The neutrophil-to-lymphocyte ratio: A potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury

Abstract

PurposeThis study aimed to determine the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in critically ill trauma patients.MethodsThis retrospective study involved adult trauma patients from 335 intensive care units (ICUs) at 208 hospitals stored in the eICU database. The primary outcome was ICU mortality. The lengths of ICU and hospital stay were calculated as the secondary outcomes. The multivariable logistic regression model was used to identify independent predictors of mortality. To identify the effect of the NLR on survival, a 15-day survival curve was used.ResultsA total of 3,865 eligible subjects were enrolled in the study. Univariate analysis showed that patients in the group with a higher NLR were more likely to receive aggressive methods of care delivery: mechanical ventilation, vasopressor, and antibiotics ( P < 0.001 for all). The ICU, in-hospital, and 15-day mortality rates of the four groups increased in turn (P < 0.001 for all). The multivariable logistic Cox regression model indicated that a higher NLR was an independent risk factor of ICU mortality in trauma patients. ROC analysis showed that the NLR had better predictive capacity on the mortality of patients with traumatic brain injury (TBI) than those with trauma (AUC 0.725 vs. 0.681). An NLR > 7.44 was an independent risk factor for ICU death in patients with TBI (OR: 1.837, 95% CI: 1.045–3.229) and TBI victims whose NLR > 7.44 had a 15-day survival disadvantage (P = 0.005).ConclusionA high NLR is associated with a poor prognosis in trauma patients, even worse in patients with TBI. An NLR > 7.44 is an independent risk factor for death in patients with TBI.

How to predict the outcome of primary brainstem hemorrhage: Six-year results of a single-center retrospective analysis

“…[17] Xu et al mentioned that an NLR > 7.44 was an independent risk factor for intensive care unit death in patients with TBI. [18] Similarly, we observed that NLR > 6.15 was associated with unfavorable outcome (both 30-day mortality and 90-day recovery) of PBH. Physiologically, the NLR represents the balance between the inflammatory activator and inflammatory regulator.…”

Evaluating the effectiveness of inflammatory markers in pediatric open globe injury using a modified pediatric ocular trauma score

“…[11][12][13][14][15][16][17][18][19] One study associated a high NLR with a poor prognosis in trauma patients, particularly those with traumatic brain injury. [25] High NLR and PLR have also been linked to poor outcomes in various diseases. According to our study's results, high NLR and PLR are associated with poor prognosis.…”