Abstract
Circulating inflammatory markers may predict the broad clinical spectrum of traumatic brain injury (TBI). The present study aimed to illustrate the role of leukocytes, precisely neutrophil and lymphocytes, in neuroinflammation as a new vista in neuro-critical care. Search terms were: elevations in peripheral blood leukocytes counts, neutrophil, lymphocyte with precisely neutrophil to lymphocyte ratios, associated with adverse outcomes of traumatic brain injury, pre and post-operative conditions of intracerebral haemorrhage, seizures, delirium, non-convulsive status epilepticus, confusion, aphasia, agitation, coma, disability and death. As a result, we identified 16 publications describing leukocyte biomarkers associated with neuroinflammation following TBI from PubMed, Cochrane Registry of Controlled Trials, Medline and Embase (Ovid) on randomised controlled trials (RCTs), non-RCTs and cohort studies published in the last decade. This study concluded that elevations in peripheral blood leukocyte and neutrophil to lymphocyte ratios could predict adverse outcomes of a cerebral haemorrhage.
Highlights
Leukocyte as neuroinflammation biomarkers has been centre of research interest for the clinicians of the neuroscience speciality in the new millennium [1,2,3]
Neutrophil to lymphocyte ratio (NLR) has been shown to be reliably related to the unfavourable outcomes in intracerebral haemorrhage (ICH) [7,8], predictor of outcome in critical illness including patients with severe traumatic brain injury (TBI) [9]
Research groups found NLR to be a predictive factor in different diseases, including cardiovascular problems, cancer [10,11] and other neurological conditions viz. stroke, mild TBI, and pediatric brain tumours [7,12,13,14,15,16]
Summary
Leukocyte as neuroinflammation biomarkers has been centre of research interest for the clinicians of the neuroscience speciality in the new millennium [1,2,3]. Neutrophil to lymphocyte ratio (NLR) calculated by dividing the absolute neutrophil count (ANC) by the absolute lymphocyte count (ALC) is a biomarker of a systematic inflammatory response [4]. Several research groups have extensively studied the roles of different inflammatory cells in TBI viz. Research groups found NLR to be a predictive factor in different diseases, including cardiovascular problems, cancer [10,11] and other neurological conditions viz. In pediatric TBI, prolonged immune response during secondary brain injury correlated with the changes in neutrophils, lymphocytes and NLR, though there was a lack of correlation between NLR and GOS-E at admission [18]. The current study aimed to determine whether elevations in peripheral blood leukocytes counts, precisely neutrophil to lymphocyte ratio, were associated with adverse outcomes in intracerebral haemorrhage and traumatic brain injury (TBI)
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