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Postoperative neutrophil-to-lymphocyte ratio variation is associated with chronic subdural hematoma recurrence

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Abstract

Introduction

Chronic subdural haematoma (CSDH) is one of the most common neurosurgical pathologies. The recurrence of chronic subdural haematomas is an important concern, considering that elderly patients are the most affected and reoperations in these patients may represent a risk of neurological and clinical complications. In accordance with the inflammatory theory regarding CSDH and its recurrence, we aimed to evaluate the role of an inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), as a risk factor and prognostic variable for CSDH recurrence.

Methods

We performed a cohort study of adult patients operated for post-traumatic CSDH traumatic CSDH between January 2015 and December 2019 in our neurotrauma unit, whose data was retrospectively retrieved. We excluded patients with previous inflammatory or infectious diseases as well as use of anticoagulant/antiplatelet medications. Neutrophil and lymphocyte counts were obtained 24 h preoperatively and 48–72 h postoperatively. The primary endpoint was symptomatic recurrence of CSDH up to 1 year after the surgery. An independent sample was used to validate the findings.

Results

The testing sample comprised 160 patients (59.4% male, mean age 69.3 ± 14.3 years, recurrence rate 22.5%). Postoperative neutrophil count and NLR were higher in those who recurred, as well as the neutrophils (median 1.15 vs 0.96, p = 0.022) and NLR (median 1.29 vs 0.79, p = 0.001) postoperative-to-preoperative ratios. Preoperative laboratory parameters or other baseline variables were not associated with recurrence. Postoperative NLR ratio (each additional unit, OR 2.53, 95% CI 1.37–4.67, p = 0.003) was independently associated with recurrence. The best cut-off for the postoperative NLR ratio was 0.995 (AUC-ROC 0.67, sensitivity 63.9%, specificity 76.6%). Postoperative NLR ratio ≥ 1 (i.e. a post-operative NLR that does not decrease compared to the preoperative value) was associated with recurrence (OR 4.59, 95% CI 2.00–10.53, p < 0.001). The validation sample analysis (66 patients) yielded similar results (AUC-ROC 0.728, 95% CI 0.594–0.862, p = 0.002) and similar cut-off (≥ 1.05, sensitivity 77.8%, specificity 66.7%).

Conclusion

NLR ratio can be a useful parameter for the prediction of post-traumatic CSDH recurrence. This hypothesis was validated in an independent sample and the accuracy was moderate.

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References

  1. Miranda LB, Braxton E, Hobbs J, Quigley MR (2011) Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 114(1):72–76

    Article  Google Scholar 

  2. Kolias AG, Chari A, Santarius T, Hutchinson PJ (2014) Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol 10(10):570–578

    Article  Google Scholar 

  3. Mori K, Maeda M (2001) Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir 41(8):371–381

    Article  CAS  Google Scholar 

  4. Balser D, Farooq S, Mehmood T, Reyes M, Samadani U (2015) Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 123(5):1209–1215

    Article  Google Scholar 

  5. Karibe H, Kameyama M, Kawase M, Hirano T, Kawaguchi T, Tominaga T (2011) Epidemiology of chronic subdural hematoma. No Shinkei Geka 39(12):1149–1153

    PubMed  Google Scholar 

  6. Kageyama H, Toyooka T, Tsuzuki N, Oka K (2013) Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg 119(2):332–337

    Article  Google Scholar 

  7. Guha D, Coyne S, Macdonald RL (2016) Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study. J Neurosurg 124(3):750–759

    Article  Google Scholar 

  8. Almenawer, S.A., Farrokhyar, F., Hong, C., Alhazzani, W., Manoranjan, B., Yarascavitch, B., Arjmand, P., Baronia, B., Reddy, K., Murty, N. and Singh, S., (2014) Chronic subdural hematoma management: a systematic review and meta-analysis of 34829 patients

  9. Glancz LJ, Poon MTC, Hutchinson PJ, Kolias AG, Brennan PM, Collaborative BNTR (2020) Drains result in greater reduction of subdural width and midline shift in burr hole evacuation of chronic subdural haematoma. Acta Neurochir 162(6):1455–1466

    Article  Google Scholar 

  10. Tao C, Wang J, Hu X, Ma J, Li H, You C (2017) Clinical value of neutrophil to lymphocyte and platelet to lymphocyte ratio after aneurysmal subarachnoid hemorrhage. Neurocrit Care 26(3):393–401

    Article  CAS  Google Scholar 

  11. Trotter W (1914) Chronic subdural haemorrhage of traumatic origin, and its relation to pachymeningitis haemorrhagica interna. Br J Surg 2(6):271–291

    Article  Google Scholar 

  12. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KL, Hutchinson PJ (2017) Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 14(1):1–13

    Article  Google Scholar 

  13. Sato S, Suzuki J (1975) Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43(5):569–578

    Article  CAS  Google Scholar 

  14. Dilektasli E, Inaba K, Haltmeier T, Wong MD, Clark D, Benjamin ER, Lam L, Demetriades D (2016) The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg 81(5):882–888

