Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: The high outcome variability of TBI has created significant interest in prognostic indicators at admission for this condition. Due to the complex inflammatory response TBI causes, the prognostic value of inflammatory markers on admission has attracted considerable interest. The purpose of this study is to investigate the role of neutrophil percentage, lymphocyte percentage, and neutrophil-to-lymphocyte ratio on admission in predicting TBI outcomes via a retrospective chart review at a high-volume quaternary center.
Methods: TBI patients from January 1st-December 31st, 2017 were retrospectively reviewed at a Level 1 trauma center. Primary outcome included favorable discharge GCS (> 13). Optimal cutoff points for continuous variables were determined using Euclidean distance analysis onto favorable discharge GCS. General linear multivariable models adjusted for confounders, including age, gender, injury severity score, neurosurgical intervention, and admission GCS, were used.
Results: A total of 100 patients were included in the analysis (admission GCS range 4-15), of which 82 (82%) experienced a good clinical outcome. In the univariate analysis, those with good neurological outcome did not exhibit significantly lower admission neutrophil percent (77 sD 10 vs 74 sD 15, p = 0.97), lymphocyte percent (14 sD 8 vs 16 sD 12, p = 0.82), or NLR (8.2 sD 5.7 vs 8.8 sD 7.8, p = 0.87) when compared to those with poor neurological outcome. After multivariate adjustment independently for each cutoff, lymphocyte percent (OR 0.92, 95% CI [0.85, 0.99], p = 0.024) and lymphocyte percent >/= 21.0 (OR 0.09, 95% CI [0.01, 0.56], p = 0.013) became significant predictors of lower odds of good neurological outcome. NLR >/= 2.85 became a significant predictor of greater odds of good neurological outcome (OR 12.7, 95% CI [2.06, 99.5], p = 0.008).
Conclusion : The present study found admission lymphocyte percent and NLR to be significant predictors of good neurological outcome in TBI.
