Advertisement

Peak Neutrophil-to-Lymphocyte Ratio Correlates with Clinical Outcomes in Patients with Severe Traumatic Brain Injury

  • Jigang Chen
  • Xiaolin Qu
  • Zhenxing Li
  • Danfeng Zhang
  • Lijun Hou
Original Article

Abstract

Background

Studies suggested that the neutrophil-to-lymphocyte ratio (NLR) was associated with unfavorable outcomes in different diseases such as intracerebral hemorrhage, cardiovascular problem, cancer, and severe traumatic brain injury (sTBI). We aimed to evaluate the relationship between peak NLR and 1-year outcomes in patients with sTBI.

Methods

We retrospectively reviewed the clinical data of patients with sTBI who were treated in our department between January 2013 and January 2017. NLRs between day 1 and day 12 after admission as well as other related indicators were collected. The relationship between peak NLR and 1-year outcomes was analyzed. Factors associated with larger peak NLR were also explored.

Results

A total of 316 patients were included, and 81.3% (257/316) experienced unfavorable outcomes. Peak NLR was identified as an independent predictor for unfavorable outcomes after sTBI in multivariable logistic regression analysis (odds ratio, 1.086; 95% confidence interval, 1.037–1.137; P < 0.001). Its predictive value was confirmed by receiver operating characteristic analysis (area under curve = 0.775; P < 0.001). The day 1 NLR as well as admission Glasgow Coma Scale score was independently correlated with increased peak NLR.

Conclusion

Peak NLR was associated with the clinical prognosis after sTBI and was a promising predictor for 1-year outcomes.

Keywords

Neutrophil-to-lymphocyte ratio Peak value Severe traumatic brain injury Clinical outcomes 

Notes

Acknowledgements

We’d like to express our sincere gratitude to Chengguang Huang, Minkun Yu, Kehua Sun, and Rulin Bai in Changzheng Hospital for their work in providing the clinical data.

Author Contribution

JC and XQ conducted the study design, data collection, and data analysis. ZL and DZ prepared the manuscript. LH reviewed and finalized the manuscript.

Source of Support

This study was funded by the National Nature Science Foundation of China (Grant No. 81671206).

Compliance with Ethical Standards

Conflict of interest

Lijun Hou received grants from National Nature Science Foundation of China. The other authors declared they had no conflicts of interest.

Ethical Approval

All procedures performed in the studies were in accordance with the ethical standards of the Changzheng Hospital and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

