Hematoma expansion (HE) typically portends a poor prognosis in spontaneous intracerebral hemorrhage (ICH). Several radiographic and laboratory values have been proposed as predictive markers of HE.

To perform a systematic review and meta-analysis on the association of neutrophil-to-lymphocyte ratio (NLR) and HE in ICH. A secondary outcome examined was the association of NLR and perihematomal (PHE) growth.

Three databases were searched (PubMed, EMBASE, and Cochrane) for studies evaluating the effect of NLR on HE and PHE growth. The inverse variance method was applied to estimate an overall effect for each specific outcome by combining weighted averages of the individual studies’ estimates of the logarithm odds ratio (OR). Given heterogeneity of the studies, a random effect was applied. Risk of bias was analyzed using the Newcastle-Ottawa Scale. The study was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The protocol was registered in PROSPERO (No. CRD42024549924).

Eleven retrospective cohort studies involving 2953 patients were included in the meta-analysis. Among those, HE was investigated in eight studies, whereas PHE growth was evaluated in three. Blood sample was obtained on admission in ten studies, and at 24 hours in one study. There was no consensus on cut-off value among the studies. NLR was found to be significantly associated with higher odds of HE (OR = 1.09, 95%CI: 1.04-1.15, I² = 86%, P < 0.01), and PHE growth (OR = 1.28, 95%CI: 1.19-1.38, I² = 0%, P < 0.01). Qualitative analysis of each outcome revealed overall moderate risk of bias mainly due to lack of control for systemic confounders.

The available literature suggests that a possible association may exist between NLR on admission and HE, and PHE growth. Future studies controlled for systemic confounders should be designed to consolidate this finding. If confirmed, NLR could be added as a readily available and inexpensive biomarker to identify a subgroup of patients at higher risk of developing HE.

• Neutrophil-to-lymphocyte ratio
• Hematoma expansion
• Perihematomal growth
• Intracerebral hemorrhage
• Hemorrhagic stroke

• Glasgow outcome scale
• Traumatic brain injury
• biomarker
• clinical outcomes
• red cell distribution width to lymphocyte ratio

• Humans
• Brain Injuries, Traumatic/blood
• Male
• Female
• Adult
• Retrospective Studies
• Erythrocyte Indices
• Middle Aged
• Young Adult
• Lymphocytes
• Glasgow Coma Scale
• Glasgow Outcome Scale
• Prognosis
• Lymphocyte Count

• MRI variables
• Novel inflammatory indicators
• Traumatic spinal cord injury

• Humans
• Spinal Cord Injuries/diagnostic imaging
• Spinal Cord Injuries/blood
• Female
• Magnetic Resonance Imaging
• Neutrophils
• Middle Aged
• Male
• Prognosis
• Adult
• Lymphocytes
• Cervical Vertebrae/diagnostic imaging
• Aged
• Retrospective Studies
• Lymphocyte Count
• Cervical Cord/diagnostic imaging
• Cervical Cord/injuries

• biomarker
• mortality
• neutrophil-to-lymphocyte ratio
• systemic immune-inflammation index
• traumatic brain injury

• Humans
• Male
• Brain Injuries, Traumatic/blood
• Brain Injuries, Traumatic/mortality
• Brain Injuries, Traumatic/immunology
• Female
• Middle Aged
• Adult
• Prognosis
• Neutrophils
• Retrospective Studies
• Critical Illness
• Aged
• Lymphocytes
• Adolescent
• Aged, 80 and over
• Blood Platelets
• Young Adult
• Platelet Count
• Inflammation/blood
• ROC Curve
• Intensive Care Units/statistics & numerical data
• Lymphocyte Count
• Predictive Value of Tests

• blood–brain barrier
• central neurological disorders
• ferroptosis
• neuroinflammation

