Evaluation of hematological markers in minor head trauma in the emergency room

Neutrophil to Lymphocyte Ratio as a Predictor of Postoperative Outcomes in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

(1) Introduction: Traumatic brain injury (TBI) is a leading cause of injury and mortality worldwide, carrying an estimated cost of $38 billion in the United States alone. Neutrophil to lymphocyte ratio (NLR) has been investigated as a standardized biomarker that can be used to predict outcomes of TBI. The aim of this review was to determine the prognostic utility of NLR among patients admitted for TBI. (2) Methods: A literature search was conducted in PubMed, Scopus, and Web of Science in November 2022 to retrieve articles regarding the use of neutrophil to lymphocyte ratio (NLR) as a prognostic measure in traumatic brain injury (TBI) patients. Inclusion criteria included studies reporting outcomes of TBI patients with associated NLR values. Exclusion criteria were studies reporting only non-primary data, those insufficiently disaggregated to extract NLR data, and non-English or cadaveric studies. The Newcastle-Ottawa Scale was utilized to assess for the presence of bias in included studies. (3) Results: Following the final study selection 19 articles were included for quantitative and qualitative analysis. The average age was 46.25 years. Of the 7750 patients, 73% were male. Average GCS at presentation was 10.51. There was no significant difference in the NLR between surgical vs. non-surgical cohorts (SMD 2.41 95% CI −1.82 to 6.63, p = 0.264). There was no significant difference in the NLR between bleeding vs. non-bleeding cohorts (SMD 4.84 95% CI −0.26 to 9.93, p = 0.0627). There was a significant increase in the NLR between favorable vs. non-favorable cohorts (SMD 1.31 95% CI 0.33 to 2.29, p = 0.0090). (4) Conclusions: Our study found that NLR was only significantly predictive for adverse outcomes in TBI patients and not surgical treatment or intracranial hemorrhage, making it nonetheless an affordable alternative for physicians to assess patient prognosis.

Diagnostic and Predictive Value of Novel Inflammatory Markers of the Severity of Acute Traumatic Spinal Cord Injury: A Retrospective Study

OBJECTIVE

In order to assess the relationships between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio, and systemic immune inflammatory index (SII) and the American Spinal Injury Association Impairment Scale (AIS) grade in patients with acute traumatic spinal cord injury (TSCI).

METHODS

We retrospectively investigated 526 patients with acute traumatic spinal cord injury admitted to the First Affiliated Hospital of Nanchang University between January 2012 and December 2021, and for whom routine blood tests were performed within 8 hours of injury. To assess the degree of impairment in TSCI patients using the American Spinal Cord Injury Association Impairment Scale. The patients were divided into 2 groups according to AIS grade as follows: patients with an AIS grade of A-B (severe and critical TSCI, respectively) were distinguished from those with an AIS grade of C-E (minimal, mild, and moderate TSCI, respectively). The association between unfavorable outcomes and each indicator was examined separately through univariate logistic regression analysis. Correlations between variables and AIS grades were analyzed by Spearman's correlation test. The discriminative ability of predictive models was evaluated using the area under the curve.

RESULTS

The NLR, PLR, and SII were elevated in patients with spinal cord injury and exceeded the reference values in 95% of cases. The AIS grades were inversely correlated with the NLR, PLR, and SII. In the receiver operating characteristic curve analysis performed to confirm the utility of the NLR, PLR, and SII for predicting the AIS grade, the area under the curve values were 0.710 (95% confidence interval [CI], 0.666-0.755), 0.603 (95% CI, 0.554-0.651) and 0.638 (95% CI, 0.591-0.685), respectively. The optimal cut-off value for the NLR was 0.361 (sensitivity = 0.79, specificity = 0.57).

CONCLUSIONS

The analysis of changes in NLR, PLR, and SII as indicators of the novel systemic inflammatory can be an important complement to traditional methods for the assessment of severity and prognosis and the possible selection of patients for close monitoring. And, NLR showed higher diagnostic performance than PLR and SII.

The prognostic value of neutrophil-to-lymphocyte ratio in patients with traumatic brain injury: A systematic review

Traumatic brain injury (TBI) places a heavy load on healthcare systems worldwide. Despite significant advancements in care, the TBI-related mortality is 30–50% and in most cases involves adolescents or young adults. Previous literature has suggested that neutrophil-to-lymphocyte ratio (NLR) may serve as a sensitive biomarker in predicting clinical outcomes following TBI. With conclusive evidence in this regard lacking, this study aimed to systematically review all original studies reporting the effectiveness of NLR as a predictor of TBI outcomes. A systematic search of eight databases was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement (PRISMA) recommendations. The risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Eight studies were ultimately included in the study. In most of the studies interrogated, severity outcomes were successfully predicted by NLR in both univariate and multivariate prediction models, in different follow-up durations up to 6 months. A high NLR at 24 and 48 h after TBI in pediatric patients was associated with worse clinical outcomes. On pooling the NLR values within studies assessing its association with the outcome severity (favorable or not), patients with favorable outcomes had 37% lower NLR values than those with unfavorable ones (RoM= 0.63; 95% CI = 0.44–0.88; p = 0.007). However, there were considerable heterogeneity in effect estimates (I² = 99%; p < 0.001). Moreover, NLR was a useful indicator of mortality at both 6-month and 1-year intervals. In conjunction with clinical and radiographic parameters, NLR might be a useful, inexpensive marker in predicting clinical outcomes in patients with TBI. However, the considerable heterogeneity in current literature keeps it under investigation with further studies are warranted to confirm the reliability of NLR in predicting TBI outcomes.

