Neutrophil‐lymphocyte ratio in Guillain‐Barré syndrome: A prognostic biomarker of severe disease and mechanical ventilation in Bangladesh

Abstract

In addition to cellular and humoral immunity, inflammatory markers play an important role in the pathogenesis of Guillain-Barré syndrome (GBS) and are used to predict prognosis in many autoimmune diseases. The aim of this study was to identify whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and monocyte-lymphocyte ratio in the early stages of GBS have prognostic value for severe disease, mechanical ventilation (MV) and poor long-term outcome. A prospective cohort study of 140 adult patients with GBS and 140 healthy controls (HC) was performed in Bangladesh during 2019-2022. Clinicodemographic characteristics of the patients were recorded, and hematological parameters were measured using an automated hematology analyzer. Median patient age was 35 (44-23) years; 71% were male; 88% were severely affected (GBS Disability Score> 3); 32% required MV. Patients had higher NLR than HC (P< .0001). Among patients, elevated NLR was associated with severe GBS and MV (P= .001 and <.0001, respectively) and moderately positively correlated with poor outcomes at 4 weeks (r = 0.423). Multiple logistic regression revealed NLR was an independent risk factor for severe GBS (OR = 5.2, 95% CI = 1.6-17.4) and MV (OR = 1.5 1.1-2.1). No significant association was observed between elevated NLR and the long-term outcome of GBS. Receiver operating characteristic curves revealed NLR cut-off values of ≥ 2.432 and ≥ 4.4423 predicted severe disease (sensitivity = 71%, specificity = 75%, AUC = 0.750, 95% CI = 0.651-0.849, P = .001) and MV (sensitivity = 65.9%, specificity = 81.7%, AUC = 0.804, 95% CI=0.724-0.884; P< .001).The NLR in the early stage of GBS may represent an independent prognostic factor of severe GBS and the requirement for MV.

The characteristics of Guillain–Barre syndrome in children in pre‐COVID‐19 and during the COVID‐19 pandemic: A cross‐sectional study

“…Also, an increase in NLR significantly increases the length of hospital stay. Some past studies also confirm our results 11,12,19 . However, studies such as Ozdemir and colleagues showed that there is no correlation between NLR, PLR, and the prognosis of children with GBS 13 …”

“…Some past studies also confirm our results. 11,12,19 However, studies such as Ozdemir and colleagues showed that there is no correlation between NLR, PLR, and the prognosis of children with GBS. 13 Patients who showed ACD pattern in CSF analysis had significantly higher levels of NLR, MLR, and PLR.…”

“…18 Furthermore, it has been shown that NLR can be used as a prognostic factor in GBS. [11][12][13]19 Due to the development of new inflammatory factors in establishing different aspects of inflammatory diseases, the current study is designed to figure out the efficacy of MLR, NLR, and PLR in determining the prognosis of children with different subtypes of GBS. Patients with a history of chronic diseases such as metabolic, malignant, other neurologic, or endocrinological diseases were excluded.…”

“…Several studies have investigated the efficacy of new parameters, for instance, neutrophil‐lymphocyte ratio (NLR), platelet‐lymphocyte ratio (PLR), and monocyte‐lymphocyte ratio (MLR) in determining the prognosis of different conditions including neurological, 9–14 vascular diseases, 15,16 diabetes, 17 and cancers 18 . Furthermore, it has been shown that NLR can be used as a prognostic factor in GBS 11–13,19 …”

A cross-sectional study of neutrophil to lymphocyte ratio as a prognostic marker in acute organophosphorus poisoning in a tertiary care hospital in Central India

“…This study's findings will contribute to a growing body of research on NLR in clinical prognostication, with relevance extending beyond organophosphorus poisoning. NLR has been previously identified as a prognostic marker in a range of medical conditions, such as acute kidney injury, 14 cardiovascular diseases, 15 and sepsis, 16 underscoring its versatility in clinical prediction. By exploring its applicability in the context of poisoning, this study adds a valuable dimension to the ongoing discourse on NLR as a universal prognostic marker.…”