The Monocyte-to-Lymphocyte Ratio at Hospital Admission Is a Novel Predictor for Acute Traumatic Intraparenchymal Hemorrhage Expansion after Cerebral Contusion

Abstract

Purpose. To explore the potential of monocyte-to-lymphocyte ratio (MLR) at hospital admission for predicting acute traumatic intraparenchymal hematoma (tICH) expansion in patients with cerebral contusion. Patients and Methods. This multicenter, observational study included patients with available at-hospital admission (baseline) and follow-up computed tomography for volumetric analysis (retrospective development cohort: 1146 patients; prospective validation cohort: 207 patients). Semiautomated software assessed tICH expansion (defined as ≥33% or 5 mL absolute growth). MLR was acquired from routine blood tests upon admission. We constructed two predictive models: basic combined model of clinical and imaging variables and MLR combined model of both MLR and other variables in the basic model. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were used to estimate the performance of MLR for predicting acute tICH expansion. Results. MLR was significantly larger in patients with acute tICH expansion compared to those without acute tICH expansion (mean [SD], 1.08 [1.05] vs. 0.59 [0.37], P < 0.001 ). A nonlinear positive relationship between MLR and the incidence of acute tICH expansion was observed. Multivariate logistic regression indicated MLR as an independent risk factor for acute tICH expansion (odds ratio (OR), 5.88; 95% confidence interval (CI), 4.02-8.61). The power of the multivariate model for predicting acute tICH expansion was substantially improved with the inclusion of MLR (AUC 0.86 vs. AUC 0.74, P < 0.001 ), as was also observed in an external validation cohort (AUC 0.83 vs. AUC 0.71, P < 0.001 ). The net benefit of MLR model was higher between threshold probabilities of 20-100% in DCA. For clinical application, a nomogram derived from the multivariate model with MLR was introduced. In addition, MLR was positively associated with 6-month unfavorable outcome. Conclusion. MLR is a novel predictor for traumatic parenchymatous hematoma expansion. A nomogram derived from the MLR model may provide an easy-to-use tool for predicting acute tICH expansion and promoting the individualized treatment of patients with hemorrhagic cerebral contusion. MLR is associated with long-term outcome after cerebral contusion.

Establishment and validation of prognosis model for patients with cerebral contusion

“…In this study, CC sites were included, including frontal lobe, parietal lobe, temporal lobe and occipital lobe. Statistical results showed that the differences were not statistically significant(P>0.05), which was inconsistent with previous reports [ 24 ]. We analyzed the reasons as follows: Basal ganglia and brain stem or cerebellum is human body important vital center, once the damage prognosis is poor, but we are all included in patients with contusion parts above the tentorium, if not acute oppression brain stem hemorrhage or edema, generally will not endanger the patient lives, usually only can cause injury of brain tissue function is impaired, leaving related sequelae.…”

“…In patients with CC, monocytes, neutrophils and lymphocytes can invade from the periphery and participate in the injury response without the control of the BBB. Sheng et al [ 24 ] established a prediction model of cerebral rebleeding risk after craniocerebral injury, and concluded that MLR had a great predictive value for the expansion of acute traumatic parenchymal hematoma. Therefore, this study included MLR as a variable in the study to explore its predictive value for the prognosis of patients with CC.…”

A Clinical Predictive Nomogram for Traumatic Brain Parenchyma Hematoma Progression

“…A high MLR may indicate a high level of intracerebral monocyte infiltration in patients with brain contusion. Given its easy accessibility, this indicator may provide new insights into neuroinflammation for promoting acute tICH expansion [18]. Consistent with its performance in the development dataset, the TPHEA nomogram maintained optimal discrimination and good calibration in an external validation dataset.…”

“…Several small retrospective studies have attempted to develop comprehensive models for tICH expansion based on clinical and imaging variables [ 11 , 15 , 16 ]. However, some crucial predictors were not considered, including baseline tICH volume, a novel imaging marker of multihematoma fuzzy sign, and an inflammatory marker of monocyte-to-lymphocyte ratio (MLR) [ 17 , 18 ]. In addition, the predictive value of these models must be verified in a large multicenter sample size.…”

Role of Monocyte-to-lymphocyte Ratio, Mean Platelet Volume-to-Platelet Count Ratio, C-Reactive Protein and Erythrocyte Sedimentation Rate as Predictor of Severity in Secondary Traumatic Brain Injury: A Literature Review

“…Jan et al also found that MLR can be used as a prognostic factor for malignancy [78]. Sheng et al suggested that MLR is a predictor of the inflammatory process and the risk of hematoma expansion in cases of cerebral contusion after brain injury [79]. In stroke patients, MLR was reported associated with depression occurrence within 3 months [80].…”