Purpose. To explore the potential of monocyte-to-lymphocyte ratio (MLR) at hospital admission for predicting acute traumatic intraparenchymal hematoma (tICH) expansion in patients with cerebral contusion. Patients and Methods. This multicenter, observational study included patients with available at-hospital admission (baseline) and follow-up computed tomography for volumetric analysis (retrospective development cohort: 1146 patients; prospective validation cohort: 207 patients). Semiautomated software assessed tICH expansion (defined as ≥33% or 5 mL absolute growth). MLR was acquired from routine blood tests upon admission. We constructed two predictive models: basic combined model of clinical and imaging variables and MLR combined model of both MLR and other variables in the basic model. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were used to estimate the performance of MLR for predicting acute tICH expansion. Results. MLR was significantly larger in patients with acute tICH expansion compared to those without acute tICH expansion (mean [SD], 1.08 [1.05] vs. 0.59 [0.37], ). A nonlinear positive relationship between MLR and the incidence of acute tICH expansion was observed. Multivariate logistic regression indicated MLR as an independent risk factor for acute tICH expansion (odds ratio (OR), 5.88; 95% confidence interval (CI), 4.02-8.61). The power of the multivariate model for predicting acute tICH expansion was substantially improved with the inclusion of MLR (AUC 0.86 vs. AUC 0.74, ), as was also observed in an external validation cohort (AUC 0.83 vs. AUC 0.71, ). The net benefit of MLR model was higher between threshold probabilities of 20-100% in DCA. For clinical application, a nomogram derived from the multivariate model with MLR was introduced. In addition, MLR was positively associated with 6-month unfavorable outcome. Conclusion. MLR is a novel predictor for traumatic parenchymatous hematoma expansion. A nomogram derived from the MLR model may provide an easy-to-use tool for predicting acute tICH expansion and promoting the individualized treatment of patients with hemorrhagic cerebral contusion. MLR is associated with long-term outcome after cerebral contusion.

中文翻译：

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入院时单核细胞与淋巴细胞的比率是脑挫伤后急性创伤性脑实质出血扩大的新预测指标

目的。探讨入院时单核细胞与淋巴细胞比率 (MLR) 预测脑挫伤患者急性外伤性脑实质内血肿 (tICH) 扩大的潜力。患者和方法. 这项多中心、观察性研究包括可入院（基线）和后续计算机断层扫描进行体积分析的患者（回顾性发展队列：1146 名患者；前瞻性验证队列：207 名患者）。半自动软件评估 tICH 扩展（定义为≥33% 或 5 mL 绝对增长）。MLR 是在入院时通过常规血液检查获得的。我们构建了两个预测模型：临床和影像学变量的基本组合模型和基本模型中 MLR 和其他变量的 MLR 组合模型。接受者操作特征 (ROC) 分析和决策曲线分析 (DCA) 用于估计 MLR 预测急性 tICH 扩张的性能。结果. 与没有急性 tICH 扩张的患者相比，有急性 tICH 扩张的患者的 MLR 显着更大（平均 [SD]，1.08 [1.05] vs. 0.59 [0.37]，）。观察到 MLR 与急性 tICH 扩张的发生率之间存在非线性正相关关系。多变量逻辑回归表明 MLR 是急性 tICH 扩张的独立危险因素（优势比 (OR)，5.88；95% 置信区间 (CI)，4.02-8.61）。加入 MLR 后，预测急性 tICH 扩张的多变量模型的功效显着提高（AUC 0.86 对比 AUC 0.74，)，正如在外部验证队列中观察到的那样（AUC 0.83 与 AUC 0.71，）。在 DCA 中，MLR 模型的净收益在 20-100% 的阈值概率之间更高。对于临床应用，引入了从具有 MLR 的多变量模型导出的列线图。此外，MLR 与 6 个月的不利结果呈正相关。结论。MLR 是创伤性实质血肿扩大的新预测因子。从 MLR 模型导出的列线图可以为预测急性 tICH 扩大和促进出血性脑挫伤患者的个体化治疗提供一种易于使用的工具。MLR 与脑挫伤后的长期预后相关。