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Prognostic value of leukocytosis in pediatric traumatic brain injury
Insights
Elevated white cell count (WCC) and neutrophil counts in children with traumatic brain injury (TBI) predict longer hospital stays and poorer outcomes. Neutrophil-to-lymphocyte ratio (NLR) is a key independent risk factor for poor TBI prognosis.
Area of Science:
- Pediatric Neurology
- Trauma Surgery
- Hematology
Background:
- Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children.
- Assessing prognostic factors in pediatric TBI is crucial for guiding clinical management and improving patient outcomes.
- Leukocytosis, an elevated white cell count (WCC), has been investigated as a potential marker in various inflammatory and traumatic conditions.
Purpose of the Study:
- To evaluate the presence and prognostic significance of leukocytosis in children experiencing isolated traumatic brain injury (TBI).
- To determine if initial white cell count (WCC) and neutrophil counts can predict hospital stay duration and functional outcomes in pediatric TBI patients.
Main Methods:
- Prospective follow-up and retrospective analysis of 201 children with isolated TBI.
- Collection of initial blood leukocyte count (WCC), neutrophil count, Glasgow Coma Scale (GCS) scores, CT findings, and 6-month Pediatric Cerebral Performance Category Scale (PCPCS) scores.
- Multivariate regression analysis to identify predictive cutoff values for WCC, neutrophil count, and neutrophil-to-lymphocyte ratio (NLR).
Main Results:
- Higher WCC and neutrophil counts correlated with increased intracranial mass effect, longer hospital stays, and worse 6-month PCPCS scores.
- Cutoff values identified: WCC > 16.1 × 10^9/L, neutrophil count > 11.9 × 10^9/L, and NLR > 5.2 predicted unfavorable outcomes.
- NLR emerged as the second most important independent risk factor for poor outcome, after GCS score.
Conclusions:
- Initial WCC, neutrophil count, and NLR are valuable predictors of prolonged hospitalization and poorer functional outcomes in pediatric isolated TBI.
- NLR is a significant independent prognostic factor in pediatric TBI.
- Incorporating WCC into existing TBI prediction models, such as the IMPACT model, can enhance prognostic accuracy for pediatric patients.
Objective:
The purpose of this study was to assess leukocytosis and its prognostic value in pediatric isolated traumatic brain injury (TBI).
Methods:
Two hundred one children with isolated TBI admitted to the authors' institution between June 2006 and June 2018 were prospectively followed and their data retrospectively analyzed. Initial blood leukocyte count (i.e., white cell count [WCC]), Glasgow Coma Scale (GCS) score, CT scans, duration of hospital stay, and Pediatric Cerebral Performance Category Scale (PCPCS) scores were analyzed.
Results:
The mean age was 4.2 years (range 0.2-16 years). Seventy-four, 70, and 57 patients had severe (GCS score 3-8), moderate (GCS score 9-13), and mild (GCS score 14-15) TBI, respectively, with associated WCC of 20, 15.9, and 10.7 × 109/L and neutrophil counts of 15.6, 11.3, and 6.1 × 109/L, respectively (p < 0.01). Higher WCC and neutrophil counts were demonstrated in patients with increased intracranial mass effect on CT, longer hospital stay, and worse 6-month PCPCS score (p < 0.05). Multivariate regression revealed a cutoff leukocyte count of 16.1 × 109/L, neutrophil count of 11.9 × 109/L, and neutrophil-to-lymphocyte ratio (NLR) of 5.2, above which length of hospital stay and PCPCS scores were less favorable. Furthermore, NLR was the second most important independent risk factor for a poor outcome (after GCS score). The IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) adult TBI prediction model applied to this pediatric cohort demonstrated increased accuracy when WCC was incorporated as a risk factor.
Conclusions:
In the largest and first prospective study of isolated pediatric head injury to date, the authors have demonstrated that WCC > 16.1 × 109/L, neutrophil count > 11.9 × 109/L and NLR > 5.2 each have predictive value for lengthy hospital stay and poor PCPCS scores, and NLR is an independent risk factor for poor outcome. Incorporating the initial leukocyte count into TBI prediction models may improve prognostication.
