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Evaluation of Peripheral Blood Inflammatory Markers in Patients with Chronic Subdural Hematoma
Ali E Kayalar1, Eylem B K Ozlu1, Mustafa U Etli2
1Department of Neurosurgery, Haydarpasa Training and Research Hospital, Istanbul, Turkey.
Insights
Inflammatory markers like neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are elevated in chronic subdural hematoma (CSH) patients. Age and NLR are independent factors associated with CSH development.
Area of Science:
- Neurosurgery
- Hematology
- Inflammatory Medicine
Background:
- Chronic subdural hematoma (CSH) is a common intracranial hemorrhage, often linked to minor head trauma, particularly in older adults.
- Inflammation is hypothesized to play a key role in the pathogenesis of CSH.
- Understanding diagnostic markers for CSH is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between peripheral blood inflammatory markers and chronic subdural hematoma (CSH).
- To determine the diagnostic utility of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and age in identifying CSH.
- To identify independent predictive factors for CSH.
Main Methods:
- Retrospective review of 68 patients diagnosed with CSH via imaging and treated surgically between 2018-2020.
- Analysis of demographic data, trauma history, and peripheral blood counts (leukocytes, neutrophils, lymphocytes, monocytes, platelets).
- Receiver operating characteristic (ROC) analysis and multiple logistic regression were employed to assess NLR, PLR, and age as discriminators and independent factors for CSH.
Main Results:
- A total of 68 patients (83.8% male) with a mean age of 72.59 years were included.
- Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were significantly higher in CSH patients compared to controls.
- Optimal cut-off values were identified: NLR 2.8, PLR 132, and age 55. Age and NLR emerged as independent factors associated with CSH (P < 0.05).
Conclusions:
- Peripheral blood inflammatory markers, including NLR and PLR, are significantly elevated in CSH patients.
- Age and NLR are identified as independent risk factors contributing to the development of chronic subdural hematoma.
- These findings suggest the potential utility of peripheral blood markers in CSH assessment, even when below standard laboratory thresholds.
Background And Aim:
Chronic subdural hematoma (CSH) refers to intracranial hemorrhages frequently caused by minor head trauma and is mostly seen in middle and advanced age. One of the hypotheses regarding the development of CSH is that the inflammatory cascade plays a pivotal role in this process.
Materials And Methods:
The inclusion criteria covered patients in all ages who were diagnosed as CSH by computed tomography and/or magnetic resonance imaging and treated by surgical intervention in our clinic between 2018 and 2020. Patient files were reviewed retrospectively, and medical records of age, gender, trauma history, unilateral or bilateral lesion, and leukocyte, neutrophil, lymphocyte, monocytes, and platelet counts were obtained. Receiver operating characteristic (ROC) analysis was used for the most appropriate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and age discrimination in the presence of CSH, and multiple logistic regression analyses were used to determine the effect of independent factors on dependent variables.
Results:
A total of 68 cases, 57 (83.8%) male and 11 (16.2%) female, aged between 13 and 93, were included in the study. The mean age of the patients included in the study was 72.59 ± 13.13 years. NLR of the cases ranged from 1.37 to 34.18, with a mean of 6.53 ± 6.74 and a median of 3.57. NLR and PLR were found to be statistically significantly higher in CSH patients compared to the healthy control group, and the cut-off values for NLR, PLR, and age were 2.8, 132, and 55, respectively. Age and NLR were found to be independent factors associated with CSH (P < 0.05).
Conclusion:
As seen from the results of this study, peripheral blood values in CSH patients may be significantly higher than in the healthy control group, while they are below the normal laboratory cut-off values.
