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Updated: Sep 26, 2025
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Pediatric traumatic brain injury: a new relation between outcome and neutrophil-to-lymphocite ratio
Pietro Marchese1, Chiara Lardone2, Alessia Canepele3
1Department of Pediatrics, University of Pisa, Italy. pitrino91@gmail.com.
Insights
The neutrophil-to-lymphocyte ratio (NLR) may help predict outcomes in pediatric traumatic brain injury (TBI). This study found NLR differences associated with neurological signs and CT findings in children with TBI.
Area of Science:
- Pediatric neurology
- Neuroinflammation
- Trauma research
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in children.
- The immune response following TBI can lead to secondary neurological injury.
- The neutrophil-to-lymphocyte ratio (NLR) is a known inflammatory marker, but its role in pediatric TBI is unclear.
Purpose of the Study:
- To evaluate the association between clinical features of TBI and NLR in pediatric patients.
- To determine if elevated NLR is linked to adverse outcomes in pediatric TBI.
- To compare NLR values between healthy children and those with TBI.
Main Methods:
- Retrospective observational study of 219 pediatric patients (2-18 years) with TBI.
- Analysis of clinical features, neurological signs, and CT findings.
- Comparison of NLR values between TBI patients and healthy controls.
Main Results:
- NLR differences were associated with neurological signs in pediatric TBI patients.
- NLR was evaluated in relation to CT findings and clinical outcomes.
- Study aimed to establish indirect association between elevated NLR and adverse outcomes.
Conclusions:
- NLR may serve as a predictive marker for outcomes in pediatric TBI.
- Further research is needed to fully elucidate the role of NLR in pediatric head trauma.
- Findings contribute to understanding inflammatory markers in pediatric TBI prognosis.
Abstract:
Leading causes of death in industrialized countries are traumatic injuries and acquired disability, and entry to the emergency department in childhood. TBI (traumatic brain injury) may involve the onset of both primary lesions and a complex immune response (sterile immune reaction to brain injury), which, in addition to neuro-protective effects, can mediate secondary neurological injury. The neutrophil-to-lymphocyte ratio (NLR), as a circulating inflammatory marker, has been related to outcomes in adult patients with non-neurologic diseases (such as gut tumours) or neurologic diseases (such as stroke or brain tumours), and to the prognosis of traumatic brain injury in adolescents and adults. However, the potential role of NLR in predicting outcomes in paediatric head trauma is not clearly defined. The aim of this retrospective observational study is to evaluate the association between clinical features predictive of intracranial and extracranial lesions in TBI and NLR and to establish whether an elevation of NLR is indirectly associated with adverse outcomes in pediatric patients with TBI. We analysed a sample of 219 pediatric patients, between 2-18 years old, after a TBI, and evaluated if differences in NLR were associated with neurological signs or positive CT in pediatric patients. We then compared the NLR values between healthy subjects and patients with TBI.
