Correlation of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Neurological Outcome in Moderate and Severe Traumatic Brain Injury Patients: Do they Improve upon the TBI Impact and Crash Diagnostic Models?

Background: We proposed to study (1) the correlation of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) with the neurologic outcome in moderate–to-severe head injury patients and (2) whether they improve the performance of the validated prognostic models available at present.

Materials and Methods: This prospective cohort study, conducted in a tertiary care neurosurgical center after ethical clearance, included patients, aged 18 to 60 years with moderate and severe isolated head injuries. Laboratory and clinical parameters were noted at admission and the extended Glasgow outcome score (GOSE) of the patients was assessed after 6 months. IMPACT and CRASH models were used to predict the outcome. Logistic regression, Pearson’s correlation, Spearman’s rank and Chi-square tests were used for analysis.

Results: Among the 96 patients included for analysis, the incidence of poor outcome was 59.38% and the mortality was 43.8%. The ability of NLR (AUROC = 0.58), PLR (AUROC = 0.58), and both combined (AUROC = 0.53) in predicting mortality, as well as neurologic outcome (AUROC: NLR = 0.47; PLR = 0.53; combined = 0.56) was insignificant. The agreement between the independently predicted neurologic outcome and mortality by NLR and PLR with IMPACT (NLR: p = 0.74; PLR: p = 0.39) and CRASH (NLR: p = 0.45; PLR: p = 0.79) models was poor.

Conclusions: NLR and PLR did not predict the neurologic outcome in moderate to severe head injury patients. Addition of these parameters to the standard TBI-IMPACT and CRASH prognostic models did not improve the predictive value of the models. In our study, the earlier validated prognostic models seem to have better predictive value than the NLR and PLR.

Publication History

Article published online:
25 March 2020