Division of Neurosurgery, Department of Surgery, Santa Casa of São Paulo School of Medical Sciences, São Paulo, Brazil.
Neurotrauma Research Group of the Neurosurgery Course, Department of Surgery, Santa Casa of São Paulo School of Medical Sciences, R. Cesário Mota Júnior, Vila Buarque. CEP 01270-900, São Paulo, SP, 112, Brazil.
Childs Nerv Syst. 2024 Dec;40(12):4251-4257. doi: 10.1007/s00381-024-06556-9. Epub 2024 Jul 30.
An inflammatory cascade associated with the systemic neutrophil response can be triggered after traumatic brain injury (TBI), causing neuronal dysfunction, which is considered to be related to the prognosis of the victims. The scope of this research is to identify the performance of the neutrophil-lymphocyte ratio (NLR) as a predictor of prognosis considering TBI severity and death as outcomes in a group of pediatric patients.
We retrospectively evaluated NLR through a consecutive review of the medical records (cross-sectional study) of children and adolescents aged < 17 years victims of TBI. To determine the highest NLR value identified as a predictor, different cutoff points were tested for each outcome. The cutoff points were defined based on the area under curve (AUC) of the receiver operating characteristic (ROC).
Among the 82 children with TBI included in the sample, the performance of AUC-ROC was 0.72 when evaluating NLR as a predictor of TBI severity, with NLR cutoff point of 3, and 0.76 when considering mortality as the outcome, with an increase in the cutoff point to 11.
NLR can be considered a biomarker of brain injury in children and adolescent victims of TBI. Patients with NLR ≥ 3 had a fivefold higher probability of severe TBI and patients with NLR ≥ 11 experienced a ninefold higher risk of death.
创伤性脑损伤 (TBI) 后可引发与全身中性粒细胞反应相关的炎症级联反应，导致神经元功能障碍，这被认为与受害者的预后有关。本研究的目的是确定中性粒细胞与淋巴细胞比值 (NLR) 在预测 TBI 严重程度和死亡结局方面的表现，将其作为一组儿科患者的预后预测因子。
我们通过对 TBI 儿童和青少年 (<17 岁) 患者的病历进行连续回顾（横断面研究），对 NLR 进行回顾性评估。为了确定作为预测因子的最高 NLR 值，我们对每个结局进行了不同的截断值测试。基于受试者工作特征曲线（ROC）的曲线下面积 (AUC) 定义了截断值。
在纳入样本的 82 名 TBI 患儿中，NLR 预测 TBI 严重程度的 AUC-ROC 性能为 0.72，截断值为 3，当考虑死亡率为结局时，AUC-ROC 性能为 0.76，截断值增加到 11。
NLR 可被视为 TBI 儿童和青少年患者脑损伤的生物标志物。NLR≥3 的患者发生严重 TBI 的可能性增加五倍，NLR≥11 的患者死亡风险增加九倍。
