ArticleFrontiers in oncology2026
Preoperative systemic inflammatory indices as risk factors for hemorrhage after supratentorial brain tumor resection in patients requiring prolonged neurosurgical intensive care: development and temporal validation of an early postoperative risk stratification model.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Postoperative hemorrhage (POH) is a serious complication after supratentorial brain tumor resection. In patients requiring prolonged neurosurgical intensive care unit (NICU) management, effective risk stratification for POH is clinically important but remains limited. Systemic inflammation, quantified by the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI), has been implicated in hemorrhagic risk. This study aimed to evaluate the associations of NLR, PLR, and SIRI with POH and to develop an integrated early postoperative risk stratification model. Methods: In this retrospective cohort study, patients with > 48 hours of NICU stay after elective supratentorial tumor resection were temporally divided into development and validation cohorts. Preoperative NLR, PLR, and SIRI were derived from routine blood tests and assessed for associations with POH. Independent risk factors were identified using multivariable logistic regression. The incremental value of inflammatory markers beyond a clinical model was evaluated. Model performance was assessed using receiver operating characteristic analysis, calibration, and decision curve analysis. Results: The study included 587 patients (438 in development, 149 in validation). POH occurred in 32.9% (144/438) and 32.2% (48/149), respectively. In multivariable analysis, SIRI (adjusted odds ratio [aOR] 1.56, 95% CI 1.18-2.06) and PLR (aOR 1.49 per 100-unit increase, 95% CI 1.05-2.11), together with basal ganglia location, tumor diameter, and postoperative systolic blood pressure (SBP), were independent risk factors for POH; NLR was not. SIRI showed the highest AUC (0.686) compared with NLR (0.673) and PLR (0.669). Adding SIRI to the clinical baseline model provided significant incremental value (IDI 0.043, Conclusions: Preoperative SIRI and PLR are independent risk factors for POH in patients requiring prolonged NICU stay after supratentorial tumor resection. An integrated early postoperative model combining SIRI and PLR may facilitate risk stratification.
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