Neutrophil-Lymphocyte Ratio (NLR) as an output-outcome predictor in moderate-severe head injury at Sanglah General Hospital, Denpasar, Indonesia

Melissa Krisanty; Tjokorda Gde Bagus Mahadewa; I Wayan Niryana; I Nyoman Semadi; I Gede Suwedagatha; I Gusti Agung Bagus Krisna Wibawa

doi:10.15562/ism.v12i2.1060

Neutrophil-Lymphocyte Ratio (NLR) as an output-outcome predictor in moderate-severe head injury at Sanglah General Hospital, Denpasar, Indonesia

Melissa Krisanty ,

Tjokorda Gde Bagus Mahadewa ,

I Wayan Niryana ,

I Nyoman Semadi ,

I Gede Suwedagatha ,

I Gusti Agung Bagus Krisna Wibawa ,

PDF |
DOI: https://doi.org/10.15562/ism.v12i2.1060 |
Published: 2021-08-10

Abstract

Background: This prospective cohort study aims to determine the best cut point value and the ability to predict Neutrophil Lymphocyte Ratio (NLR), analyze the most dominant factors, and the direct influence of the NLR to output and outcome in moderate and severe trauma to the head injury at Sanglah General Hospital, Denpasar, Indonesia.

Methods: This study was an observational analytic with a prospective cohort design. The subjects of this study were head injury patients over 16 years old with Glasgow Coma Scale (GCS) ? 12 who visited and were treated at Sanglah General Hospital, Denpasar, Indonesia. Patients less than 16 years old, history of alcohol intoxication, stroke, metabolic disease, and multiple traumas were not included as research subjects. Data were analyzed using SPSS version 20 for Windows.

Results: The research conducted on 49 respondents found that the best cut-off point of NLR was 6.05 has the most significant predictor (OR=7.6; p=0.001) and dominant (OR=64.97; p=0.002) factors to the output-outcome predictor in moderate-severe head injury. In addition, this cut-off value (6.05) also has a direct influence (x-value=0.523) in the occurrence of output and outcome unfavorable in moderate-severe head injury.

Conclusion: the cut-off NLR values of 6.05 became the dominant predictor that directly affected the output and outcome unfavorable in moderate-severe head injury.

References

Stocchetti N, Carbonara M, Citerio G, Ercole A, Skrifvars MB, Smielewski P, et al. Severe traumatic brain injury: targeted management in the intensive care unit. Lancet Neurol. 2017;16(6):452-464.
Golden N, Mardhika PE, Niryana W, Sukarya IM, Prabawa IPY. Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis. 2020;11(3):699- 705.
Hazeldine J, Lord JM, Belli A. Traumatic Brain Injury and Peripheral Immune Suppression: Primer and Prospectus. Front Neurol. 2015;6:235.
Marks W, Golabek-Dropiewska K, Bryl E, Dudek R, Wieruszewski J, Stasiak M, et al. Immunomonitoring in patients with early moderate and severe head trauma. Cent Eur J Public Health. 2013;38(4):494-499.
Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.
Wiranata S, Anjani IAW, Saputra IPGS, Sadvika IGAS, Prabawa IPY, Supadmanaba IG, et al. Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as a Stage Determination in Breast Cancer. Open Access Maced J Med Sci. 2020;8(B):1058-1063.
Subramanian A, Agrawal D, Pandey RM, Nimiya M, Albert V, et al. The Leukocyte Count, Immature Granulocyte Count and Immediate Outcome in Head Injury Patients, Brain Injury-Pathogenesis, Monitoring, Recovery and Management. In: AGRAWAL, P. A. (ed.). InTech. 2012, p. 139-152.
Liao Y, Liu P, Guo F, Zhang ZY, Zhang Z. Oxidative burst of circulating neutrophils following traumatic brain injury in human. PLoS One. 2013;8(7):e68963.
Junger WG, Rhind SG, Rizoli SB, Cuschieri J, Baker AJ, Shek PN, et al. Prehospital hypertonic saline resuscitation attenuates the activation and promotes apoptosis of neutrophils in patients with severe traumatic brain injury. Shock. 2013;40(5):366-74.
Wolach B, Sazbon L, Gavrieli R, Broda A, Schlesinger M. Early immunological defects in comatose patients after acute brain injury. J Neurosurg. 2001;94(5):706-711.
Zhang Z, Zoltewicz JS, Mondello S, Newsom KJ, Yang Z, Yang B, et al. Human traumatic brain injury induces autoantibody response against glial fibrillary acidic protein and its breakdown products [published correction appears in PLoS One. 2014;9(6):e101712]. PLoS One. 2014;9(3):e92698.
Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol. 2008;101(6):747-52.
Kastilong M, Subrata II, Tangkudung G, Khosama H. Rasio Neutrofil Limfosit dan Luaran Cedera Kepala. Jurnal Sinaps. 2018;1(2):20-28.

