Dynamic changes of neutrophil to lymphocyte ratio in patients with severe traumatic brain injury and the construction of prognostic model
Liu Jianyu
Wang Yongqian
Wang Weiping
Abstract：Objective To investigate the changes of neutrophil to lymphocyte ratio(NLR) in patients with severe traumatic brain injury (sTBI) within 7 days after admission;to construct a prediction model for 6-month prognosis based on logistic regression results.Methods From January 2014 to January 2018,261 patients with sTBI in Longhua Hospital,Shanghai University of Traditional Chinese Medicine were retrospectively analyzed.NLR values in 7 days after admission were collected.According to Glasgow Outcome Scale (GOS) score at 6 months after discharge,all patients were divided into good prognosis group (GOS score≥4) and poor prognosis (GOS score ＜ 4) group.Dynamic characteristics of NLR after admission and risk factors of 6-month prognosis were analyzed.A prediction model for 6-month prognosis was established.The accuracy of the model was evaluated by multivariate logistic regression and receiver operating characteristic curve.Results The 6-month follow-up rate was 100％.Among them,59 patients had poor prognosis and 202 patients had good prognosis.NLR values in 6 days after admission in poor prognosis group were significantly higher than those in good prognosis group (P ＜ 0.01).The peak value of NLR appeared at the 3rd day after admission in both groups.Multivariate logistic regression showed that hith age,low GCS score at admission(low),high NLR at the 1st and 3rd days after admission(NLR-1 d,NLR-3 d) were independent risk factors of poor prognosis(all P ＜ 0.01).Areas under the curve(AUC) of age,GCS score at admission,NLR-1 d and NLR-3 d were 0.720(95％ confidence interval:0.665-0.772),0.796(95％ confidence interval:0.745-0.841),0.760(95％ confidence interval:0.708-0.809) and 0.780(95％ confidence interval:0.727-0.829).The prognostic prediction model was constructed based on the 4 risk factors.Model 1:age + GCS score at admission;Model 2:Age + GCS score at admission + NLR-1 d;Model 3:age+GCS score at admission + NLR-3 d;Model 4:age +GCS score at admission + NLR-1 d + NLR-3 d.Model 4 showed the best accuracy(AUC:0.978 for Model 4 ＞ 0.932 for Model 3 ＞ 0.853 for Model 2 ＞ 0.824 for Model 1).Conclusions NLR values at the 1st and 3rd days after admission are independent risk factors of poor prognosis in patients with sTBI.NLR combined with age and GCS score shows high accuracy in predicting the
Keywords：Severe traumatic brain injuryNeutrophil to lymphocyte ratioPrognosis
Publication Date：2019-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1656-1660 )