The Role of Neutrophil to Lymphocyte Ratio in Prognosis of Spinal Cord Injury: A Systematic Review and Meta-analysis
Yang Yang Endro Arjuna1, Utsav Patel3, Jeremiah H. Wijaya4, Prakriti Arya5, Sanidhya S. Karve6, Alexander Erick Purnomo2, Shakunt Sarvaiya7, Alan Kaye8, Saurabh Kataria9
1Department of Medicine, 2Departement of Medicine, University of Pelita Harapan, Karawaci, Tangerang, Banten, Indonesia, 3Mayo Clinic, FL, USA, 4Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia, 5Internal Medicine, Doctors Hospital at Renaissance, TX 78539, USA, 6Radiology, Amrita Institute Of Medical Sciences, Kochi, India, 7G.M.E.R.S Medical College and Hospital, Vadodara, Gujarat, India, 8Anesthesiology and Pain Medicine, 9Neurology and Pain Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport LA 71103, USA
Objective:
We aimed to evaluate the prognostic value of Neutrophil-to-lymphocyte ratio in Spinal cord injury patients.
Background:
Spinal cord injury (SCI) is a debilitating condition linked to long-term morbidity and significant
quality-of-life impacts. Accurate prognostication for SCI patients is crucial for informing
treatment strategies, managing expectations, and enhancing outcomes. The neutrophil-to-
lymphocyte ratio (NLR) shows potential as a reliable prognostic marker for SCI, necessitating
further research to confirm its clinical utility and routine application.
Design/Methods:
We conducted a thorough search of electronic databases, including PubMed, Europe PMC,
Science Direct, and Google Scholar, using relevant keywords such as neutrophil-to-lymphocyte
ratio, spinal cord injury, prognosis, and outcome along with Boolean operators. Our selection included studies related to SCI and NLR, emphasizing outcomes like
functional recovery, ASIA scores, neurological improvement, and long-term survival, while
excluding case reports, reviews, commentaries, editorials, and animal studies.
Results:
Three studies with a total of 997 patients met the inclusion criteria. Our study found that a higher
NLR was associated with worse prognosis (MD = 10.36, 95% CI [2.01, 18.72], p = 0.02, I² =
97%). The odds ratio (OR) was 0.83 (95% CI [0.63, 1.09], p = 0.18, I² = 80%). The AUC value
indicated good discrimination ability (AUC = 0.83, 95% CI [0.70 to 0.97], p < 0.01, I² = 98%),
though high heterogeneity may complicate interpretation.
Conclusions:
Higher NLR values are associated with worse outcomes. Significant heterogeneity and limited
findings from current studies may complicate interpretation. Future research should prioritize
larger studies with wider coverage.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.