Hematological markers for prediction computed tomography findings in mild traumatic brain injury

Year 2024, Volume: 6 Issue: 6, 355 - 360, 28.10.2024

Nezih Kavak , Nurgül Balcı

Abstract

Aims: This study aims to examine the levels of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in mild head injury (mTBI) patients to determine their predictive value for the necessity of head computed tomography (CT).
Methods: mTBI patients admitted to the emergency department demographic details, levels of NLR and PLR, and outcomes from brain CT scans were evaluated. Based on the CT scan outcomes, patients were classified into two groups: one with no detectable abnormalities (group 1) and another with detected abnormalities as acute epidural hematoma, acute subdural hematoma, or subarachnoid hemorrhage (group 2). The levels of NLR and PLR were then compared across these groups.
Results: In the study, out of 221 patients, 131 (59.3%) were male, and the overall mean age was 51.47±13.91 years. The most common cause of admission was traffic accidents, accounting for 70 patients (31.7%). The mean Glasgow Coma Scale score of the patients was 13.99±0.94. Group 2 consisted of 66 patients (29.9%), with 44 (66.7%) having an acute subdural hematoma, 16 (24.2%) with subarachnoid hemorrhage, and 6 (9.1%) with acute epidural hemorrhage. The mean NLR and PLR were 1.85±0.77 and 133.99±51.70, respectively. NLR values in group 2 were significantly higher than those in group 1 (p<0.000), whereas no significant difference was found in PLR values between the groups (p>0.05). The optimal cutoff value for NLR was determined to be >1.64.
Conclusion: NLR levels, readily derived from standard hematological assessments, function as an objective and inflammatory biomarker. Initial NLR measurements hold the potential for forecasting abnormal findings in head CT scans associated with mTBI patients.

Keywords

Traumatic brain injury, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, computed tomography, mild head injury

Ethical Statement

Ethical approval was granted by the Ankara Etlik City Hospital Clinical Research Ethics Committee (Date: 27.09.2023 and Decision No 2023-588).

References

• Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020;104(2):213-238.
• Lui A, Kumar KK, Grant GA. Management of severe traumatic brain injury in pediatric patients. Front Toxicol. 2022;4:910972.
• Sabouri E, Majdi A, Jangjui P, Rahigh Aghsan S, Naseri Alavi SA. Neutrophil-to-lymphocyte ratio and traumatic brain injury: a review study. World Neurosurg. 2020;140:142-147.
• Ray S, Luke J, Kreitzer N. Patient-centered mild traumatic brain injury interventions in the emergency department. Am J Emerg Med. 2024;79:183-191.
• H Hopman J, A L Santing J, A Foks K, et al. Biomarker S100B in plasma a screening tool for mild traumatic brain injury in an emergency department. Brain Inj. 2023;37(1):47-53.
• Vos PE, Alekseenko Y, Battistin L, et al. Mild traumatic brain injury: mild traumatic brain injury. Eur J Neurol. 2012;19(2):191-198.
• Miyagawa T, Saga M, Sasaki M, Shimizu M, Yamaura A. Statistical and machine learning approaches to predict the necessity for computed tomography in children with mild traumatic brain injury. Plos one. 2023;18(1):e0278562
• Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380:499-505.
• Torabi M, Amiri ZS, Mirzaee M. Blood glucose level as a predictor of abnormal brain computed tomography scan findings in patients with mild traumatic brain injury. Bull Emerg Trauma. 2023;11(2):83-89.
• Schwulst S.J., Trahanas D.M., Saber R. Traumatic brain injury-induced alterations peripheral immunity. J Trauma Acute Care Surg. 2013;75(5):780-788.
• Xiong Y, Mahmood A, Chopp M. Current understanding of neuroinflammation after traumatic brain injury and cell-based therapeutic opportunities. Chin J Traumatol. 2018;21(3):137-151.
• Werner JK, Stevens RD. Traumatic brain injury: recent advances in plasticity and regeneration. Curr Opin Neurol 2015;28(6):565-573.
• Kusuma GFP, Maliawan S, Mahadewa TGB, Senapathi TGA, Lestari AAW, Muliarta IM. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio correlations with C-reactive protein and erythrocyte sedimentation rate in traumatic brain injury. Maced J Med Sci. 2020;8(B):1185-1192.
• Wang R, He M, Zhang J, Wang S, Xu J. A prognostic model incorporating red cell distribution width to platelet ratio for patients with traumatic brain injury. Ther Clin Risk Manag. 2021; 17:1239-1248.
• Reinus WR, Wippold FJ, Erickson KK. Practical selection criteria for noncontrast cranial computed tomography in patients with head trauma. Ann Emerg Med. 1993;22(7):1148-1155.
• Alexiou GA, Lianos GD, Tzima A, et al. Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury. Biomark Med. 2020;14(12):1085-1090.
• Kalra S, Malik R, Singh G, et al. Pathogenesis and management of traumatic brain injury (TBI): role of neuroinflammation and anti-inflammatory drugs. Inflammopharmacology. 2022;30(4):1153-1166.
• Mishra RK, Galwankar S, Gerber J, et al. Neutrophil-lymphocyte ratio as a predictor of outcome following traumatic brain injury: systematic review and meta-analysis. J Neurosci Rural Pract. 2022; 13(4):618-635.
• Defort P, Retkowska-Tomaszewska N, Kot M, et al. Inflammatory predictors of prognosis in patients with traumatic cerebral haemorrhage: retrospective study. J Clin Med. 2022;11(3):705.
• Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022;23(7):3636.
• Corbett JM, Ho KM, Honeybul S. Prognostic significance of abnormal hematological parameters in severe traumatic brain injury requiring decompressive craniectomy. J Neurosurg. 2019; 132(2):545-551.
• Siwicka-Gieroba D, Malodobry K, Biernawska J, et al. The neutrophil/lymphocyte count ratio predicts mortality in severe traumatic brain injury patients. J Clin Med. 2019;8(9):1453.
• 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-E59.
• Zhao JL, Du ZY, Yuan Q, et al. Prognostic value of neutrophil-to-lymphocyte ratio in predicting the 6-month outcome of patients with traumatic brain injury: a retrospective study. World Neurosurg. 2019;124: e411-e416.
• Xie QJ, Huang W, Shen L, Wang MH, Liu KF, Liu F. Combination of neutrophil-to-lymphocyte ratio and admission glasgow coma scale score is independent predictor of clinical outcome in diffuse axonal injury. World Neurosurg. 2021;152:e118-e127.
• Acar E, Demir A, Alatas Ö, et al. Evaluation of hematological markers in minor head trauma in the emergency room. Eur J Trauma Emerg Sur. 2016;42(5):611-616.
• Li W, Deng W. Platelet-to-lymphocyte ratio predicts short-term mortality in patients with moderate to severe traumatic brain injury. Sci Rep. 2022;12(1):13976.
• Tao C, Wang J, Hu X, et al. Clinical value of neutrophil to lymphocyte and platelet to lymphocyte ratio after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2017;26(3):393-401.
• Siempis T, Georgalis PA, Lianos G, et al. Blood biomarkers for prediction of positive CT findings in mild traumatic brain injury in paediatric population. J Integr Neurosci. 2023;22(4):91.