• 82271409, 81971163, 82293650, 82293651 National Natural Science Foundation of China
• JYFY-23KF002 Open project of Hebei Key Laboratory of Forensic Medcine
• SR13450121 the outstanding young backbone teacher of the "Blue Project" in Jiangsu Province
• PAPD the Priority Academic Program Development of Jiangsu Higher Education Institutions

• cerebral contusion
• inflammatory index
• long-term unfavorable prognosis
• monocyte-to-lymphocyte ratio
• neutrophil-to-lymphocyte ratio
• traumatic brain injury

• Humans
• Male
• Middle Aged
• Female
• Neutrophils
• Monocytes
• Retrospective Studies
• Prospective Studies
• Brain Contusion
• Lymphocytes
• Prognosis

• Cranioplasty
• Decompressive craniectomy
• Neutrophil-to-lymphocyte ratio
• Outcome
• Traumatic brain injury

• Acute traumatic spinal cord injury
• Neutrophils
• Novel inflammatory indicators
• Predictive

• Humans
• Retrospective Studies
• Prognosis
• Lymphocytes
• Blood Platelets
• Spinal Cord Injuries
• Spinal Injuries

• Biomarkers
• Inflammation
• Status epilepticus
• Systemic inflammatory response syndrome

• Glasgow Outcome Scale
• carbon dioxide
• nomogram
• prognosis
• system immune inflammation index
• traumatic brain injury

Traumatic brain injury (TBI) places a heavy load on healthcare systems worldwide. Despite significant advancements in care, the TBI-related mortality is 30–50% and in most cases involves adolescents or young adults. Previous literature has suggested that neutrophil-to-lymphocyte ratio (NLR) may serve as a sensitive biomarker in predicting clinical outcomes following TBI. With conclusive evidence in this regard lacking, this study aimed to systematically review all original studies reporting the effectiveness of NLR as a predictor of TBI outcomes. A systematic search of eight databases was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement (PRISMA) recommendations. The risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Eight studies were ultimately included in the study. In most of the studies interrogated, severity outcomes were successfully predicted by NLR in both univariate and multivariate prediction models, in different follow-up durations up to 6 months. A high NLR at 24 and 48 h after TBI in pediatric patients was associated with worse clinical outcomes. On pooling the NLR values within studies assessing its association with the outcome severity (favorable or not), patients with favorable outcomes had 37% lower NLR values than those with unfavorable ones (RoM= 0.63; 95% CI = 0.44–0.88; p = 0.007). However, there were considerable heterogeneity in effect estimates (I² = 99%; p < 0.001). Moreover, NLR was a useful indicator of mortality at both 6-month and 1-year intervals. In conjunction with clinical and radiographic parameters, NLR might be a useful, inexpensive marker in predicting clinical outcomes in patients with TBI. However, the considerable heterogeneity in current literature keeps it under investigation with further studies are warranted to confirm the reliability of NLR in predicting TBI outcomes.

• King Abdulaziz University

• Meta-analysis
• Neutrophil-lymphocyte ratio
• Outcome
• Systematic review
• Traumatic brain injury

The purpose of this study was to explore the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on 30-day outcomes in patients with spontaneous intracerebral hemorrhage (ICH) after surgical treatment.

This retrospective study utilized data from patients with ICH who underwent craniotomy or minimally invasive puncture and drainage (MIPD) between January 2015 and June 2021. The patients meeting the inclusion criteria were divided into two groups according to 30-day outcomes, namely, the favorable outcome group and the poor outcome group. Sex, age, time from onset to admission, vital signs at admission, admission Glasgow Coma Scale (GCS) score, diabetes mellitus, hypertension, hematoma volume, hematoma location, surgical approach, and NLR at different time points were all recorded and analyzed.

