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Updated: Dec 26, 2025
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Using the neutrophil-to-lymphocyte ratio to predict outcomes in pediatric patients with traumatic brain injury
Rebekah Kimball1, Elad Shachar2, Stephanie Eyerly-Webb3
1Florida Atlantic University, College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA.
Insights
Elevated neutrophil-to-lymphocyte ratios (NLRs) in pediatric patients with traumatic brain injury (TBI) indicate worse outcomes. This blood marker may help predict TBI prognosis and guide future therapies.
Area of Science:
- Neurology
- Immunology
- Pediatrics
Background:
- Traumatic brain injury (TBI) triggers an inflammatory response that can worsen secondary brain injury.
- Predicting outcomes in pediatric TBI is crucial for effective management.
- Peripheral inflammatory markers may offer insights into TBI prognosis.
Purpose of the Study:
- To investigate the association between neutrophil-to-lymphocyte ratios (NLRs) and adverse outcomes in pediatric TBI patients.
- To determine if NLR is a useful predictor of outcomes following pediatric TBI.
Main Methods:
- Retrospective review of 188 pediatric TBI patients (0-18 years).
- Calculation of NLRs from complete blood counts at admission and 24, 48, 72 hours post-injury.
- Analysis of clinical data including Glasgow Coma Scale (GCS), post-traumatic amnesia (PTA), loss of consciousness (LOC), and Glasgow Outcome Scale Extended Pediatric Version (GOS-E Peds).
Main Results:
- Higher NLRs at 24 and 48 hours post-TBI correlated with worse GOS-E Peds outcomes.
- Patients experiencing loss of consciousness (LOC) had significantly higher NLRs on admission and at 24 hours.
- No significant NLR differences were found based on GCS or PTA.
Conclusions:
- Elevated NLRs in pediatric TBI patients at 24 and 48 hours post-injury are associated with poorer outcomes.
- NLR shows potential as a cost-effective and valuable outcome predictor for pediatric TBI.
- Further prospective trials are warranted to validate NLR as a therapeutic target.
Objective:
The brain's inflammatory reaction to traumatic brain injury (TBI) generally peaks between 24 and 48 h after injury. This inflammatory cascade can be neuroprotective or may mediate secondary brain injury beyond the initial TBI. Therefore, circulating inflammatory markers may be useful for predicting outcomes in pediatric TBI. The goal of this study was to determine whether elevations in peripheral blood neutrophil-to-lymphocyte ratios (NLRs) are associated with adverse outcomes in pediatric TBI patients.
Patients And Methods:
188 pediatric patients (0-18 years) presenting to our institution with TBI from 2007 to 2017 were retrospectively reviewed. Absolute neutrophil and lymphocyte counts from a complete blood count (CBC) were used to calculate NLRs on admission (<12 h) and approximately 24, 48, and 72 h after injury. Data points included Glasgow Coma Scale (GCS) on admission, presence of post-traumatic amnesia (PTA), loss of consciousness (LOC), and Glasgow Outcome Scale Extended Pediatric Version (GOS-E Peds) with a median outcome span of 86 days.
Results:
A one-way ANOVA demonstrated statistically significant differences in NLR at 24 h (p = 0.004) and 48 h (p=0.003) among patients stratified by GOS-E Peds. No significant differences in NLR were observed at any time point based on GCS or PTA. Patients who experienced LOC had a significantly higher NLR on admission (p=0.013) and at 24 h (p<0.001) than those who did not.
Conclusion:
In this study, relatively higher NLRs at 24 and 48 h post-TBI were associated with worse outcomes in pediatric patients. This suggests that NLR may be a useful and cost-effective outcome predictor in pediatric TBI as well as a possible future target for therapeutic intervention, warranting larger prospective trials.
