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ORIGINAL PAPER
Mortality prediction in patients with acute brain injury using peripheral blood cell analysis: a retrospective study
 
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Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
 
 
Submission date: 2024-06-25
 
 
Acceptance date: 2024-12-09
 
 
Publication date: 2025-09-30
 
 
Corresponding author
Hanna Miszczenkow
Hanna Miszczenkow Department of Anaesthesiology and Intensive Care Medical University of Silesia Katowice, Poland
 
 
Medical Studies 2025;41(3):284-291
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Acute brain injury remains a reason for high mortality as well as a cause of long-term disability among patients hospitalized in the intensive care unit (ICU). Moreover, this injury induces a cascade of changes among morphotic blood cells.

Aim of the research:
Our study was to evaluate the most accurate predictor derived from peripheral blood cell counts for 30-day mortality in patients suffering from acute brain injury with intracranial bleeding, and therefore to determine whether simple indices based on blood morphology can predict mortality in acute brain injury. Material and methods: This is a retrospective study of 71 patients presenting with an acute brain injury with intracranial bleeding, hospitalized in the ICU. Daily changes in the blood morphology and ratios between the blood cells were statistically analyzed in terms of clinical data as comorbidities.

Results and conclusions:
The groups differed in terms of length of hospitalization and ICU stay, age, GCS after first assessment, along with SAPS II and APACHE II scores. Coefficients of variation were significant in platelet count throughout 72 hours of observation. Although the PLT:WBC ratio on day 2 was found to be statistically significant, with AUC estimated as satisfactory, in a multivariate analysis it did not fulfil the conditions of an independent factor able to predict the assumed short-term mortality period. No universal biomarker for predicting 30-day mortality can be defined for this heterogeneous group of patients after acute brain injury with intracranial bleeding.
REFERENCES (43)
1.
Ziu E, Khan Suheb MZ, Mesfin FB. Subarachnoid Hemorrhage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
 
2.
Macdonald RL, Schweizer TA. Spontaneous subarachnoid haemorrhage. Lancet. 2017; 389(10069): 655-666.
 
3.
de Rooij NK, Linn FHH, van der Plas JA, Algra A, Rinkel GJE. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry. 2007; 78(12): 1365-1372.
 
4.
Suarez JI, Bershad EM. Aneurysmal Subarachnoid Hemorrhage. In: Stroke. Elsevier 2016; 516-536. doi:10.1016/B978-0-323-29544-4.00029-3.
 
5.
Modi S, Shah K, Schultz L, Tahir R, Affan M, Varelas P. Cost of hospitalization for aneurysmal subarachnoid hemorrhage in the United States. Clin Neurol Neurosurg. 2019; 182: 167-170.
 
6.
Gardner AJ, Zafonte R. Neuroepidemiology of traumatic brain injury. Handb Clin Neurol. 2016; 138: 207-223.
 
7.
GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(1): 56-87.
 
8.
Kaplan ZLR, van der Vlegel M, van Dijck JTJM, Pisică D, van Leeuwen N, Lingsma HF, Steyerberg EW, Haagsma JA, Majdan M, Polinder S. Intramural Healthcare Consumption and Costs After Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma. 2023; 40(19-20): 2126-2145.
 
9.
Hasan GM, Anwar S, Shamsi A, Sohal SS, Hassan MI. The neuroprotective potential of phytochemicals in traumatic brain injury: mechanistic insights and pharmacological implications. Front Pharmacol. 2023; 14: 1330098.
 
10.
Berger RP, Ta’asan S, Rand A, Lokshin A, Kochanek P. Multiplex assessment of serum biomarker concentrations in well-appearing children with inflicted traumatic brain injury. Pediatr Res. 2009; 65(1): 97-102.
 
11.
Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006; 5(1): 53-63.
 
12.
Li Y, Tao C, An N, Liu H, Liu Z, Zhang H, Sun Y, Xing Y, Gao Y. Revisiting the role of the complement system in intracerebral hemorrhage and therapeutic prospects. Int Immunopharmacol. 2023; 123: 110744.
 
