Relationship between NLR and PLR Ratios and the Occurrence and Prognosis of Progressive Hemorrhagic Injury in Patients with Traumatic Brain Injury.

Objective: This study aimed to evaluate the relationship between neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) ratios and the occurrence and prognosis of progressive hemorrhagic injury (PHI) in patients with traumatic brain injury (TBI).

Methods: This retrospective study included 166 TBI patients. Clinical data were collected and NLR and PLR were assessed. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive value of NLR and PLR for PHI occurrence in TBI patients. Logistic regression analysis was performed to identify risk factors influencing PHI development and poor neurological prognosis.

Results: The PHI group (n = 77) exhibited significantly higher NLR and PLR ratios than the non-PHI group (n = 89). Independent risk factors for PHI occurrence included higher Abbreviated Injury Scale scores, absent pupillary reflexes, lower Glasgow Coma Scale (GCS) scores, and elevated NLR and PLR ratios. The combined use of NLR and PLR ratios demonstrated superior predictive performance for PHI occurrence, with a higher area under the curve (AUC: 0.843) and sensitivity (77.9%, cutoff values: 17.19 for NLR and 196.33 for PLR) compared to NLR alone (AUC: 0.794, sensitivity: 53.2%, cutoff value: 21.78) or PLR alone (AUC: 0.665, sensitivity: 53.2%, cutoff value: 235.48). For poor neurological prognosis, higher AIS scores, lower GCS scores, and elevated NLR ratios were identified as independent risk factors.

Conclusion: TBI patients with elevated NLR and PLR ratios are at increased risk of developing PHI. In severe TBI cases, patients with high NLR ratios during the early stages tend to experience poor neurological outcomes.