A total of 128 patients were finally enrolled in this study, including 32 and 96 patients in the favorable outcome group and the poor outcome group, respectively. During the course of ICH, the changing trend of NLR was to increase first and then decrease and peaked within 48 h after surgery. In the univariate analysis, systolic blood pressure, admission GCS score, hematoma volume, surgical approach, and NLR within 48 h after surgery were statistically significant. In the multivariable analysis, NLR within 48 h after surgery (odds ratio [OR] = 1.342, p < 0.001) was an independent risk factor of the 30-day outcomes in patients with ICH after surgical treatment. The receiver operating characteristic (ROC) analysis showed that the best predictive cut-off value for NLR within 48 h after surgery was 12.35 [sensitivity 82.9%, specificity 81.8%, and area under the curve (AUC) 0.877] and 14.46 (sensitivity 55.1%, specificity 87.5%, and area under the curve 0.731) for the MIPD group and the craniotomy group, respectively.

In the process of ICH, the value of NLR was increased first and then decreased and peaked within 48 h after surgery. NLR within 48 h after surgery was an independent risk factor of the 30-day outcomes in patients with ICH. The peak NLR >12.35 or 14.46 in patients receiving MIPD or craniotomy reflected a poor prognosis, respectively.

Hematoma expansion can be related to increased mortality and poor clinical outcomes in patients with intracerebral hemorrhage (ICH). So, early identification and prevention of hematoma expansion can be considered as an important therapeutic aim. This study aimed to evaluate the hypothesis that the neutrophil to lymphocyte ratio (NLR) is associated with hematoma expansion in ICH patients.

We retrospectively evaluated the clinical data of a total of 221 patients with ICH who were treated in our department between April 2018 and April 2021. The demographic, clinical, radiological, and laboratory test data including the NLR upon admission were investigated. A binary logistic regression analysis was used to assess the independent associations between different variables and hematoma expansion.

A total of 221 patients with ICH were included. There were 122 (55.2%) males and 99 (44.8%) females. The mean age (years) at admission was 66.43 ± 8.28.

The hematoma expansion occurred in 57 (25.8%) cases. The results of the multivariate analysis showed that hematoma volume at baseline (OR, 3.12; 95% CI 1.78–5.02; P < 0.001), admission systolic blood pressure (OR, 2.87; 95% CI 1.79–4.34; P = 0.013), Glasgow Coma Scale (GCS) (OR, 1.94; 95% CI 1.45–2.93; P = 0.020), and NLR (OR, 1.74; 95% CI 1.16–2.60; P = 0.032) were correlated with hematoma expansion in these patients.

Our findings suggest that NLR can be a predictor of hematoma expansion in patients with ICH. This cost-effective and easily available biomarker could be used to early prediction of hematoma expansion in these patients.

• Glasgow Coma Scale
• Hematoma expansion
• Intracerebral hemorrhage
• Neutrophil-to-lymphocyte ratio

• Glasgow outcome scale
• Neutrophil-to-lymphocyte ratio
• Prognosis
• Traumatic brain injury

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.

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.

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.

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.

We aimed to evaluate the relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammation index (SII), and Glasgow Coma Scale (GCS) score in patients with traumatic intracerebral haemorrhage (TICH). We retrospectively investigated 95 patients with TICH hospitalised at the Neurosurgery Department in Zielona Gora from January 2017 to March 2021. Routine blood tests were performed 5 h after injury. NRL and SII were significantly higher in patients with GCS ≤ 8 than patients with GCS > 8 and exceeded reference values in 95% of patients. GCS was inversely correlated with NLR and SII. Receiver operating characteristic (ROC) analysis confirmed the value of NLR and SII regarding GCS score; Area Under the Curve (AUC) 0.748, 95% Confidence Interval (CI) 0.615–0.880. An optimised NLR cut-off value of 0.154 was identified with a sensitivity of 0.90 and specificity of 0.56. The value of SII regarding GCS was confirmed with ROC curves; AUC 0.816, 95% CI 0.696–0.935. An optimised NLR cut-off value of 0.118 was identified with a sensitivity of 0.95 and specificity of 0.57. NLR and SII are significantly related to GCS scores and are promising predictors of clinical prognosis in TICH patients.