The association between hematologic parameters and intracranial injuries in pediatric patients with traumatic brain injury

OBJECTIVE

Analyzing the association between hematologic parameters and abnormal cranial computerized tomography (CT) findings after head trauma.

MATERIAL AND METHODS

A total of 287 children with isolated traumatic brain injury (TBI) were divided into the 'normal' (NG), 'linear fracture' (LFG) and 'intraparenchymal injury' groups (IPG) based on head CT findings. Demographical/clinical data and laboratory results were obtained from medical records.

RESULTS

The neutrophil-lymphocyte ratio was markedly higher in the LFG (p = 0.010 and p = 0.016, respectively) and IPG (p = 0.004 and p < 0.001, respectively) compared with NG. Lower lymphocyte-monocyte ratio (p = 0.044) and higher red cell distribution width-platelet ratio (RPR) (p = 0.030) were associated with intraparenchymal injuries. Patients requiring neurosurgical intervention had higher neutrophil-lymphocyte ratio (p = 0.026) and RPR values (p = 0.031) and lower platelet counts (p = 0.035). Lower levels of erythrocytes (p = 0.005), hemoglobin (p = 0.003) and hematocrit (p = 0.002) were associated with severe TBI and unfavorable outcome (p = 0.012, p = 0.004 and p = 0.006, respectively).

CONCLUSIONS

Hematologic parameters are useful in predicting the presence of abnormal cranial CT findings in children with TBI in association with injury severity; surgery need and clinical outcome.

Inflammatory Predictors of Prognosis in Patients with Traumatic Cerebral Haemorrhage: Retrospective Study

We aimed to evaluate the relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammation index (SII), and Glasgow Coma Scale (GCS) score in patients with traumatic intracerebral haemorrhage (TICH). We retrospectively investigated 95 patients with TICH hospitalised at the Neurosurgery Department in Zielona Gora from January 2017 to March 2021. Routine blood tests were performed 5 h after injury. NRL and SII were significantly higher in patients with GCS ≤ 8 than patients with GCS > 8 and exceeded reference values in 95% of patients. GCS was inversely correlated with NLR and SII. Receiver operating characteristic (ROC) analysis confirmed the value of NLR and SII regarding GCS score; Area Under the Curve (AUC) 0.748, 95% Confidence Interval (CI) 0.615–0.880. An optimised NLR cut-off value of 0.154 was identified with a sensitivity of 0.90 and specificity of 0.56. The value of SII regarding GCS was confirmed with ROC curves; AUC 0.816, 95% CI 0.696–0.935. An optimised NLR cut-off value of 0.118 was identified with a sensitivity of 0.95 and specificity of 0.57. NLR and SII are significantly related to GCS scores and are promising predictors of clinical prognosis in TICH patients.

Diagnostic and predictive value of white blood cell count, erythrocyte sedimentation rate, and coagulation tests in patients with blunt head trauma

Introduction: Head trauma is the third leading cause of death and one of the most common causes of referral to the emergency department. Prognosis in these patients identifies individuals at higher risk and provides them with faster and more complete treatment, so it is of particular importance. The aim of this study is to evaluate the diagnostic and predictive value of white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and coagulation tests in the outcome of patients with blunt head trauma. Methods: In this retrospective study, 91 patients referred to the emergency department of Imam Reza hospital of Tabriz, with a complaint of DAI type of blunt head trauma, were enrolled in a complete and sequential study during the first six months of the year 2017. The patientswere divided into two groups according to good or poor prognosis and their association with leukocytosis status and other paraclinical factors at the baseline. Results: The final outcome in high consciousness group was 13.3% need for intubation,26.7% need for surgery, 50% improvement without complications, and 10% mortality. In the low consciousness group, 16.7% required intubation, 20.0% required surgery, 10% had no complications, and 53.3% experienced mortality. The significance level of the chi-squaretest was 0.001. Independent t test results showed that the WBC and ESR values in the lowconsciousness group were significantly higher than the high consciousness group. But the international normalized ratio (INR) in the high consciousness group was significantly higher than the low consciousness group (P<0.05). Conclusion: There is a significant relationship between severity of injury and leukocytosis, ESRelevation, and related coagulopathy after major trauma.

Effectiveness of complete blood count parameters for predicting intracranial injury in children with minor head trauma

Objective: We aimed to investigate the relationship between trauma severity and platelet indices (PI) and white blood cell (WBC) count to identify traumatic brain injury (TBI) in children with minor head trauma (MHT). Materials and methods: This prospective study included children with acute isolated MHT who underwent head computed tomography (CT) based on Pediatric Emergency Care Research Network (PECARN) criteria. Mean platelet volume (MPV), platelet distribution width (PDW), MPV to platelet ratio (MPV/PL), MPV to white blood cell ratio (MPV/WBC), and MPV to Neutrophil ratio (MPV/Neu) were evaluated. Results: 86 children with MHT and 245 controls were included the study. WBC, Neu count, MPV, MPV/WBC, MPV/Neu and MPV/PI ratios were statistically different among patients with abnormal CT, patients with normal CT and healthy controls (p < 0.05). For predicting abbreviated injury score (AIS) > 1, the AUC values of WBC, neutrophil, MPV/WBC and MPV/Neu were 0.746, 0.739, 0.726 and 0.724, respectively. Conclusion: In children with MHT who underwent CT, WBC, Neu counts, MPV/WBC and MPV/Neu ratios may be helpful for predicting the severity of trauma in pediatric emergency department.