9%) patients died, and one patient was lost to follow-up. The level of blood calcium and lactate, the presence of electroencephalography reactivity, and Glasgow Coma Scale (GCS) score were significantly associated with the patient’s outcome. Based on the regression coefficients from logistic regression analysis, we constructed a scoring system (CEGL; C: calcium, E: EEG reactivity, G: GCS, L: lactate) to predict the possibility of a patient’s death. The area under the receiver operating characteristic curve was 0.91 (P &lt; 0.001, 95% CI [0.87–0.95]) with a specificity of 97.7% and a positive predictive value of 97.4%. <b>Conclusion:</b> CEGL score can provide clinicians useful information for assessment of patient prognosis within 6 months after HIE.

<b>背景：</b> 缺氧缺血性脑病（hypoxic-ischemic encephalopathy, HIE）成年患者往往产生高昂医疗成本，且预后不佳。目前尚缺乏用于预测患者预后的全面量化方法。<b>方法：</b> 本项前瞻性观察研究共纳入73例成年HIE患者，于HIE发病后3日内完成临床评估、实验室检测及电生理检查。采用logistic回归模型筛选与患者预后相关的独立影响因素。<b>结果：</b> 经6个月随访，44例（61.1%）患者存活，28例（38.9%）患者死亡，另有1例失访。血钙水平、血乳酸水平、脑电图反应性（electroencephalography reactivity）是否存在及格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分均与患者预后显著相关。基于logistic回归分析得到的回归系数，本研究构建了用于预测患者死亡风险的评分系统（CEGL评分；C：血钙（calcium），E：脑电图反应性（EEG reactivity），G：GCS评分，L：血乳酸（lactate））。受试者工作特征曲线（receiver operating characteristic curve）下面积为0.91（P<0.001，95%置信区间[0.87~0.95]），特异度为97.7%，阳性预测值为97.4%。<b>结论：</b> CEGL评分可为临床医师提供有效参考信息，用于评估HIE患者发病后6个月的预后情况。