• brain injury
• falls
• lymphocytes
• neutrophils
• systemic inflammation

Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 10⁹/L vs. 216.5 × 10⁹/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.

• PLR
• TXA
• coagulopathy
• open traumatic brain injury
• prognosis

Traumatic brain injury (TBI) induces immune dysfunction that can be captured clinically by an increase in the neutrophil-to-lymphocyte ratio (NLR). However, few studies have characterized the temporal dynamics of NLR post-TBI and its relationship with hospital-acquired infections (HAI), resource utilization, or outcome. We assessed NLR and HAI over the first 21 days post-injury in adults with moderate-to-severe TBI (n = 196) using group-based trajectory (TRAJ), changepoint, and mixed-effects multivariable regression analysis to characterize temporal dynamics. We identified two groups with unique NLR profiles: a high (n = 67) versus a low (n = 129) TRAJ group. High NLR TRAJ had higher rates (76.12% vs. 55.04%, p = 0.004) and earlier time to infection (p = 0.003). In changepoint-derived day 0–5 and 6–20 epochs, low lymphocyte TRAJ, early in recovery, resulted in more frequent HAIs (p = 0.042), subsequently increasing later NLR levels (p ≤ 0.0001). Both high NLR TRAJ and HAIs increased hospital length of stay (LOS) and days on ventilation (p ≤ 0.05 all), while only high NLR TRAJ significantly increased odds of unfavorable six-month outcome as measured by the Glasgow Outcome Scale (GOS) (p = 0.046) in multivariable regression. These findings provide insight into the temporal dynamics and interrelatedness of immune factors which collectively impact susceptibility to infection and greater hospital resource utilization, as well as influence recovery.

• Glasgow outcome scale
• hospital acquired infection
• hospital resource utilization
• inflammation
• mechanical ventilation
• neutrophil-to-lymphocyte ratio
• traumatic brain injury

• R01 HD048162 NIH HHS
• R49-CCR-323155 CDC HHS
• T32HL134615 NIH HHS
• T32 HL134615 NHLBI NIH HHS

• behavioral symptoms
• children
• differential model
• mental disorder recovery treatment
• minor brain injury syndrome

• Attention Deficit Disorder with Hyperactivity/epidemiology
• Brain
• Brain Injuries
• Child
• Diagnostic and Statistical Manual of Mental Disorders
• Humans

• Cerebral contusion
• Emergency medicine
• Neutrophil-to-lymphocyte ratio
• Traumatic brain injury

• 6-Month outcome
• Admission GCS score
• Diffuse axonal injury
• Inflammation
• Neutrophil-to-lymphocyte ratio

• Adult
• Aged
• Diffuse Axonal Injury/blood
• Diffuse Axonal Injury/diagnosis
• Diffuse Axonal Injury/therapy
• Female
• Glasgow Coma Scale/trends
• Humans
• Lymphocytes/metabolism
• Male
• Middle Aged
• Neutrophils/metabolism
• Patient Admission/trends
• Prognosis
• Retrospective Studies
• Treatment Outcome

• multiple trauma
• prognosis
• prognostic factor
• traumatic brain injury

• epidural hematoma
• emergency surgery
• mortality
• prognostic factor
• subdural hematoma

• Adult
• Aged
• Biomarkers/blood
• Craniotomy
• Creatinine/blood
• Emergency Service, Hospital
• Epinephrine/therapeutic use
• Female
• Glasgow Coma Scale
• Hematoma, Epidural, Cranial/blood
• Hematoma, Epidural, Cranial/mortality
• Hematoma, Epidural, Cranial/surgery
• Hematoma, Subdural, Intracranial/blood
• Hematoma, Subdural, Intracranial/mortality
• Hematoma, Subdural, Intracranial/surgery
• Humans
• Intraoperative Period
• Lymphocyte Count
• Male
• Middle Aged
• Partial Thromboplastin Time
• Prognosis
• Retrospective Studies
• Vasoconstrictor Agents/therapeutic use

• CONUT
• Controlling nutritional status score
• Prognosis marker
• Traumatic brain injury

The aim of this study was to investigate the neuroprotective effects of hydrochloride fasudil (HF) in rats following intracerebral hemorrhage (ICH).

