The Neutrophil/Lymphocyte Count Ratio Predicts Mortality in Severe Traumatic Brain Injury Patients

Abstract

Introduction: Neutrophil-lymphocyte count ratio (NLCR) is a simple and low-cost marker of inflammatory response. NLCR has shown to be a sensitive marker of clinical severity in inflammatory-related tissue injury, and high value of NLCR is associated with poor outcome in traumatic brain injured (TBI) patients. The purpose of this study was to retrospectively analyze NLCR and its association with outcome in a cohort of TBI patients in relation to the type of brain injury. Methods: Adult patients admitted for isolated TBI with Glasgow Coma Score lower than eight were included in the study. NLCR was calculated as the ratio between the absolute neutrophil and lymphocyte count immediately after admission to the hospital, and for six consecutive days after admission to the intensive care unit (ICU). Brain injuries were classified according to neuroradiological findings at the admission computed tomography (CT) as DAI—patients with severe diffuse axonal injury; CE—patients with hemispheric or focal cerebral edema; ICH—patients with intracerebral hemorrhage; S-EH/SAH—patients with subdural and/or epidural hematoma/subarachnoid hemorrhage. Results: NLCR was calculated in 144 patients. Admission NLCR was significantly higher in the non-survivors than in those who survived at 28 days (p < 0.05) from admission. Persisting high NLCR value was associated with poor outcome, and admission NLCR higher than 15.63 was a predictor of 28-day mortality. The highest NLCR value at admission was observed in patients with DAI compared with other brain injuries (p < 0.001). Concussions: NLCR can be a useful marker for predicting outcome in TBI patients. Further studies are warranted to confirm these results.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio Correlations with C-reactive Protein and Erythrocyte Sedimentation Rate in Traumatic Brain Injury

“…This study found that men were more likely to had a TBI compared to women. It supported several previous studies, which found that men had a bigger proportion compared to women in experiencing TBI, reaching 77-88% of TBI cases [29], [30], [34], [35], [36], [37]. The high incidence of TBI in men can be due to the fact that men are more dominant in doing high-risk activities, experiencing work-related accidents, and experiencing assaultrelated injuries compared to women [38].…”

Early alterations of circulating immune cell counts in severe trauma patients are related to later occurrence of nosocomial infection, sepsis and mortality

“…The neutrophil-lymphocyte ratio (NLR) has been widely proved to be a simple and reliable marker for assessing systemic inflammation and prognosis in non-traumatic and traumatic patients [1, [18][19][20][21][22][23]. In our study, we validated the predicted value of NLR (D3) and NLR (D7) using ROC curve given their differences between each two groups (Fig.…”

A New Inflammatory Parameter Can Predict Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt

“…The acute in ammation phase of foreign body reaction against biomaterials is characterized by migration, adhesion, activation of neutrophils and mast cells, and lasts for hours to few days 27 . Just as the process of brain injury 28 , neutrophils' number increase greatly in the peripheral blood and they can enter central nervous system through the damaged blood brain barrier early 11 . Recruitment and in ltration of neutrophils around catheter could induce neurotoxicity by following pathways: production of cytotoxic mediators and proin ammatory cytokines, activation of matrix metalloproteinases and increase of oxidate stress [29][30][31] .…”

“…We hereby assume that in ammatory response is one of the mechanisms associated with DICH following VP shunt. The neutrophil-to-lymphocyte ratio(NLR), as a rapid and economic biomarker of systemic in ammation 9 , has been a dependable predictor of clinical outcome in patients with spontaneous intracerebral hemorrhage 10 and traumatic brain injury 11 .…”