The Neutrophil-to-lymphocyte Ratio in Myelin Oligodendrocyte Glycoprotein Antibody Associated-Disease (MOGAD): A Systematic Review with Meta-analysis
Ivan Alegre-Cordero1, Gerardo Luna-Peralta1, Adriana Reyes-Barreto1, Fritz Vascones Roman2, Cecilia Raraz-Rivera2, Karlos Acurio2, Miguel Cabanillas-Lazo3, Carlos Quispe-Vicuña3
1Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú, 2Facultad de medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú, 3Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú
Objective:
To summarize the evidence on the neutrophil-to-lymphocyte ratio (NLR) as a biomarker in myelin oligodendrocyte glycoprotein antibody associated-disease (MOGAD).
Background:
MOGAD is an immune-mediated disorder with a wide range of clinical presentations. While the neutrophil-to-lymphocyte ratio (NLR) has been extensively studied as a prognostic factor in other immune conditions such as Guillain-Barré syndrome and Neuromyelitis Optica Spectrum Disorder (NMOSD), its value in MOGAD remains poorly understood.
Design/Methods:
We systematically searched 5 databases (PubMed, Embase, Scopus, Web of Science and Google Scholar) until August 2024 for studies evaluating pre-treatment NLR values in MOGAD patients. No age or language restrictions were imposed. A meta-analysis using a random-effects model to estimate pooled effects was realized for each outcome and a narrative synthesis when this was not possible. Quality was assessed using the NewCastle-Ottawa scale for observational studies. GRADE criteria were used to identify the certainty of evidence (CoE) for each result.
Results:
Eight studies were selected, representing a total of 1149 patients. We included 5 cohorts and 3 case-control studies. NLR values were lower in patients with MOGAD compared with patients with NMOSD (MD: -0.42; 4 studies; 91 participants; 95% CI: -1.72 to 0.89; I2 = 83%; CoE very low) and, on the contrary, NLR values were higher in patients with MOGAD compared with Healthy controls (HC) (MD: 0.79; 3 studies; 66 participants; 95% CI: 0.17 to 1.41; I2 = 71%; CoE very low). All studies had a low risk of bias.
Conclusions:
NLR appears to be a useful biomarker for MOGAD, as it was significantly elevated in the patient group compared to HC, though with very low certainty. The lower NLR levels in MOGAD compared to NMOSD suggest that NLR may vary with disease severity and could serve as a prognostic biomarker. However, larger studies are needed to further assess its prognostic value.
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