The predictive effect of peripheral blood leukocyte levels on the progression of hematoma after cerebral contusion and laceration
Objective To explore the predictive value of peripheral blood leukocyte levels for hematoma progression in patients with cerebral contusion and laceration.Methods A retrospective analysis was conducted on clinical data of 248 patients with cerebral contusion and laceration who were admitted to the Department of Neurosurgery at Affiliated Hospital of Yangzhou University from January 2021 to January 2023.Hematoma progression was determined based on CT scan results within 24 hours after injury(hematoma volume increased by more than 25％or new intracranial hematoma).Gender,age,Glasgow Coma Scale(GCS)at admission,hematoma type(subdural hematoma or epidural hematoma),hematoma location,medical history,surgical intervention,and peripheral blood laboratory parameters within 24 hours post-onset[including white blood cells,neutrophils,lymphocytes,monocytes,platelets,creatinine,D-dimer levels,prothrombin time(PT),activated partial thromboplastin time(APTT),neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammatory index(SII),monocyte-to-lymphocyte ratio(MLR),platelet-to-lymphocyte ratio(PLR),derived NLR(dNLR)]were compared between the non-progression group and progression group.Factors with a significance level of P＜0.1 were included in a multivariate logistic regression model to analyze the impact of leukocyte levels on hematoma progression.Receiver operating characteristic(ROC)curves were generated,and the area under the curve(AUC)was calculated to assess the predictive value of leukocyte levels for hematoma progression in cerebral contusion patients.Results Among the 248 patients,142 were in the non-progression group and 106 in the progression group.The white blood cell count[M(Q1,Q3)]was 12.53(9.19,15.45)x 109/L in the non-progression group and 13.01(10.83,15.76)x 109/L in the progression group,with a statistically significant difference(P=0.043).Multivariate logistic regression analysis showed that,in addition to low GCS at admission(OR=0.84,95％CI:0.73-0.96)and a history of anticoagulant or antiplatelet use(OR=1.34,95％CI:1.12-1.97),an increase in white blood cell count(0R=1.16,95％CI:1.01-1.32)and a decrease in MLR(OR=3.55,95％CI:1.19-10.60)were independent factors influencing hematoma progression in cerebral contusion(all P＜0.05).The ROC curve model constructed based on these parameters showed an AUC of 0.60 for predicting hematoma progression with GCS at admission and a history of anticoagulant or antiplatelet use.When white blood cell count and MLR were added to the model,the AUC increased to 0.75.Conclusion The level of peripheral blood leukocytes is an important factor influencing the progression of hematoma in patients with cerebral contusion and laceration,and has predictive value for the progression of hematoma in patients.
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