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Objective <p>Chronic subdural haematoma (cSDH) is common in elderly patients, and its pathophysiology involves sustained inflammation. Peripheral blood inflammatory markers may therefore serve as prognostic indicators. This study evaluated whether haematological, coagulation and inflammatory markers predict postsurgical functional recovery and recurrence in patients undergoing cSDH evacuation.</p> Methods <p>This retrospective cohort study included 309 consecutive adults who underwent cSDH evacuation at a tertiary centre in Porto, Portugal (January 2019–May 2025). Patients with conditions or medications affecting systemic inflammation were excluded. Peripheral blood biomarkers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune–inflammation index [SII] and red cell distribution width-to-platelet ratio [RPR]) were measured within 24&#xa0;h of admission. The primary outcome was poor functional recovery (modified Rankin Scale score 3–6) at 3 months postoperatively; the secondary outcome was recurrence requiring reintervention.</p> Results <p>Among 309 patients (median age, 78 years; 196 [63.4%] men), recurrence was 12.9% (<i>n</i> = 40) and overall mortality was 3.2% (<i>n</i> = 10). In multivariable analysis, the strongest independent predictors of poor functional outcome were a higher Charlson Comorbidity Index (adjusted odds ratio [aOR], 1.46; 95% CI, 1.20–1.79; <i>P</i> &lt; 0.001) and a lower admission Glasgow Coma Scale score (aOR, 0.48; 95% CI, 0.35–0.64; <i>P</i> &lt; 0.001). Adding inflammatory biomarkers (NLR, PLR, SII) did not significantly predict poor functional outcome. Conversely, RPR independently predicted recurrence (aOR per 0.01-unit increase, 1.25; 95% CI, 1.06–1.47; <i>P</i> = 0.007); clinical severity indicators did not.</p> Conclusion <p>Peripheral blood inflammatory markers did not independently predict functional recovery after cSDH evacuation; baseline clinical characteristics remained the strongest prognosticators. However, elevated RPR independently predicted postoperative recurrence. Clinically, while standard assessments should drive functional prognostication, RPR is a readily available biomarker to identify high-risk patients requiring closer monitoring for recurrence.</p>

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Prognostic Value of Peripheral Blood Inflammatory Markers in Chronic Subdural Haematoma: A Retrospective Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • João Meira Gonçalves,
  • Inês Gonçalves,
  • Paulo Linhares

摘要

Objective

Chronic subdural haematoma (cSDH) is common in elderly patients, and its pathophysiology involves sustained inflammation. Peripheral blood inflammatory markers may therefore serve as prognostic indicators. This study evaluated whether haematological, coagulation and inflammatory markers predict postsurgical functional recovery and recurrence in patients undergoing cSDH evacuation.

Methods

This retrospective cohort study included 309 consecutive adults who underwent cSDH evacuation at a tertiary centre in Porto, Portugal (January 2019–May 2025). Patients with conditions or medications affecting systemic inflammation were excluded. Peripheral blood biomarkers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune–inflammation index [SII] and red cell distribution width-to-platelet ratio [RPR]) were measured within 24 h of admission. The primary outcome was poor functional recovery (modified Rankin Scale score 3–6) at 3 months postoperatively; the secondary outcome was recurrence requiring reintervention.

Results

Among 309 patients (median age, 78 years; 196 [63.4%] men), recurrence was 12.9% (n = 40) and overall mortality was 3.2% (n = 10). In multivariable analysis, the strongest independent predictors of poor functional outcome were a higher Charlson Comorbidity Index (adjusted odds ratio [aOR], 1.46; 95% CI, 1.20–1.79; P < 0.001) and a lower admission Glasgow Coma Scale score (aOR, 0.48; 95% CI, 0.35–0.64; P < 0.001). Adding inflammatory biomarkers (NLR, PLR, SII) did not significantly predict poor functional outcome. Conversely, RPR independently predicted recurrence (aOR per 0.01-unit increase, 1.25; 95% CI, 1.06–1.47; P = 0.007); clinical severity indicators did not.

Conclusion

Peripheral blood inflammatory markers did not independently predict functional recovery after cSDH evacuation; baseline clinical characteristics remained the strongest prognosticators. However, elevated RPR independently predicted postoperative recurrence. Clinically, while standard assessments should drive functional prognostication, RPR is a readily available biomarker to identify high-risk patients requiring closer monitoring for recurrence.