To Kang-Wei, Hsu Shiun-Yuan, Yu Chia-Ying, Tsai Yu-Chin, Lin You-Cheng, Hsieh Ching-Hua
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung 83301, Taiwan.
Emerg Med Int. 2024 Dec 19;2024:8099416. doi: 10.1155/emmi/8099416. eCollection 2024.
White blood cell (WBC) subtypes reflect immune and inflammatory conditions in patients. This study aimed to examine the association between the ratio of platelets to WBC subtypes and mortality outcomes in patients with moderate-to-severe traumatic brain injury (TBI). The Trauma Registry System of the hospital was retrospectively reviewed to gather medical records of 2397 adult patients who were hospitalized from 2009 to 2020 and had moderate-to-severe TBI with a head abbreviated injury scale (AIS) score of 3 or higher. The monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were compared between the survivors ( = 2, 138) and nonsurvivors ( = 259). A multivariate logistic regression analysis was performed to investigate the independent effects of the univariate prognostic factors on mortality outcomes. The survival variations among the PLR subgroups were evaluated by the Kaplan-Meier survival analysis including a log-rank test. The PLR of the deceased patients was considerably lower than that of the survivors (129.5 ± 130.1 vs. 153.2 ± 102.1, < 0.001). However, no significant differences were observed in monocyte and neutrophil counts, MLR, or NLR between the deceased and survivor groups. A lower PLR was recognized as an independent risk factor for mortality (odds ratio: 1.26, 95% confidence interval: 1.06-1.51, =0.010). The receiver operating characteristic (ROC) established PLR as the most strong predictor among the three ratios (area under the ROC curve = 0.627, sensitivity = 0.846, and specificity = 0.382, according to the cut-off value = 68.57). When the patient groups were divided by PLR quartile, the Kaplan-Meier analysis showed significantly worse survival in the lowest PLR quartile group (< 83.1) compared with the highest quartile group (≥ 189.1) ( < 0.001). Lower PLR is associated with greater mortality in adult patients with moderate-to-severe TBI. PLR may be a valuable measure for classifying mortality risk in this population.
白细胞（WBC）亚型反映了患者的免疫和炎症状况。本研究旨在探讨中度至重度创伤性脑损伤（TBI）患者血小板与白细胞亚型比例与死亡率之间的关联。回顾性查阅了医院的创伤登记系统，收集了2009年至2020年住院的2397例成年患者的病历，这些患者患有中度至重度TBI，头部简明损伤量表（AIS）评分为3分或更高。比较了幸存者（n = 2138）和非幸存者（n = 259）之间的单核细胞与淋巴细胞比例（MLR）、中性粒细胞与淋巴细胞比例（NLR）以及血小板与淋巴细胞比例（PLR）。进行多因素逻辑回归分析，以研究单因素预后因素对死亡率的独立影响。通过包括对数秩检验的Kaplan-Meier生存分析评估PLR亚组之间的生存差异。死亡患者的PLR显著低于幸存者（129.5±130.1 vs. 153.2±102.1，P < 0.001）。然而，死亡组和存活组之间在单核细胞和中性粒细胞计数、MLR或NLR方面未观察到显著差异。较低的PLR被认为是死亡率的独立危险因素（比值比：1.26，95%置信区间：1.06 - 1.51，P = 0.010）。受试者工作特征（ROC）曲线确定PLR是三个比值中最强的预测指标（根据截断值 = 68.57，ROC曲线下面积 = 0.627，敏感性 = 0.846，特异性 = 0.382）。当根据PLR四分位数对患者组进行划分时，Kaplan-Meier分析显示，最低PLR四分位数组（< 83.1）的生存率明显低于最高四分位数组（≥ 189.1）（P < 0.001）。较低的PLR与中度至重度TBI成年患者的较高死亡率相关。PLR可能是该人群死亡率风险分类的一个有价值的指标。
