Platelet-Lymphocyte and Neutrophil-Lymphocyte Ratio for Prediction of Hospital Outcomes in Patients with Abdominal Trauma

Abstract

Background. The platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) reflect the patient inflammatory and immunity status. We investigated the role of on-admission PLR and NLR in predicting massive transfusion protocol (MTP) activation and mortality following abdominal trauma. Methods. A 4-year retrospective analysis of all adult abdominal trauma patients was conducted. Patients were classified into survivors and nonsurvivors and low vs. high PLR. The discriminatory power for PLR and NLR to predict MTP and mortality was determined. Multivariate logistic regression analysis was performed for predictors of mortality. Results. A total of 1199 abdominal trauma patients were included (18.7% of all the trauma admissions). Low PLR was associated with more severe injuries and greater rates of hospital complications including mortality in comparison to high PLR. On-admission PLR and NLR were higher in the survivors than in nonsurvivors (149.3 vs. 76.3 ( p = 0.001 ) and 19.1 vs. 13.7 ( p = 0.009 ), respectively). Only PLR significantly correlated with injury severity score, revised trauma score, TRISS, serum lactate, shock index, and FASILA score. Optimal cutoffs of PLR and NLR for predicting mortality were 98.5 and 18.5, respectively. The sensitivity and specificity of PLR were 81.3% and 61.1%, respectively, and 61.3% and 51.3%, respectively, for NLR. The AUROC for predicting MTP was 0.69 (95% CI: 0.655–0.743) for PLR and 0.55 (95% CI: 0.510–0.598) for NLR. To predict hospital mortality, the area under the curve (AUROC) for PLR was 0.77 (95% CI: 0.712–0.825) and 0.59 (95% CI: 0.529–0.650) for the NLR. On multivariate logistic regression analysis, the age, Glasgow Coma Scale, sepsis, injury severity score, and PLR were independent predictors of mortality. Conclusion. On-admission PLR but not NLR helps early risk stratification and timely management and predicts mortality in abdominal trauma patients. Further prospective studies are required.

Identification of Immune-Related Genes Concurrently Involved in Critical Illnesses Across Different Etiologies: A Data-Driven Analysis

“…The neutrophil/lymphocyte ratio and monocyte/high-density lipoprotein cholesterol ratio trend to an elevated level in non-surviving patients with sepsis, and evaluation of the neutrophil/lymphocyte ratio together with monocyte/high-density lipoprotein cholesterol ratio is an independent risk factor for increased mortality ( 25 ). In abdominal trauma patients, on-admission platelet/lymphocyte ratio but not neutrophil/lymphocyte ratio helps early risk stratification and timely management and predicts mortality ( 26 ). Abnormal CD4+ and CD8+ T cell responses are major components of a dysregulated acquired immune response, and the immune dysfunction of Tregs also contributes to pathogenesis ( 27 ).…”

Association of White Blood Cell Subtypes and Derived Ratios with a Mortality Outcome in Adult Patients with Polytrauma

“…Under severe trauma, the deactivation of monocytes is correlated with the injury severity of the patients [ 30 ], leading to immunocompetence of the cells with a profound loss of antigen-presenting ability [ 31 ]. However, although MLR, NLR, and PLR have been implicated as useful biomarkers for trauma patients in some studies [ 32 , 33 , 34 , 35 ], this study of propensity score-matched patient populations with polytrauma revealed that there was no significant difference in the counts of monocytes, neutrophils, and platelets, as well as in MLR, NLR, and PLR between patients who died and survived. In contrast, patients who died had a significantly higher lymphocyte count than the survivors.…”

Increased neutrophil-to-lymphocyte ratio is associated with unfavorable functional outcomes in acute pontine infarction

“…The neutrophil-to-lymphocyte ratio (NLR) combines information on neutrophils and lymphocytes and is less affected than other indices by physiological factors, specimen handling and other factors; it is also inexpensive and easy to obtain and produces relatively stable results. Recently, many studies confirmed the association between this indicator and multiple diseases, including acute coronary syndrome, cancer, and neuromyelitis optica spectrum disorder, and showed that the NLR has high clinical application value [ 7 – 10 ]. Relevant studies have found that the NLR may be an independent predictor of unfavorable prognosis and early death in patients with acute cerebral infarction [ 11 – 13 ].…”