    Article  CAS  Google Scholar 

  15. Dong CH, Wang ZM, Chen SY (2018) Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem 52:131–136

    Article  Google Scholar 

  16. Chen W, Yang J, Li B, Peng G, Li T, Li L, Wang S (2018) Neutrophil to lymphocyte ratio as a novel predictor of outcome in patients with severe traumatic brain injury. J Head Trauma Rehabil 33(1):E53–E59

    Article  Google Scholar 

  17. Tao C, Hu X, Wang J, Ma J, Li H, You C (2017) Admission neutrophil count and neutrophil to lymphocyte ratio predict 90-day outcome in intracerebral hemorrhage. Biomark Med 11(1):33–42

    Article  CAS  Google Scholar 

  18. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S (2008) Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 63(6):1125–1129

    Article  Google Scholar 

  19. Yang W, Huang J (2017) Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin 28(2):205–210

    Article  Google Scholar 

  20. Edlmann E, Holl DC, Lingsma HF, Bartek J, Bartley A, Duerinck J, Jensen TSR, Soleman J, Shanbhag NC, Devi BI, Laeke T (2020) Systematic review of current randomised control trials in chronic subdural haematoma and proposal for an international collaborative approach. Acta Neurochir 1–14

  21. Edlmann E, Thelin EP, Caldwell K, Turner C, Whitfield P, Bulters D, Holton P, Suttner N, Owusu-Agyemang K, Al-Tamimi YZ, Gatt D (2019) Dex-CSDH randomised, placebo-controlled trial of dexamethasone for chronic subdural haematoma: report of the internal pilot phase. Sci Rep 9(1):1–13

    Article  CAS  Google Scholar 

  22. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ (2013) The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 88(1):218–230

    Article  Google Scholar 

  23. Zhang Y, Yang Y, Long S, Li G (2020) Assessment of peripheral blood cell inflammatory markers in patients with chronic subdural hematoma. Clin Neurol Neurosurg 191:105738

    Article  Google Scholar 

  24. Frati A, Salvati M, Mainiero F, Ippoliti F, Rocchi G, Raco A, Caroli E, Cantore G, Delfini R (2004) Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma: a prospective study. J Neurosurg 100(1):24–32

    Article  Google Scholar 

  25. Kocaturk O, Besli F, Gungoren F, Kocaturk M, Tanriverdi Z (2019) The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke. Neurol Sci 40(1):139–146

    Article  Google Scholar 

  26. Inci I, Kusbeci OY, Eskut N (2020) The neutrophil-to-lymphocyte ratio as a marker of peripheral inflammation in progressive supranuclear palsy: a retrospective study. Neurol Sci 41(5):1233–1237

    Article  Google Scholar 

  27. Ying A, Cheng Y, Lin Y, Yu J, Wu X, Lin Y (2020) Dynamic increase in neutrophil levels predicts parenchymal hemorrhage and function outcome of ischemic stroke with r-tPA thrombolysis. Neurol Sci 1–9

  28. Deng QW, Gong PY, Chen XL, Liu YK, Jiang T, Zhou F et al (2020) Admission blood cell counts are predictive of stroke-associated infection in acute ischemic stroke patients treated with endovascular therapy. Neurol Sci 1–13

  29. de Morais ANLR, Baylão VMR, Silva TM, Dos Santos AG, Azevedo M, de Oliveira AJ (2021) Is neutrophil-lymphocyte ratio a useful tool for predicting outcome in subarachnoid hemorrhage? A systematic review. Neurosurg Rev 1–6

  30. Faria SS, Fernandes PC Jr, Silva MJB, Lima VC, Fontes W, Freitas-Junior R, Eterovic AK, Forget P (2016) The neutrophil-to-lymphocyte ratio: a narrative review. ecancermedicalscience 10

  31. Hara M, Tamaki M, Aoyagi M, Ohno K (2009) Possible role of cyclooxygenase-2 in developing chronic subdural hematoma. J Med Dent Sci 56(3):101–106

    PubMed  Google Scholar 

  32. Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N (1992) Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir 32(4):207–209

    Article  CAS  Google Scholar 

  33. Sarti C, Tuomilehto J, Salomaa V, Sivenius J, Kaarsalo E, Narva EV, Salmi K, Torppa J (1991) Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985. Stroke 22(7):848–853

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil

    Adilson J M de Oliveira, Davi J. F. Solla, Klever F. de Oliveira, Bruno S. Amaral, Almir F. Andrade & Wellingson S. Paiva

  2. Neurocience centre, Clínica Girassol, Comandante Gika street, 225, CEP: 01419-000, Luanda, Angola

    Adilson J M de Oliveira

  3. NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK

    Davi J. F. Solla, Angelos G. Kolias & Wellingson S. Paiva

  4. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Angelos G. Kolias

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  1. Adilson J M de Oliveira
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Correspondence to Adilson J M de Oliveira.

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de Oliveira, A.J.M., Solla, D.J.F., de Oliveira, K.F. et al. Postoperative neutrophil-to-lymphocyte ratio variation is associated with chronic subdural hematoma recurrence. Neurol Sci 43, 427–434 (2022). https://doi.org/10.1007/s10072-021-05241-y

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