ArticleCNS neuroscience & therapeutics2026
Early Postoperative Inflammatory Indices Predict Long-Term Neuro-ICU Stay in Patients Requiring Prolonged Care After Supratentorial Brain Tumor Resection: Development and Validation of an Integrated Model.
Article in CNS neuroscience & therapeutics, 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
backgroundLong-term stay (LTS) in the neurosurgical intensive care unit (Neuro-ICU) after supratentorial brain tumor resection disproportionately consumes healthcare resources, but early risk stratification tools remain lacking. We evaluated five early postoperative inflammatory indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index [SII], and systemic inflammation response index [SIRI]) to develop an integrated prediction model.
methodsThis retrospective study included patients requiring > 48-h Neuro-ICU care after elective supratentorial tumor resection. Patients were temporally partitioned into derivation (n = 432) and validation (n = 146) cohorts. Inflammatory indices were measured within 24 h postoperatively. Following least absolute shrinkage and selection operator (LASSO) feature selection, five machine learning classifiers were compared. Model performance was assessed for discrimination, calibration, and clinical utility, alongside subgroup analyses and a series of sensitivity analyses. A nomogram and web-based risk calculator were developed.
resultsLTS occurred in 47.5% and 49.3% of the derivation and validation cohorts, respectively. LTS patients showed higher early postoperative SIRI and PLR and lower LMR, whereas preoperative indices did not differ. All three were independent predictors of LTS. The integrated model combined these indices with preoperative Karnofsky Performance Status, postoperative steroid use, and retained endotracheal intubation at blood sampling. It yielded an AUC of 0.845 in the derivation cohort and 0.816 in the validation cohort, compared with 0.715 for the clinical baseline model (p < 0.001; IDI 0.212; cNRI 0.981). These indices maintained independent predictive value, and model performance remained stable across subgroup and sensitivity analyses.
conclusionEarly postoperative SIRI, PLR, and LMR independently predict LTS in patients requiring prolonged care (> 48 h) after supratentorial brain tumor resection. An integrated model with these indices and early clinical variables provides reliable risk stratification within 24 postoperative hours.
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