Male Wistar rats were randomly divided into four groups: normal, sham-operated, ICH, and ICH/HF. ICH was induced by injection of non-anticoagulant autologous arterial blood into the right caudate nucleus. The levels of Rho-associated protein kinase 2 (ROCK2) mRNA and protein around the site of the hematoma were measured by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA), respectively. The levels of interleukin-6 and tumor necrosis factor-α in serum were detected by ELISA. The inflammatory cells and changes in the neuronal morphology around the hematoma were visualized using hematoxylin and eosin and Nissl staining. Brain edema was measured by comparing wet and dry brain weights.

Following ICH, the levels of ROCK2 were significantly increased from day 1 to day 7. The levels of ROCK2 were significantly lower in rats treated with HF than in controls. The levels of inflammatory cytokines and brain water content were significantly higher in rats treated with HF than in controls. Administration of HF significantly reduced the levels of inflammatory cytokines and brain water content from day 1 to day 7. In the acute phase of ICH, a large number of neutrophils infiltrated the perihematomal areas. In comparison with the ICH group, the ICH/HF group showed markedly fewer infiltrating neutrophils on day 1. Nissl staining showed that ICH caused neuronal death and loss of neurons in the perihematomal areas at all time points and that treatment with HF significantly attenuated neuronal loss.

HF exerts neuroprotective effects in ICH rats by inhibiting the expression of ROCK2, reducing neutrophil infiltration and production of inflammatory cytokines, decreasing brain edema, and attenuating loss of neurons.

• Rho-associated protein kinase
• brain injury
• hydrochloride fasudil
• inflammation
• intracerebral hemorrhage

• Chronic subdural hematoma
• Inflammatory marker
• Neutrophil/lymphocyte ratio
• Platelet/lymphocyte ratio

Introduction: Neutrophil-lymphocyte count ratio (NLCR) is a simple and low-cost marker of inflammatory response. NLCR has shown to be a sensitive marker of clinical severity in inflammatory-related tissue injury, and high value of NLCR is associated with poor outcome in traumatic brain injured (TBI) patients. The purpose of this study was to retrospectively analyze NLCR and its association with outcome in a cohort of TBI patients in relation to the type of brain injury. Methods: Adult patients admitted for isolated TBI with Glasgow Coma Score lower than eight were included in the study. NLCR was calculated as the ratio between the absolute neutrophil and lymphocyte count immediately after admission to the hospital, and for six consecutive days after admission to the intensive care unit (ICU). Brain injuries were classified according to neuroradiological findings at the admission computed tomography (CT) as DAI—patients with severe diffuse axonal injury; CE—patients with hemispheric or focal cerebral edema; ICH—patients with intracerebral hemorrhage; S-EH/SAH—patients with subdural and/or epidural hematoma/subarachnoid hemorrhage. Results: NLCR was calculated in 144 patients. Admission NLCR was significantly higher in the non-survivors than in those who survived at 28 days (p < 0.05) from admission. Persisting high NLCR value was associated with poor outcome, and admission NLCR higher than 15.63 was a predictor of 28-day mortality. The highest NLCR value at admission was observed in patients with DAI compared with other brain injuries (p < 0.001). Concussions: NLCR can be a useful marker for predicting outcome in TBI patients. Further studies are warranted to confirm these results.

• Extended Glasgow Outcome Score
• Neutrophil-lymphocyte count ratio
• cerebral edema
• diffuse axonal injury
• traumatic brain injury