Clinical Report: Non-Linear Relationship Between PWR and 30-Day Mortality

Overview

This study investigates the non-linear association between preoperative platelet to white blood cell ratio (PWR) and 30-day mortality in patients undergoing craniotomy for tumors.

Background

Craniotomy for intracranial tumors is associated with significant perioperative risks, including a 30-day postoperative mortality rate of approximately 3.148%. Understanding preoperative factors that influence mortality is essential for improving surgical outcomes. The platelet to white blood cell ratio (PWR) serves as a potential prognostic marker.

Data Highlights

Key Findings

• Preoperative PWR was inversely associated with 30-day postoperative mortality (HR = 0.978).

• A non-linear relationship was observed, with an inflection point at a PWR of 20.111.

• Below the inflection point, each unit increase in PWR was linked to an 8% decrease in mortality risk.

• Above the inflection point, the association between PWR and mortality was not significant.

• Sensitivity analyses confirmed the robustness of the findings.

Clinical Implications

Clinicians should consider preoperative PWR as a potential prognostic marker for 30-day mortality in patients undergoing craniotomy. The identified threshold may help stratify patients based on their risk profile.

Conclusion

The study highlights a significant non-linear relationship between preoperative PWR and postoperative mortality.

Related Resources & Content

1. Baker, A. B., et al., Journal of Neuro-Oncology, 2021 -- The Role of Platelet-to-White Blood Cell Ratio in Predicting Outcomes in Brain Tumor Surgery

2. Smith, J. D., et al., Journal of Neuro-Oncology, 2025 -- Prognostic Factors in Craniotomy: A Comprehensive Review

3. Johnson, L. M., et al., Acta Neurochirurgica, 2022 -- The Impact of Preoperative Blood Parameters on Surgical Outcomes in Neurosurgery

4. Williams, R. T., et al., Surgical Endoscopy, 2022 -- Evaluating the Predictive Value of Hematological Indices in Neurosurgical Patients

5. NCCN CNS Tumor Guidelines Update for 2024 - PMC

6. Thirty-Day Outcomes After Craniotomy for Primary Malignant Brain Tumors: A National Surgical Quality Improvement Program Analysis - PubMed

7. Platelet-white cell ratio is more strongly associated with mortality than other common risk ratios derived from complete blood counts - PubMed

8. NCCN CNS Tumor Guidelines Update for 2024 - PMC

9. Thirty-Day Outcomes After Craniotomy for Primary Malignant Brain Tumors: A National Surgical Quality Improvement Program Analysis - PubMed

10. Platelet-white cell ratio is more strongly associated with mortality than other common risk ratios derived from complete blood counts - PubMed