Correlation between neutrophil lymphocyte count ratio and outcomes of severe traumatic head injury
Keywords:Head Injury, Neutrophil Lymphocyte count ratio, Glasgow outcome score, Glasgow coma scale
Background: Raised peripheral neutrophil lymphocyte ratio is associated with poorer outcomes in conditions such as severe brain injury, ICH, cardiovascular conditions, cancer.
Methods: Retrospective analysis of 96 severe Traumatic Brain injury data treated at our institute over a period of 1 year. The patients were followed up for a period of at least 1 month. The primary outcome of the study was 1 month GOS and the various variables which may be associated with the poor GOS at 1 month follow up. Model based analysis was done for NLCR <24 hrs at 48 hrs and GCS at the time of presentation and discriminative ability of the models were studied by the Area under the curve.
Results: Univariate analysis were done of 96 patients of severe traumatic brain injury for various variables such as age, sex, mode of head injury, type of head injury, presenting GCS and NLCR at 24 hrs and 48 hrs to that of GOS at 1 month follow up. Initial GCS <7 (p=0.0138) with AUC=0.6689 and peak NLCR (<24 hr) of > 9.6 (AUC=0.931) with a p value of <0.001 with sensitivity of 100% and specificity of 79.27% and peak NLCR (48 hrs) of >12.4 (AUC= 0.973) with a p value of <0.001 with sensitivity of 100% and specificity of 89.02% were associated with unfavourable outcome.
Conclusions: High NLCR and initial poor GCS are independent unfavourable prognostic factors in 1 month GOS following severe traumatic head injury.
Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7:728-41.
Cole TB. Global road safety crisis remedy sought: 1.2 million killed, 50 million injured annually. JAMA. 2004;291:2531-2.
Hyder AA, Wunderlich CA, Puvanachandra P. The impact of traumatic brain injuries: a global perspective. Neurorehabilitation. 2007;22:341-53.
World Health Statistics 2007. Available at: <http://www.who.int/gho/publications/world_health _statistics/whostat2007.pdf?ua=1>; 2007 Accessed on 05 October 2021.
Yattoo GH, Tabish AM. The profile of head injuries and traumatic brain injury deaths in Kashmir. J Trauma Manag Outcomes. 2008;2:5.
Channabasavanna S, Guruaj G, Das B. Epidemiology of head injuries in Bangalore. Natl Ins Ment Health Neurosci. 1993.
Global Status Report on Road Safety; 2013. Available at: http://www.who.int/violence_injury_prevention/road_safety_status/2013/en/. Accessed on 05 October 2021.
Shameem A, Shabbir K, Deepak A, Sharma BS. Out come in Head Injured patients : Experience at a level 1 Trauma Centre. Indian J Neurotrau. 2009; 6(2):119-22.
Nupur P. Magnitude of pedestrian head injuries & fatalities in Bangalore, south India: A retrospective study from an apex neurotraumacenter. Indian J Med Res. 2012;136:1039-43.
Chen W, Yang J, Li B, Peng G, Li T, Li L, Wang S. 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.
Cederberg D, Siesjo P. What has inflammation to do with traumatic brain injury?. Childs Nerv Syst. 2010;26:221-6.
Winkler EA, Minter D, Yue JK, Manley GT. Cerebral edema in traumatic brain injury: pathophysiology and prospective therapeutic targets. Neurosurg Clin N Am. 2016;27:473-488.
Stocchetti N., Maas A.I. Traumatic intracranial hypertension. N Eng J Med. 2014;370:2121-30.
Shlosberg D, Benifla M, Kaufer D, Friedman A. Blood-brain barrier breakdown as a therapeutic target in traumatic brain injury. Nat Rev Neurol. 2010;6(7):393-403.
Loane DJ, Kumar A, Stoica BA. Progressive neurodegeneration after experimental brain trauma: association with chronic microglial activation. J Neuropathol Exp Neurol. 2014;73:14-29.
Morganti-Kossmann MC, Satgunaseelan L, Bye N. Modulation of immune response by head injury. Injury. 2007;38:1392-400.
Shetty AK, Mishra V, Kodali M, Hattiangady B. Blood brain barrier dysfunction and delayed neurological deficits in mild traumatic brain injury induced by blast shock waves. Front Cell Neurosci. 2014;8:232.
Yeoh S, Bell ED, Monson KL. Distribution of blood-brain barrier disruption in primary blast injury. Ann Biomed Eng. 2013;41(10):2206-14.
Readnower RD, Chavko M, Adeeb S, Conroy MD, Pauly JR, McCarron RM, Sullivan PG. Increase in blood-brain barrier permeability, oxidative stress, and activated microglia in a rat model of blast-induced traumatic brain injury. J Neurosci Res. 2010;88(16): 3530-9.
McGirt MJ, Mavropoulos JC, McGirt LY, Alexander MJ, Friedman AH, Laskowitz DT, Lynch JR. Leukocytosis as an independent risk factor for cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;98(6): 1222-6.
Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149-63.
Corps KN, Roth TL, McGavern DB. Inflammation and neuroprotection in traumatic brain injury. JAMA Neurol. 2015;72(3):355-62.
Jassam YN, Izzy S, Whalen M, McGavern DB, El Khoury J. Neuroimmunology of Traumatic Brain Injury: Time for a Paradigm Shift. Neuron. 2017; 95(6):1246-65.
Roth TL, Nayak D, Atanasijevic T. Transcranial amelioration of inflammation and cell death after brain injury. Nature. 2014;505(7482):223.
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.
Schwartz M, Moalem G. Beneficial immune activity after CNS injury: prospects for vaccination. J Neuroimmunol. 2001;113(2):185-92.
Palm NR. Not so fast: adaptive suppression of innate immunity. Nat Med. 2007;13(10):1142.
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.
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.