[1] Stocchetti N, Carbonara M, Citerio G, Ercole A, Skrifvars MB, Smielewski P, et al. Severe traumatic brain injury: targeted management in the intensive care unit. Lancet Neurol. 2017;16(6):452-464.

[2] Golden N, Mardhika PE, Niryana W, Sukarya IM, Prabawa IPY. Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis. 2020;11(3):699- 705.

[3] Hazeldine J, Lord JM, Belli A. Traumatic Brain Injury and Peripheral Immune Suppression: Primer and Prospectus. Front Neurol. 2015;6:235.

[4] Marks W, Golabek-Dropiewska K, Bryl E, Dudek R, Wieruszewski J, Stasiak M, et al. Immunomonitoring in patients with early moderate and severe head trauma. Cent Eur J Public Health. 2013;38(4):494-499.

[5] Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.

[6] Wiranata S, Anjani IAW, Saputra IPGS, Sadvika IGAS, Prabawa IPY, Supadmanaba IG, et al. Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as a Stage Determination in Breast Cancer. Open Access Maced J Med Sci. 2020;8(B):1058-1063.

[7] Subramanian A, Agrawal D, Pandey RM, Nimiya M, Albert V, et al. The Leukocyte Count, Immature Granulocyte Count and Immediate Outcome in Head Injury Patients, Brain Injury-Pathogenesis, Monitoring, Recovery and Management. In: AGRAWAL, P. A. (ed.). InTech. 2012, p. 139-152.

[8] Liao Y, Liu P, Guo F, Zhang ZY, Zhang Z. Oxidative burst of circulating neutrophils following traumatic brain injury in human. PLoS One. 2013;8(7):e68963.

[9] Junger WG, Rhind SG, Rizoli SB, Cuschieri J, Baker AJ, Shek PN, et al. Prehospital hypertonic saline resuscitation attenuates the activation and promotes apoptosis of neutrophils in patients with severe traumatic brain injury. Shock. 2013;40(5):366-74.

[10] Wolach B, Sazbon L, Gavrieli R, Broda A, Schlesinger M. Early immunological defects in comatose patients after acute brain injury. J Neurosurg. 2001;94(5):706-711.

[11] Zhang Z, Zoltewicz JS, Mondello S, Newsom KJ, Yang Z, Yang B, et al. Human traumatic brain injury induces autoantibody response against glial fibrillary acidic protein and its breakdown products [published correction appears in PLoS One. 2014;9(6):e101712]. PLoS One. 2014;9(3):e92698.

[12] Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol. 2008;101(6):747-52.

[13] Kastilong M, Subrata II, Tangkudung G, Khosama H. Rasio Neutrofil Limfosit dan Luaran Cedera Kepala. Jurnal Sinaps. 2018;1(2):20-28.

Neutrophil-Lymphocyte Ratio (NLR) as an output-outcome predictor in moderate-severe head injury at Sanglah General Hospital, Denpasar, Indonesia

Abstract

References

How to Cite

Search Panel