Department of Microbiology and Immunology & Key Immunopathology Laboratory of Guangdong Province, Shantou University Medical College, Shantou, Guangdong, China.
Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Mediators Inflamm. 2020 Dec 28;2020:5483981. doi: 10.1155/2020/5483981. eCollection 2020.
To explore the potential of monocyte-to-lymphocyte ratio (MLR) at hospital admission for predicting acute traumatic intraparenchymal hematoma (tICH) expansion in patients with cerebral contusion. . This multicenter, observational study included patients with available at-hospital admission (baseline) and follow-up computed tomography for volumetric analysis (retrospective development cohort: 1146 patients; prospective validation cohort: 207 patients). Semiautomated software assessed tICH expansion (defined as ≥33% or 5 mL absolute growth). MLR was acquired from routine blood tests upon admission. We constructed two predictive models: basic combined model of clinical and imaging variables and MLR combined model of both MLR and other variables in the basic model. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were used to estimate the performance of MLR for predicting acute tICH expansion.
MLR was significantly larger in patients with acute tICH expansion compared to those without acute tICH expansion (mean [SD], 1.08 [1.05] vs. 0.59 [0.37], < 0.001). A nonlinear positive relationship between MLR and the incidence of acute tICH expansion was observed. Multivariate logistic regression indicated MLR as an independent risk factor for acute tICH expansion (odds ratio (OR), 5.88; 95% confidence interval (CI), 4.02-8.61). The power of the multivariate model for predicting acute tICH expansion was substantially improved with the inclusion of MLR (AUC 0.86 vs. AUC 0.74, < 0.001), as was also observed in an external validation cohort (AUC 0.83 vs. AUC 0.71, < 0.001). The net benefit of MLR model was higher between threshold probabilities of 20-100% in DCA. For clinical application, a nomogram derived from the multivariate model with MLR was introduced. In addition, MLR was positively associated with 6-month unfavorable outcome.
MLR is a novel predictor for traumatic parenchymatous hematoma expansion. A nomogram derived from the MLR model may provide an easy-to-use tool for predicting acute tICH expansion and promoting the individualized treatment of patients with hemorrhagic cerebral contusion. MLR is associated with long-term outcome after cerebral contusion.
探讨入院时单核细胞与淋巴细胞比值（MLR）预测脑挫裂伤患者急性创伤性脑实质血肿（tICH）扩大的潜力。这项多中心、观察性研究纳入了有入院时（基线）和随访 CT 容积分析（回顾性发展队列：1146 例；前瞻性验证队列：207 例）可用资料的患者。半自动软件评估 tICH 扩大（定义为≥33%或绝对增长 5 mL）。MLR 从入院时的常规血液检查中获得。我们构建了两个预测模型：临床和影像学变量的基本联合模型，以及 MLR 和基本模型中其他变量的 MLR 联合模型。接收者操作特征（ROC）分析和决策曲线分析（DCA）用于评估 MLR 预测急性 tICH 扩大的性能。
与无急性 tICH 扩大的患者相比，急性 tICH 扩大患者的 MLR 显著更大（平均值[标准差]，1.08[1.05] vs. 0.59[0.37]，<0.001）。观察到 MLR 与急性 tICH 扩大发生率之间呈非线性正相关关系。多变量逻辑回归表明 MLR 是急性 tICH 扩大的独立危险因素（优势比（OR），5.88；95%置信区间（CI），4.02-8.61）。包含 MLR 后，多变量模型预测急性 tICH 扩大的效能显著提高（AUC 0.86 与 AUC 0.74，<0.001），在外部验证队列中也观察到这一点（AUC 0.83 与 AUC 0.71，<0.001）。在 DCA 中，阈值概率在 20-100%之间，MLR 模型的净获益更高。对于临床应用，引入了一个基于包含 MLR 的多变量模型的列线图。此外，MLR 与 6 个月不良预后呈正相关。
MLR 是创伤性实质血肿扩大的一个新的预测指标。基于 MLR 模型的列线图可能为预测急性 tICH 扩大提供一种易于使用的工具，并促进脑出血性脑挫裂伤患者的个体化治疗。MLR 与脑挫裂伤后长期预后相关。
