Neurological research · 2025
Predictive value of neutrophil-to-lymphocyte ratio for mortality in surgically treated patients with acute subdural hematoma.
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Fu Shilong, Wu Zongping, Wang Guofeng
Аннотация
OBJECTIVES: Despite prompt surgical intervention, acute subdural hematoma (ASDH) following traumatic brain injury has a high mortality rate. This study aimed to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for mortality in patients with ASDH.
METHODS: Consecutive patients with ASDH who underwent neurosurgical treatment from January 2016 to September 2024 were retrospectively analyzed. Independent predictors of 30-day mortality were identified using both univariate and multivariate logistic regression analyses. The NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. Receiver operating characteristic (ROC) curve was used to assess the predictive value of admission NLR and to determine its optimal cutoff value. Using the identified predictors, we further assessed and compared the prognostic performance of a basic model (excluding NLR) with that of a full model (including NLR) via ROC curve analysis.
RESULTS: Among the 161 included patients, 37.3% did not survive 30 days after surgery. The independent prognostic factors were preoperative bilateral pupillary dilation, lower admission Glasgow Coma Scale (GCS) score, and higher admission NLR. The area under the ROC curve (AUC) for the NLR in predicting 30-day mortality was 0.713 (95% confidence interval: 0.627-0.799), with an optimal cutoff value of 9.888 yielding a sensitivity of 0.6 and a specificity of 0.792. The predictive performance of the full model incorporating NLR surpassed that of the basic model containing only GCS score and pupillary dilation (AUC: 0.928 vs. 0.907, p = 0.042).
DISCUSSION: Admission NLR is easily calculated and can predict 30-day mortality of surgically treated patients with ASDH.
METHODS: Consecutive patients with ASDH who underwent neurosurgical treatment from January 2016 to September 2024 were retrospectively analyzed. Independent predictors of 30-day mortality were identified using both univariate and multivariate logistic regression analyses. The NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. Receiver operating characteristic (ROC) curve was used to assess the predictive value of admission NLR and to determine its optimal cutoff value. Using the identified predictors, we further assessed and compared the prognostic performance of a basic model (excluding NLR) with that of a full model (including NLR) via ROC curve analysis.
RESULTS: Among the 161 included patients, 37.3% did not survive 30 days after surgery. The independent prognostic factors were preoperative bilateral pupillary dilation, lower admission Glasgow Coma Scale (GCS) score, and higher admission NLR. The area under the ROC curve (AUC) for the NLR in predicting 30-day mortality was 0.713 (95% confidence interval: 0.627-0.799), with an optimal cutoff value of 9.888 yielding a sensitivity of 0.6 and a specificity of 0.792. The predictive performance of the full model incorporating NLR surpassed that of the basic model containing only GCS score and pupillary dilation (AUC: 0.928 vs. 0.907, p = 0.042).
DISCUSSION: Admission NLR is easily calculated and can predict 30-day mortality of surgically treated patients with ASDH.