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. 2022 Oct 24:13:1021877.
doi: 10.3389/fneur.2022.1021877. eCollection 2022.

The prognostic value of neutrophil-to-lymphocyte ratio in patients with traumatic brain injury: A systematic review

Sherief Ghozy  1   2 , Amr Ehab El-Qushayri  3 , Joseph Varney  4 , Salah Eddine Oussama Kacimi  5 , Eshak I Bahbah  6 , Mostafa Ebraheem Morra  7 , Jaffer Shah  8 , Kevin M Kallmes  9   10 , Alzhraa Salah Abbas  3 , Mohamed Elfil  11 , Badrah S Alghamdi  12   13 , Ghulam Ashraf  14 , Rowa Alhabbab  15   16 , Adam A Dmytriw  17   18
Affiliations

The prognostic value of neutrophil-to-lymphocyte ratio in patients with traumatic brain injury: A systematic review

Sherief Ghozy et al. Front Neurol. .

Abstract

Traumatic brain injury (TBI) places a heavy load on healthcare systems worldwide. Despite significant advancements in care, the TBI-related mortality is 30-50% and in most cases involves adolescents or young adults. Previous literature has suggested that neutrophil-to-lymphocyte ratio (NLR) may serve as a sensitive biomarker in predicting clinical outcomes following TBI. With conclusive evidence in this regard lacking, this study aimed to systematically review all original studies reporting the effectiveness of NLR as a predictor of TBI outcomes. A systematic search of eight databases was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement (PRISMA) recommendations. The risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Eight studies were ultimately included in the study. In most of the studies interrogated, severity outcomes were successfully predicted by NLR in both univariate and multivariate prediction models, in different follow-up durations up to 6 months. A high NLR at 24 and 48 h after TBI in pediatric patients was associated with worse clinical outcomes. On pooling the NLR values within studies assessing its association with the outcome severity (favorable or not), patients with favorable outcomes had 37% lower NLR values than those with unfavorable ones (RoM= 0.63; 95% CI = 0.44-0.88; p = 0.007). However, there were considerable heterogeneity in effect estimates (I 2 = 99%; p < 0.001). Moreover, NLR was a useful indicator of mortality at both 6-month and 1-year intervals. In conjunction with clinical and radiographic parameters, NLR might be a useful, inexpensive marker in predicting clinical outcomes in patients with TBI. However, the considerable heterogeneity in current literature keeps it under investigation with further studies are warranted to confirm the reliability of NLR in predicting TBI outcomes.

Keywords: mortality; neutrophil-to-lymphocyte ratio; prediction; systematic (literature) review; traumatic brain injury.

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Conflict of interest statement

KK was employed by Nested Knowledge. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Comparison of neutrophil-lymphocyte ratio (NLR) in patients with favorable outcomes to those with unfavorable ones.
Figure 3
Figure 3
Underlying pathophysiology of traumatic brain injury. DAMPs, Damage-associated molecular patterns; iNOS, inducible nitric oxyde synthase; MP-TF, micro particles tissue factor; ROS, reactive oxygen species; SIRS, systemic inflammatory response syndrome; tPA, tissue plasminogene activator.
See this image and copyright information in PMC

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