Neutrophil to lymphocyte ratio in the prediction of coagulopathy in traumatic brain injury.

Aim: Traumatic brain injury (TBI) is a public health issue of increasing incidence. Coagulopathy after TBI is a frequent event, associated with a poor prognosis, and biomarkers that could predict coagulopathy occurrence are needed. The neutrophil-to-lymphocyte ratio (NLR) is useful as a cost-effective biomarker to assess prognosis and the need for cranial computed tomography in patients with mild TBI. As no study has yet evaluated the association of NLR with coagulopathy, we investigated whether the NLR at presentation could predict coagulopathy occurrence after TBI. Materials & methods: A retrospective study was conducted of patients aged >18 years who attended the emergency department (ED) with TBI, over a 3-year period. We included all patients for whom the NLR at presentation was available, and who underwent a brain CT scan. Results: The study included 173 patients (mean age 57.4 ± 21.1 years) with TBI, the most frequent cause of which was a fall. According to the Glasgow Coma Scale, 37 patients had severe TBI, 19 moderate and 117 mild TBI and 40 patients (23.1%) developed coagulopathy. Their mean NLR was 7.5 ± 6.7. Using receiver operating characteristic curve analysis, a cut-off value of 4.2 for NLR had 87.5% sensitivity and 52.9% specificity for predicting coagulopathy occurrence. Conclusion: Coagulopathy occurs frequently after TBI. This study investigated the value of NLR as a biomarker to predict coagulopathy occurrence, and concluded that NLR might be a novel and inexpensive biomarker for decision making in the management of TBI. Combination of NLR with other low-cost biomarkers and the clinical findings might further increase accuracy in the prediction of coagulopathy.

Plain language summary Traumatic brain injury (TBI) is a public health issue of increasing incidence. Coagulopathy after TBI is a frequent event, associated with a poor prognosis and biomarkers that could predict coagulopathy occurrence are needed. The neutrophil-to-lymphocyte ratio (NLR) is useful as a cost-effective biomarker to assess prognosis and the need for cranial computed tomography in patients with mild TBI. We found that NLR could additionally predict which TBI patients might develop coagulopathy with a 87.5% sensitivity and 52.9% specificity. Combination of NLR with other low-cost biomarkers and the clinical findings might further increase accuracy in the prediction of coagulopathy.

A case report of abdominal compartment syndrome caused by malposition of a femoral venous catheter.

INTRODUCTION: Venous catheter malposition is a rare event with potential catastrophic consequences. To our knowledge we describe one of the first case reports of an adult presenting with a rare late complication of femoral venous catheter malposition: abdominal compartment syndrome. PRESENTATION OF CASE: A 39 year-old female sustained severe cerebral injury in a road traffic accident. During initial resuscitation a femoral venous catheter was inserted without ultrasound guidance with no immediate concerns. After 48h whilst in intensive care unit the patient developed progressive abdominal distension. Bedside investigations revealed raised intra-abdominal pressures associated with new organ failure. Subsequent an emergency laparotomy and on-table intravenous contrast radiographs revealed extravasation of contrast into the peritoneal space from the malposition of the catheter into the abdominal cavity. DISCUSSION: Complications of central venous catheterization are associated with adverse events with significant morbidity to the patient as well as having cost implications. Mechanical complications are underreported but are potentially preventable through ultrasound-guided insertion, in accordance with international guidelines. CONCLUSION: This case report highlights the importance of safe methods of catheter insertion, the need for increased awareness of late femoral catheter malposition and its potential catastrophic consequences.