The neutrophil-to-lymphocyte ratio: A potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury

Jinghong Xu; Shuhe Li; Ka Yin Lui; Xiaodong Song; Xiaoguang Hu; Lu Cao; Yanping Zhu; Fa Huang; Xiaobin Lin; Changjie Cai

doi:10.3389/fsurg.2022.917172

The neutrophil-to-lymphocyte ratio: A potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury

Front Surg. 2022 Aug 23:9:917172. doi: 10.3389/fsurg.2022.917172. eCollection 2022.

Authors

Jinghong Xu¹, Shuhe Li¹, Ka Yin Lui¹, Xiaodong Song¹, Xiaoguang Hu¹, Lu Cao², Yanping Zhu¹, Fa Huang³, Xiaobin Lin⁴, Changjie Cai¹

Affiliations

¹ Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
² Department of Extracorporeal Circulation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³ Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
⁴ Department of Pharmacology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Abstract

Purpose: This study aimed to determine the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in critically ill trauma patients.

Methods: This retrospective study involved adult trauma patients from 335 intensive care units (ICUs) at 208 hospitals stored in the eICU database. The primary outcome was ICU mortality. The lengths of ICU and hospital stay were calculated as the secondary outcomes. The multivariable logistic regression model was used to identify independent predictors of mortality. To identify the effect of the NLR on survival, a 15-day survival curve was used.

Results: A total of 3,865 eligible subjects were enrolled in the study. Univariate analysis showed that patients in the group with a higher NLR were more likely to receive aggressive methods of care delivery: mechanical ventilation, vasopressor, and antibiotics ( P < 0.001 for all). The ICU, in-hospital, and 15-day mortality rates of the four groups increased in turn (P < 0.001 for all). The multivariable logistic Cox regression model indicated that a higher NLR was an independent risk factor of ICU mortality in trauma patients. ROC analysis showed that the NLR had better predictive capacity on the mortality of patients with traumatic brain injury (TBI) than those with trauma (AUC 0.725 vs. 0.681). An NLR > 7.44 was an independent risk factor for ICU death in patients with TBI (OR: 1.837, 95% CI: 1.045-3.229) and TBI victims whose NLR > 7.44 had a 15-day survival disadvantage (P = 0.005).

Conclusion: A high NLR is associated with a poor prognosis in trauma patients, even worse in patients with TBI. An NLR > 7.44 is an independent risk factor for death in patients with TBI.

Keywords: intensive care unit mortality; intensive care unit stay; neutrophil to lymphocyte ratio; trauma; traumatic brain injury.