Clinical value of NLR, PLR and their combined indicators in predicting the prognosis of traumatic brain injury and the construction of prognostic model

doi:10.3877/cma.j.issn.2095-9141.2021.05.003

Abstract

Abstract:

Objective

To study the changes of biochemical and inflammatory indicators in patients with traumatic brain injury (TBI), and to explore the predictive value of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) on prognosis of patients.

Methods

The general data of 132 patients with TBI admitted to Neurosurgery Department of Jining First People’s Hospital from January 2019 to January 2020 were analyzed retrospectively. According to the GOS score 6 months after injury, the patients were divided into good prognosis group (91 cases) and poor prognosis group (41 cases). The general clinical data and laboratory examination indicators were collected to analyze whether there were any differences in NLR and PLR between the two groups. Multivariate logistic regression was used to analyze the independent risk factors affecting the poor prognosis of TBI. The prognosis model was constructed, and the predictive value of NLR and PLR alone and combined indicators on the prognosis of patients was obtained by receiver operating characteristic curve (ROC) analysis.

Results

There were significant differences in NLR and PLR between the two groups (P<0.05). Multivariate regression analysis showed that age, admission GCS score, NLR and PLR were independent risk factors for poor prognosis at 6 months after injury in TBI patients (P<0.05). According to the independent risk factors obtained in this study, the patient prognosis model was constructed. Model 1: age+GCS score; Model 2: age+GCS score+NLR; Model 3: age+GCS score+PLR; Model 4: age+GCS score+NLR. The ROC curve analysis showed that the area under curve (AUC) of each model were 0.685, 0.822, 0.671 and 0.864 respectively. The AUC of model 4 is the largest, which indicates that the prediction accuracy of model 4 is the highest.

Conclusion

NLR, PLR and their combined indicators have certain predictive value for the prognosis of TBI patients. The greater the NLR and PLR values, the greater the possibility of poor prognosis in 6 months of TBI patients. The accuracy of NLR, PLR combined with age and GCS score in predicting the prognosis of TBI patients is significantly improved.

Key words: Traumatic brain injury, Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio, Prognosis

Haoyang Chen, Lei Feng. Clinical value of NLR, PLR and their combined indicators in predicting the prognosis of traumatic brain injury and the construction of prognostic model[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(05): 266-270.

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References 20

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项目		预后良好组（n=91）	预后不良组（n=41）	χ²/t值	P值
性别[例（%）]				0.644	0.422
	男	62（68.1）	25（61.0）
	女	29（31.9）	16（39.0）
年龄（岁，±s）		51.21±14.45	59.44±12.29	2.932	0.004
冠心病史[例（%）]		11（12.1）	8（19.5）	1.264	0.261
糖尿病史[例（%）]		10（11.0）	8（19.5）	1.744	0.187
高血压史[例（%）]		19（20.9）	13（31.7）	1.427	0.232
入院时GCS评分（分，±s）		10.89±2.14	7.29±2.65	7.645	<0.001
入院时收缩压（mmHg，±s）		135.67±16.82	140.37±21.32	1.246	0.217
入院时舒张压（mmHg，±s）		84.31±13.19	82.73±12.27	0.649	0.518
瞳孔对光反射迟钝[例（%）]		16（17.6）	26（63.4）	27.368	<0.001
入院血糖（mmol/L，±s）		7.62±1.56	9.53±1.94	6.013	<0.001
纤维蛋白原（g/L，±s）		2.37±0.67	2.23±0.55	1.112	0.269
部分活化凝血酶时间（s，±s）		25.16±3.44	25.35±4.57	0.234	0.816

项目		预后良好组（n=91）	预后不良组（n=41）	χ²/t值	P值
性别[例（%）]				0.644	0.422
	男	62（68.1）	25（61.0）
	女	29（31.9）	16（39.0）
年龄（岁，±s）		51.21±14.45	59.44±12.29	2.932	0.004
冠心病史[例（%）]		11（12.1）	8（19.5）	1.264	0.261
糖尿病史[例（%）]		10（11.0）	8（19.5）	1.744	0.187
高血压史[例（%）]		19（20.9）	13（31.7）	1.427	0.232
入院时GCS评分（分，±s）		10.89±2.14	7.29±2.65	7.645	<0.001
入院时收缩压（mmHg，±s）		135.67±16.82	140.37±21.32	1.246	0.217
入院时舒张压（mmHg，±s）		84.31±13.19	82.73±12.27	0.649	0.518
瞳孔对光反射迟钝[例（%）]		16（17.6）	26（63.4）	27.368	<0.001
入院血糖（mmol/L，±s）		7.62±1.56	9.53±1.94	6.013	<0.001
纤维蛋白原（g/L，±s）		2.37±0.67	2.23±0.55	1.112	0.269
部分活化凝血酶时间（s，±s）		25.16±3.44	25.35±4.57	0.234	0.816

组别	例数	血常规（×10⁹/L）				NLR	PLR
组别	例数	WBC	NE	LY	Plt	NLR	PLR
预后良好组	91	10.57（8.16，15.58）	8.48（5.59，13.57）	1.58（1.25，1.99）	211（180，241）	5.52（3.42，8.65）	127.04（103.52，164.13）
预后不良组	41	15.25（11.14，20.52）	12.81（9.64，17.42）	0.77（0.44，0.98）	174（155，238）	18.45（11.42，27.24）	255.88（182.04，401.79）
Z值		3.851	4.155	7.692	1.226	8.190	7.035
P值		<0.001	<0.001	<0.001	0.168	<0.001	<0.001

组别	例数	血常规（×10⁹/L）				NLR	PLR
组别	例数	WBC	NE	LY	Plt	NLR	PLR
预后良好组	91	10.57（8.16，15.58）	8.48（5.59，13.57）	1.58（1.25，1.99）	211（180，241）	5.52（3.42，8.65）	127.04（103.52，164.13）
预后不良组	41	15.25（11.14，20.52）	12.81（9.64，17.42）	0.77（0.44，0.98）	174（155，238）	18.45（11.42，27.24）	255.88（182.04，401.79）
Z值		3.851	4.155	7.692	1.226	8.190	7.035
P值		<0.001	<0.001	<0.001	0.168	<0.001	<0.001

变量	回归系数	标准误	Wald χ²值	OR值	95%CI
入院GCS评分	-0.885	0.271	10.686	0.421	0.243~0.701
NLR	0.293	0.110	7.095	1.335	1.081~1.664
PLR	0.023	0.009	7.210	1.021	1.006~1.041
年龄	0.089	0.043	4.370	1.087	1.006~1.189

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