Pediatric traumatic brain injury: a new relation between outcome and neutrophil-to-lymphocite ratio

Pietro  Marchese; Chiara  Lardone; Alessia Canepele; Samanta  Biondi; Costantino  Roggi; Francesco  Massart; Alice  Bonuccelli; Diego Peroni; Alice  Giotta Lucifero; Sabino Luzzi; Thomas Foiadelli; Alessandro  Orsini

doi:10.23750/abm.v92iS4.12666

Pediatric traumatic brain injury: a new relation between outcome and neutrophil-to-lymphocite ratio

Authors

Pietro Marchese Department of Pediatrics, University of Pisa, Italy
Chiara Lardone Department of Pediatrics, University of Pisa, Italy
Alessia Canepele Department of Anesthesia, University of Firenze, Italy
Samanta Biondi Department of Pediatrics, University of Pisa, Italy
Costantino Roggi Department of Pediatrics, University of Pisa, Italy
Francesco Massart Department of Pediatrics, University of Pisa, Italy
Alice Bonuccelli Department of Pediatrics, University of Pisa, Italy
Diego Peroni Department of Pediatrics, University of Pisa, Italy
Alice Giotta Lucifero Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
Sabino Luzzi Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
Thomas Foiadelli Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
Alessandro Orsini Department of Pediatrics, University of Pisa, Italy

Keywords:

Emergency Department, Neutrophil-To-Lymphocite Ratio, Traumatic Brain Injury

Abstract

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.

References

Da Dalt L, Parri N, Amigoni A, Nocerino A, Selmin F, Manara R, et al. Italian guidelines on the assessment and management of pediatric head injury in the emergency department. Ital J Pediatr. 2018;44(1):7.

Elsawaf Y, Anetsberger S, Luzzi S, Elbabaa SK. Early Decompressive Craniectomy as Management for Severe Traumatic Brain Injury in the Pediatric Population: A Comprehensive Literature Review. World Neurosurg. 2020;138:9-18.

Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Iotti GA, et al. Trauma Coagulopathy and Its Outcomes. Medicina (Kaunas). 2020;56(4).

Belisle S, Lim R, Hochstadter E, Sangha G. Approach to Pediatric Traumatic Brain Injury in the Emergency Department. Curr Pediatr Rev. 2018;14(1):4-8.

Choe M, Barlow KM. Pediatric Traumatic Brain Injury and Concussion. Continuum (Minneap Minn). 2018;24(1, Child Neurology):300-11.

Dewan MC, Mummareddy N, Wellons JC, 3rd, Bonfield CM. Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review. World Neurosurg. 2016;91:497-509.e1.

Sharp N, Tieves K. Pediatric Head Trauma. J Pediatr Intensive Care. 2015;4(1):47-54.

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1-82.

Luzzi S, Maestro MD, Elia A, Vincitorio F, Perna GD, Zenga F, et al. Morphometric and Radiomorphometric Study of the Correlation Between the Foramen Magnum Region and the Anterior and Posterolateral Approaches to Ventral Intradural Lesions. Turk Neurosurg. 2019;29(6):875-86.

Iranmanesh F. Outcome of head trauma. Indian J Pediatr. 2009;76(9):929-31.

Savioli G, Ceresa IF, Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, et al. Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists. Medicina (Kaunas). 2020;56(6).

Savioli G, Ceresa IF, Luzzi S, Giotta Lucifero A, Pioli Di Marco MS, Manzoni F, et al. Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications? Medicina (Kaunas). 2021;57(4).

Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Luzzi S, et al. Major Trauma in Elderly Patients: Worse Mortality and Outcomes in an Italian Trauma Center. J Emerg Trauma Shock. 2021;14(2):98-103.

Corps KN, Roth TL, McGavern DB. Inflammation and neuroprotection in traumatic brain injury. JAMA Neurol. 2015;72(3):355-62.

Liu YW, Li S, Dai SS. Neutrophils in traumatic brain injury (TBI): friend or foe? J Neuroinflammation. 2018;15(1):146.

McKee CA, Lukens JR. Emerging Roles for the Immune System in Traumatic Brain Injury. Front Immunol. 2016;7:556.

Orsini A, Foiadelli T, Costagliola G, Michev A, Consolini R, Vinci F, et al. The role of inflammatory mediators in epilepsy: Focus on developmental and epileptic encephalopathies and therapeutic implications. Epilepsy Res. 2021;172:106588.

Luzzi S, Crovace AM, Lacitignola L, Valentini V, Francioso E, Rossi G, et al. Engraftment, neuroglial transdifferentiation and behavioral recovery after complete spinal cord transection in rats. Surg Neurol Int. 2018;9:19.

Luzzi S, Del Maestro M, Elbabaa SK, Galzio R. Letter to the Editor Regarding "One and Done: Multimodal Treatment of Pediatric Cerebral Arteriovenous Malformations in a Single Anesthesia Event". World Neurosurg. 2020;134:660.

Luzzi S, Giotta Lucifero A, Brambilla I, Semeria Mantelli S, Mosconi M, Foiadelli T, et al. Targeting the medulloblastoma: a molecular-based approach. Acta Biomed. 2020;91(7-s):79-100.

Foiadelli T, Naso M, Licari A, Orsini A, Magistrali M, Trabatti C, et al. Advanced pharmacological therapies for neurofibromatosis type 1-related tumors. Acta Biomed. 2020;91(7-s):101-14.

Chelly H, Chaari A, Daoud E, Dammak H, Medhioub F, Mnif J, et al. Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases. J Trauma. 2011;71(4):838-46.

Lyttle MD, Crowe L, Oakley E, Dunning J, Babl FE. Comparing CATCH, CHALICE and PECARN clinical decision rules for paediatric head injuries. Emerg Med J. 2012;29(10):785-94.

Dayan PS, Ballard DW, Tham E, Hoffman JM, Swietlik M, Deakyne SJ, et al. Use of Traumatic Brain Injury Prediction Rules With Clinical Decision Support. Pediatrics. 2017;139(4).

Zhao JL, Du ZY, Yuan Q, Yu J, Sun YR, Wu X, et al. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Predicting the 6-Month Outcome of Patients with Traumatic Brain Injury: A Retrospective Study. World Neurosurg. 2019.

Kimball R, Shachar E, Eyerly-Webb S, Patel DM, Spader H. Using the neutrophil-to-lymphocyte ratio to predict outcomes in pediatric patients with traumatic brain injury. Clin Neurol Neurosurg. 2020;193:105772.

Leetch AN, Wilson B. Pediatric Major Head Injury: Not a Minor Problem. Emerg Med Clin North Am. 2018;36(2):459-72.

Badawy MK, Dayan PS, Tunik MG, Nadel FM, Lillis KA, Miskin M, et al. Prevalence of Brain Injuries and Recurrence of Seizures in Children With Posttraumatic Seizures. Acad Emerg Med. 2017;24(5):595-605.

Garone G, Reale A, Vanacore N, Parisi P, Bondone C, Suppiej A, et al. Acute ataxia in paediatric emergency departments: a multicentre Italian study. Arch Dis Child. 2019;104(8):768-74.