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

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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.

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References

  1. Carney NA, Ghajar J. Guidelines for the management of severe traumatic brain injury. Introduction. J Neurotrauma. 2007;24(Suppl 1(5)):1–106.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  6. Barlow KM. Traumatic brain injury. Handb Clin Neurol. 2013;112:891–904.

    Article  PubMed  Google Scholar 

  7. Saatman KE, Duhaime AC, Bullock R, et al. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25(7):719–38.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Smajic J, Tupkovic LR, Husic S, et al. Systemic inflammatory response syndrome in surgical patients. Med Arch. 2018;72(2):116–9.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  23. Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24(1):S59–64.

    Google Scholar 

  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.

    Article  Google Scholar 

  25. Feinberg M, Mai JC, Ecklund J. Neurosurgical management in traumatic brain injury. Semin Neurol. 2015;35(1):50–6.

    Article  PubMed  Google Scholar 

  26. Hilden J, Glasziou P. Regret graphs, diagnostic uncertainty and Youden’s index. Stat Med. 2015;15(10):969–86.

    Article  Google Scholar 

  27. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5.

    Article  CAS  Google Scholar 

  28. Marshall L. The outcome of severe closed head injury. J Neurosurg. 1991;75(5):S28–36.

    Article  Google Scholar 

  29. Hanley JA, Mcneil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  33. Gong C, Hoff JT, Keep RF. Acute inflammatory reaction following experimental intracerebral hemorrhage in rat. Brain Res. 2000;871(1):57–65.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  35. Roth TL, Nayak D, Atanasijevic T, et al. Transcranial amelioration of inflammation and cell death after brain injury. Nature. 2014;505(7482):223.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Schwartz M, Moalem G. Beneficial immune activity after CNS injury: prospects for vaccination. J Neuroimmunol. 2001;113(2):185–92.

    Article  CAS  PubMed  Google Scholar 

  39. Palm N. R Not so fast: adaptive suppression of innate immunity. Nat Med. 2007;13(10):1142.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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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.

Funding

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

Author information

Author notes

  1. Jigang Chen, Xiaolin Qu and Zhenxing Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China

    Jigang Chen, Xiaolin Qu, Zhenxing Li, Danfeng Zhang & Lijun Hou

Authors
  1. Jigang Chen
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  2. Xiaolin Qu
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  3. Zhenxing Li
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  4. Danfeng Zhang
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Contributions

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

Corresponding authors

Correspondence to Danfeng Zhang or Lijun Hou.

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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.

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Cite this article

Chen, J., Qu, X., Li, Z. et al. Peak Neutrophil-to-Lymphocyte Ratio Correlates with Clinical Outcomes in Patients with Severe Traumatic Brain Injury. Neurocrit Care 30, 334–339 (2019). https://doi.org/10.1007/s12028-018-0622-9

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  • DOI: https://doi.org/10.1007/s12028-018-0622-9

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