Role of Monocyte-to-lymphocyte Ratio, Mean Platelet Volume-to-Platelet Count Ratio, C-Reactive Protein and Erythrocyte Sedimentation Rate as Predictor of Severity in Secondary Traumatic Brain Injury: A Literature Review

Tjokorda Istri Sri Dalem  Natakusuma; Tjokorda Gde Bagus Mahadewa; Putu Eka  Mardhika; Sri Maliawan; Tjokorda Gde Agung Senapathi; Christopher Ryalino

doi:10.3889/oamjms.2021.6985

Authors

Tjokorda Istri Sri Dalem Natakusuma Postgraduate Degree Program, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Tjokorda Gde Bagus Mahadewa Department of Surgery https://orcid.org/0000-0002-4445-4085
Putu Eka Mardhika Department of Surgery https://orcid.org/0000-0002-2260-9437
Sri Maliawan Department of Surgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia https://orcid.org/0000-0003-2389-3481
Tjokorda Gde Agung Senapathi Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
Christopher Ryalino Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia https://orcid.org/0000-0001-9618-6230

DOI:

https://doi.org/10.3889/oamjms.2021.6985

Keywords:

C-reactive protein, Erythrocyte sedimentation rate, Inflammation, Mean platelet volume to platelet count ratio, Monocyte to lymphocyte ratio, Traumatic brain injury

Abstract

BACKGROUND: Secondary traumatic brain injury (TBI) is injury to the brain following primary TBI because of neuroinflammation as consequences of neuronal and glial cell injury which cause release of various inflammation cytokine and chemokine. Biomarker examination to predict the severity of secondary TBI is important to provide appropriate treatment to the patient. This article reviews possibility several common laboratory parameter such as monocyte-to-lymphocyte ratio (MLR), mean platelet volume-to-platelet count (PC) ratio (MPV-PCR), c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to predict severity of secondary TBI.

LITERATURE REVIEW: TBI activates microglia which increase infiltration and proliferation of monocyte. Neuroinflammation also increases thrombopoiesis which leads to increase megakaryocytes production. In the other hand, due to disruption of brain blood vessels because of trauma, coagulation cascade is also activated and leads to consumptive coagulopathy. These are reflected as high monocyte count, low PC, and high MPV. Lymphocyte count is reported low in TBI especially in poor outcome patients. CRP is an acute phase reactant that increased in inflammation condition. In TBI, increased production of Interleukin-6 leads to increase CRP production. In head injured patients, ESR level does not increase significantly in the acute phase of inflammation but last longer when compared to CRP.

CONCLUSION: MLR, MPV-PCR, CRP, and ESR could be predictor of severity in secondary TBI.

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