References

  1. 1.
    Carney NA, Ghajar J. Guidelines for the management of severe traumatic brain injury. Introduction. J Neurotrauma. 2007;24(Suppl 1(5)):1–106.CrossRefGoogle Scholar
  2. 2.
    Cheng P, Yin P, Ning P, et al. Trends in traumatic brain injury mortality in China, 2006–2013: a population-based longitudinal study. PLoS Med. 2017;14(7):e1002332.CrossRefGoogle Scholar
  3. 3.
    Søreide K, Krüger AJ, Vårdal AL, et al. Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World J Surg. 2007;31(11):2092–103.CrossRefGoogle Scholar
  4. 4.
    Myburgh JA, Cooper DJ, Finfer SR, et al. Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma Inj Infect Crit Care. 2008;64(4):854–62.CrossRefGoogle Scholar
  5. 5.
    Murray GD, Teasdale GM, Braakman R, et al. The European brain injury consortium survey of head injuries. Acta Neurochir. 1999;141(3):223–36.CrossRefGoogle Scholar
  6. 6.
    Barlow KM. Traumatic brain injury. Handb Clin Neurol. 2013;112:891–904.CrossRefGoogle Scholar
  7. 7.
    Saatman KE, Duhaime AC, Bullock R, et al. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25(7):719–38.CrossRefGoogle Scholar
  8. 8.
    Smajic J, Tupkovic LR, Husic S, et al. Systemic inflammatory response syndrome in surgical patients. Med Arch. 2018;72(2):116–9.CrossRefGoogle Scholar
  9. 9.
    Tschoeke SK, Hellmuth M, Hostmann A, Ertel W, Oberholzer A. The early second hit in trauma management augments the proinflammatory immune response to multiple injuries. J Trauma Acute Care Surg. 2007;62(6):1403–4.CrossRefGoogle Scholar
  10. 10.
    Lumsdaine W, Easton RM, Lott NJ, et al. Neutrophil oxidative burst capacity for peri-operative immune monitoring in trauma patients. Inj Int J Care Inj. 2014;45(8):1144–8.CrossRefGoogle Scholar
  11. 11.
    Faist E, Kupper TS, Baker CC, et al. Depression of cellular immunity after major injury. Its association with posttraumatic complications and its reversal with immunomodulation. Arch Surg. 1986;121(9):1000–5.CrossRefGoogle Scholar
  12. 12.
    Albertsmeier M, Quaiser D, Von DV, et al. Major surgical trauma differentially affects T-cells and APC. Innate Immun. 2015;21(1):55–64.CrossRefGoogle Scholar
  13. 13.
    Zahorec R. Ratio of neutrophil to lymphocyte counts–rapid and simple parameter of systemic inflammation and stress in critically ill. Bratislavské Lekárske Listy. 2001;102(1):5–14.PubMedGoogle Scholar
  14. 14.
    Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017;8(34):57489.CrossRefGoogle Scholar
  15. 15.
    Giede-Jeppe A, Bobinger T, Gerner ST, et al. Neutrophil-to-lymphocyte ratio is an independent predictor for in-hospital mortality in spontaneous intracerebral hemorrhage. Cerebrovasc Dis. 2017;44(1–2):26–34.CrossRefGoogle Scholar
  16. 16.
    Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal. 2014;28(1):27–31.CrossRefGoogle Scholar
  17. 17.
    Yu S, Arima H, Bertmar C, et al. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci. 2018;387:115–8.CrossRefGoogle Scholar
  18. 18.
    Bambury RM, Teo MY, Power DG, et al. The association of pre-treatment neutrophil to lymphocyte ratio with overall survival in patients with glioblastoma multiforme. J Neurooncol. 2013;114(1):149–54.CrossRefGoogle Scholar
  19. 19.
    Proctor MJ, McMillan DC, Morrison DS, et al. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107(4):695–9.CrossRefGoogle Scholar
  20. 20.
    Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013;11(1):55–9.CrossRefGoogle Scholar
  21. 21.
    Chen W, Yang J, Li B, et al. Neutrophil to lymphocyte ratio as a novel predictor of outcome in patients with severe traumatic brain injury. J Head Trauma Rehabil. 2018;33(1):E53–9.PubMedGoogle Scholar
  22. 22.
    Dilektasli E, Inaba K, Haltmeier T, et al. The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg. 2016;81(5):882–8.CrossRefGoogle Scholar
  23. 23.
    Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(1):S59–64.Google Scholar
  24. 24.
    Galgano M, Toshkezi G, Qiu X, et al. Traumatic brain injury: current treatment strategies and future endeavors. Cell Transpl. 2017;26(7):1118–30.CrossRefGoogle Scholar
  25. 25.
    Feinberg M, Mai JC, Ecklund J. Neurosurgical management in traumatic brain injury. Semin Neurol. 2015;35(1):50–6.CrossRefGoogle Scholar
  26. 26.
    Hilden J, Glasziou P. Regret graphs, diagnostic uncertainty and Youden’s index. Stat Med. 2015;15(10):969–86.CrossRefGoogle Scholar
  27. 27.
    Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5.CrossRefGoogle Scholar
  28. 28.
    Marshall L. The outcome of severe closed head injury. J Neurosurg. 1991;75(5):S28–36.Google Scholar
  29. 29.
    Hanley JA, Mcneil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29.CrossRefGoogle Scholar
  30. 30.
    Saika A, Bansal S, Philip M, Devi BI, Shukla DP. Prognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury. Acta Neurochir. 2015;157(8):1323.CrossRefGoogle Scholar
  31. 31.
    Poon WS, Zhu XL, Ng SC, Wong GK. Predicting one year clinical outcome in traumatic brain injury (TBI) at the beginning of rehabilitation. Acta Neurochir Suppl. 2005;93(93):207–8.CrossRefGoogle Scholar
  32. 32.
    Xue M, Bigio MRD. Comparison of brain cell death and inflammatory reaction in three models of intracerebral hemorrhage in adult rats. J Stroke Cerebrovasc Dis. 2003;12(3):152–9.CrossRefGoogle Scholar
  33. 33.
    Gong C, Hoff JT, Keep RF. Acute inflammatory reaction following experimental intracerebral hemorrhage in rat. Brain Res. 2000;871(1):57–65.CrossRefGoogle Scholar
  34. 34.
    Rhind SG, Crnko NT, Baker AJ, et al. Prehospital resuscitation with hypertonic saline-dextran modulates inflammatory, coagulation and endothelial activation marker profiles in severe traumatic brain injured patients. J Neuroinflamm. 2010;7(1):5.CrossRefGoogle Scholar
  35. 35.
    Roth TL, Nayak D, Atanasijevic T, et al. Transcranial amelioration of inflammation and cell death after brain injury. Nature. 2014;505(7482):223.CrossRefGoogle Scholar
  36. 36.
    Carlos TM, Clark RSB, Franicola-Higgins D, Schiding JK, Kochanek PM. Expression of endothelial adhesion molecules and recruitment of neutrophils after traumatic brain injury in rats. J Leukoc Biol. 1997;61(3):279–85.CrossRefGoogle Scholar
  37. 37.
    Liao Y, Liu P, Guo F, Zhang Z, Zhang Z. Oxidative burst of circulating neutrophils following traumatic brain injury in human. PLoS ONE. 2013;8(7):e68963.CrossRefGoogle Scholar
  38. 38.
    Schwartz M, Moalem G. Beneficial immune activity after CNS injury: prospects for vaccination. J Neuroimmunol. 2001;113(2):185–92.CrossRefGoogle Scholar
  39. 39.
    Palm N. R Not so fast: adaptive suppression of innate immunity. Nat Med. 2007;13(10):1142.CrossRefGoogle Scholar
  40. 40.
    Meisel C, Schwab JM, Prass K, Meisel A, Dirnagl U. Central nervous system injury-induced immune deficiency syndrome. Nat Rev Neurosci. 2005;6(10):775–86.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Changzheng HospitalSecond Military Medical UniversityShanghaiChina

Personalised recommendations