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Intracranial pressure, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein, and D-dimer mortality predictors in isolated severe traumatic brain injury

Year: 2026

Type: article

Abstract: Background: Severe traumatic brain injury (STBI) is associated with high mortality and significant management challenges, particularly due to elevated intracranial pressure (ICP) and its role in triggering secondary injury through inflammatory pathways. This study investigates the predictive value of initial ICP, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and D-dimer for 14-day mortality in patients with isolated STBI. Methods: A prospective cohort study was conducted at Ngoerah Hospital, Denpasar, including patients with isolated STBI requiring ICP monitoring. Initial ICP, NLR, PLR, CRP, and D-dimer levels (measured on day 3 of admission) were analyzed. The primary endpoint was 14-day mortality. Results: Among participants, 64.7% were male and 62.5% were aged 25–40 years. An initial ICP >20 cm H 2 O was significantly associated with increased 14-day mortality (relative risk [RR]: 6.43; P < 0.05; 95% confidence interval [CI]: 0.966–43.25). PLR <90.63 was also linked to higher mortality ( P = 0.036). No significant associations were found for NLR, CRP, or D-dimer. Conclusion: An initial ICP exceeding 20 cmH2O (14.71 mmHg) may serve as a new predictive threshold for 14-day mortality in isolated STBI patients. In addition, low PLR (<90.63) may serve as an early mortality predictor. Further studies are needed to clarify the role of other biomarkers.

Source: Surgical Neurology International

DOI: 10.25259/sni_983_2025