13.
van Erp IAM, Michailidou I, van Essen TA, van der Jagt M, Moojen W, Peul WC, Baas F, Fluiter K. Tackling neuroinflammation after traumatic brain injury: complement inhibition as a therapy for secondary injury. Neurotherapeutics. 2023; 20(1): 284-303.
 
14.
van Erp IAM, van Essen TA, Fluiter K, van Zwet E, van Vliet P, Baas F, Haitsma I, Verbaan D, Coert Bert, de Ruiter GCW, Moojen WA, van der Jagt M, Peul WC. Safety and efficacy of C1-inhibitor in traumatic brain injury (CIAO@TBI): study protocol for a randomized, placebo-controlled, multi-center trial. Trials. 2021; 22(1): 874,.
 
15.
Das M, Mohapatra S, Mohapatra SS. New perspectives on central and peripheral immune responses to acute traumatic brain injury. J Neuroinflammation. 2012; 9: 236.
 
16.
Helmy A, De Simoni MG, Guilfoyle MR, Carpenter KLH, Hutchinson PJ. Cytokines and innate inflammation in the pathogenesis of human traumatic brain injury. Prog Neurobiol. 2011; 95(3): 352-372.
 
17.
Smrcka M, Mrlian A, Karlsson-Valik J, Klabusay M. The effect of head injury upon the immune system. Bratisl Lek Listy. 2007; 108(3): 144-148.
 
18.
Giede-Jeppe A, Reichl J, Sprügel MI, Lücking H, Hoelter P, Eyüpoglu IY, Kuramatsu JB, Huttner HB, Gerner ST. Neutrophil-to-lymphocyte ratio as an independent predictor for unfavorable functional outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg. 2019; 132(2): 400-407.
 
19.
Agnihotri S, Czap A, Staff I, Fortunato G, McCullough LD. Peripheral leukocyte counts and outcomes after intracerebral hemorrhage. J Neuroinflammation. 2011; 8: 160.
 
20.
Prisco L, Iscra F, Ganau M, Berlot G. Early predictive factors on mortality in head injured patients: a retrospective analysis of 112 traumatic brain injured patients. J Neurosurg Sci. 2012; 56(2): 131-136.
 
21.
Dienel A, Kumar T P, Blackburn SL, McBride DW. Role of platelets in the pathogenesis of delayed injury after subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2021; 41(11): 2820-2830.
 
22.
Hirashima Y, Hamada H, Kurimoto M, Origasa H, Endo S. Decrease in platelet count as an independent risk factor for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2005; 102(5): 882-887.
 
23.
Yun S, Jun Yi H, Hoon Lee D, Hoon Sung J. Clinical significance of platelet to neutrophil ratio and platelet to lymphocyte ratio in patients with aneurysmal subarachnoid hemorrhage. J Clin Neurosci. 2021; 92: 49-54.
 
24.
Geng L, Zuo L, Li H, Wang Y, Zhang Q, Ran J, Yan F, Zhang Z, Xie C. Association of platelet-to-neutrophil ratios with 1-year outcome and mortality in patients with acute ischemic stroke. Neurosci Lett. 2023; 798: 137016.
 
25.
Liu F, Jin M, Zhang Z, Gao J, Wang X. Platelet-to-neutrophil ratio is related to hemorrhagic transformation in patients with acute cerebral infarction. Neurologist. 2022; 27(5): 230-234.
 
26.
Wang K, Li R, Chen X, Zhao Y, Hao Q. Platelet-to-white blood cell ratio: a feasible predictor for unfavorable functional outcome in patients with aneurysmal subarachnoid hemorrhage. J Clin Neurosci. 2023; 115: 108-113.
 
27.
Li W, Deng W. Platelet-to-lymphocyte ratio predicts short-term mortality in patients with moderate to severe traumatic brain injury. Sci Rep. 2022; 12(1): 13976.
 
