Abstract
Background The platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) reflect the patient inflammatory and immunity status. We investigated the role of on-admission PLR and NLR in predicting massive transfusion protocol (MTP) activation and mortality following abdominal trauma. Methods A 4-year retrospective analysis of all adult abdominal trauma patients was conducted. Patients were classified into survivors and nonsurvivors and low vs. high PLR. The discriminatory power for PLR and NLR to predict MTP and mortality was determined. Multivariate logistic regression analysis was performed for predictors of mortality. Results A total of 1199 abdominal trauma patients were included (18.7% of all the trauma admissions). Low PLR was associated with more severe injuries and greater rates of hospital complications including mortality in comparison to high PLR. On-admission PLR and NLR were higher in the survivors than in nonsurvivors (149.3 vs. 76.3 (p = 0.001) and 19.1 vs. 13.7 (p = 0.009), respectively). Only PLR significantly correlated with injury severity score, revised trauma score, TRISS, serum lactate, shock index, and FASILA score. Optimal cutoffs of PLR and NLR for predicting mortality were 98.5 and 18.5, respectively. The sensitivity and specificity of PLR were 81.3% and 61.1%, respectively, and 61.3% and 51.3%, respectively, for NLR. The AUROC for predicting MTP was 0.69 (95% CI: 0.655–0.743) for PLR and 0.55 (95% CI: 0.510–0.598) for NLR. To predict hospital mortality, the area under the curve (AUROC) for PLR was 0.77 (95% CI: 0.712–0.825) and 0.59 (95% CI: 0.529–0.650) for the NLR. On multivariate logistic regression analysis, the age, Glasgow Coma Scale, sepsis, injury severity score, and PLR were independent predictors of mortality. Conclusion On-admission PLR but not NLR helps early risk stratification and timely management and predicts mortality in abdominal trauma patients. Further prospective studies are required.
Highlights
Traumatic injury is associated with significant morbidity and mortality and remains a public health problem worldwide [1]
platelet-to-lymphocyte ratio (PLR) significantly correlated with injury severity score, revised trauma score, trauma and injury severity score (TRISS), serum lactate, shock index, and FASILA score
The area under the curve (AUROC) for PLR was 0.77 and 0.59 for the neutrophil-to-lymphocyte ratio (NLR)
Summary
Traumatic injury is associated with significant morbidity and mortality and remains a public health problem worldwide [1]. We investigated the role of on-admission PLR and NLR in predicting massive transfusion protocol (MTP) activation and mortality following abdominal trauma. The discriminatory power for PLR and NLR to predict MTP and mortality was determined. Low PLR was associated with more severe injuries and greater rates of hospital complications including mortality in comparison to high PLR. Optimal cutoffs of PLR and NLR for predicting mortality were 98.5 and 18.5, respectively. The area under the curve (AUROC) for PLR was 0.77 (95% CI: 0.712– 0.825) and 0.59 (95% CI: 0.529–0.650) for the NLR. On multivariate logistic regression analysis, the age, Glasgow Coma Scale, sepsis, injury severity score, and PLR were independent predictors of mortality. On-admission PLR but not NLR helps early risk stratification and timely management and predicts mortality in abdominal trauma patients.
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