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Platelet-to-lymphocyte ratio as a prognostic predictive marker on adults with traumatic brain injury: Systematic
Muhana Fawwazy Ilyas1, Aldebaran Lado2, Enrico Ananda Budiono2
1Department of Neurology, Faculty of Medicine, Dr. Moewardi General Hospital, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia.
Insights
The platelet-to-lymphocyte ratio (PLR) shows potential as a prognostic marker for adult traumatic brain injury (TBI) outcomes, including mortality and neurological function. Further research is needed to confirm its clinical utility.
Area of Science:
- Hematology
- Neurology
- Critical Care Medicine
Background:
- The prognostic value of the platelet-to-lymphocyte ratio (PLR) is established in various diseases, but its role in traumatic brain injury (TBI) requires further elucidation.
- Adult TBI prognosis is complex, necessitating reliable and accessible predictive markers.
Purpose of the Study:
- To systematically review and evaluate the platelet-to-lymphocyte ratio (PLR) as a prognostic predictive marker in adult patients with traumatic brain injury (TBI).
Main Methods:
- A systematic review adhering to PRISMA 2020 guidelines was conducted.
- Searches across multiple databases (PubMed, Scopus, etc.) identified observational studies up to February 2023.
- Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and risk of bias with the Ro-BANS tool.
Main Results:
- Four studies with 1,467 participants were included; study quality was generally high (NOS 8-9).
- Three studies indicated that a high admission PLR independently predicts increased 30-day mortality and adverse 6-month outcomes (Glasgow Outcome Scale) in TBI patients.
- One study suggested PLR may have limited predictive value for mortality or favorable outcomes compared to other hematological parameters.
Conclusions:
- The platelet-to-lymphocyte ratio (PLR) shows promise as an independent prognostic marker in adult TBI.
- PLR is a simple, low-cost, and routinely performed test, making it potentially valuable in clinical practice, especially in resource-limited settings.
- Further research is essential to confirm the clinical utility of PLR in TBI prognosis and address existing knowledge gaps.
Background:
The platelet-to-lymphocyte ratio (PLR) has emerged as a prognostic predictive marker in various diseases, but its role in traumatic brain injury (TBI) has not been fully elucidated. This study aims to evaluate the role of PLR as a prognostic predictive marker in adults with TBI.
Methods:
This systematic review was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-analysis Guidelines 2020. A comprehensive search was performed using PubMed, Google Scholar, Scopus, Crossref, OpenAlex, Semantic Scholar, Library of Congress, and Jisc Library Hub Discover database to identify relevant studies published up to February 2023. Both prospective and retrospective observational studies written in English or Indonesian were included in the study. No restrictions were placed on the year and country of publication and duration of follow-up. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS), and the risk of bias was estimated using the Cochrane Risk of Bias Assessment Tool for Nonrandomized Research (Ro-BANS) tool. A narrative synthesis was also conducted to summarize the findings.
Results:
We retrieved 1644 references using the search strategy, and 1623 references were excluded based on screening the title and abstract. The full text was retrieved for 20 articles and subjected to the eligibility criteria, of which 16 were excluded from the study. Four papers with a total of 1.467 sample sizes were included in the review. The median of NOS for study quality was 8-9, with the risk of selection bias using the Ro-BANS tool being low in all studies except for the blinding outcome assessments, which are all unclear. The study finding suggests that the PLR has the potential as an independent prognostic predictive marker in adult patients with TBI. In three studies, a high level of admission PLR may independently predict an increasing mortality risk in 30 days and adverse outcomes measured by the Glasgow outcome scale in 6 months following TBI. However, one study shows that PLR may have limited value as a predictor of mortality or favorable neurological outcomes compared to other hematological parameters. Further studies were needed to establish the clinical utility of PLR and fill the present gaps.
Conclusion:
This systematic review provides evidence supporting the utilization of PLR as a prognostic predictive marker in adult patients with TBI. The PLR can mainly be utilized, especially in rural practice, as PLR is a simple, low-cost, and routinely performed hematological examination.