28.
Bolton WS, Gharial PK, Akhunbay-Fudge C, Chumas P, Mathew RK, Anderson IA. Day 2 neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for prediction of delayed cerebral ischemia in subarachnoid hemorrhage. Neurosurg Focus. 2022; 52(3): E4.
 
29.
Al-Mufti F, Amuluru K, Damodara N, Dodson V, Roh D, Agarwal S, Meyers PM, Connolly Jr ES, Schmidt MJ, Claassen J, Park S. Admission neutrophil-lymphocyte ratio predicts delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. J Neurointerv Surg. 2019; 11(11): 1135-1140.
 
30.
Guo R, Wu Y, Chen R, Yu Z, You C, Ma L, Tian M. Clinical value of neutrophil-to-lymphocyte ratio in primary intraventricular hemorrhage. World Neurosurg. 2019; 127: e1051-e1056.
 
31.
Tao C, Wang J, Hu X, Ma J, Li H, You C. Clinical value of neutrophil to lymphocyte and platelet to lymphocyte ratio after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2017; 26(3): 393-401.
 
32.
Hathidara MY, Campos Y, Chandrashekhar S, Xu C, Olson DWM, Venkatachalam A, Ray B. Scoring system to predict hospital outcome after subarachnoid hemorrhage–incorporating systemic response: the CRIG Score. J Stroke Cerebrovasc Dis. 2022; 31(8): 106577.
 
33.
Oliveira AJM de, Rabelo NN, Telles JPM, Solla DJF, da Silva Coelho ACS, Barbosa GB, Barbato NC, Yoshikawa MH, Teixeira MJ, Figueiredo EG. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and prognosis after aneurysmal subarachnoid hemorrhage: a cohort study. Arq Neuropsiquiatr. 2023; 81(6): 515-523.
 
34.
Chen L, Zhang Q. Increased mean platelet volume is associated with poor outcome in patients with aneurysmal subarachnoid hemorrhage. World Neurosurg. 2020; 137: e118-e125.
 
35.
Wang Z, Pei W, Chen L, Ning Y, Luo Y. Mean platelet volume/platelet count ratio is associated with poor clinical outcome after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2020; 29(11): 105208.
 
36.
Wu F, Wang Q, Qiao Y, Yu Q, Wang F. A new marker of short-term mortality and poor outcome in patients with acute ischemic stroke: mean platelet volume-to-lymphocyte ratio. Medicine. 2022; 101(40): e30911.
 
37.
Beyan C, Beyan E. Mean platelet volume may not be a marker for prognosis in patients with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2021; 30(2): 105492.
 
38.
Hou Y, Fan J, Yuan H, Zheng H, Yang H, Li H, Chen R, Yu J. Prognostic capacity of the systemic inflammation response index for functional outcome in patients with aneurysmal subarachnoid hemorrhage. Front Neurol. 2023; 14: 1054315.
 
39.
Luo F, Li Y, Zhao Y, et al. Systemic immune-inflammation index predicts the outcome after aneurysmal subarachnoid hemorrhage. Neurosurg Rev. 2022; 45(2): 1607-1615.
 
40.
Yun S, Yi HJ, Lee DH, Sung JH. Systemic inflammation response index and systemic immune-inflammation index for predicting the prognosis of patients with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2021; 30(8): 105861.
 
41.
Yu T, Wang Z. Use of a systemic inflammatory response index to predict non-traumatic non-aneurysmal subarachnoid hemorrhage patient outcomes. J Stroke Cerebrovasc Dis. 2022; 31(12): 106863.
 
42.
Zhu G, Yuan A, Yu D, Zha A, Wu H. Machine learning to predict mortality for aneurysmal subarachnoid hemorrhage (aSAH) using a large nationwide EHR database. PLoS Digit Health. 2023; 2(12): e0000400.
 
43.
 
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ISSN:1899-1874
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