The Neutrophil-to-Lymphocyte Ratio (NLR) as a Prognostic Biomarker in Children with Guillain-Barre Syndrome (GBS): A Systematic Review
Milagros Pascual-Guevara1, Miguel Cabanillas Lazo1
1Sociedad Científica de San Fernando, Lima, Perú. Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Perú
Objective:
To summarize the evidence of NLR as a potential biomarker for children with GBS
Background:
GBS is the most common acquired polyneuropathy in childhood and is characterized by progressive weakness or sensory loss followed by slow clinical recovery. Given that it is an "autoimmunity by molecular mimicry" that causes damage to Schwann cells and destruction of myelin due to neutrophilia and lymphocytopenia generated by systemic inflammation, NLR could be a potential biomarker, especially in children who tend to present residual symptoms that require prolonged and expensive rehabilitation
Design/Methods:
A systematic search was performed in PubMed, Embase, Scopus, Google Scholar, WOS and Scielo until September 2023. We included analytical observational studies. The evidence was synthesized narratively, and the quality of studies was evaluated according to study designs. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE)system to narrative results
Results:
We selected 3 observational studies from 216 in the initial search with a total of 116 children GBS patients. NLR was significantly higher in patients versus controls irrespective of whether criteria GBS was used. About GBS prognosis, higher NLR was reported in patients with Hughes>3 (MD: 0.44; 95% IC: -0.29 to 1.17) and those with motor residual deficits (MD: 1.31; 95% IC: 0.43 to 2.19) with moderate and high certainty, respectively. In relation to mechanical ventilation use, with moderate certainty the mean NLR was lower (MD: -0.54; 95% IC: -1.25 to 0.17).
Conclusions:
Mean NLR is higher in GBS patients compared to healthy controls. Furthermore, with moderate and high certainty we found that NLR could be a prognostic factor for disability, residual motor deficits and mechanical ventilation in children GBS patients; however further research is needed.