Neutrophil-to-lymphocyte ratio as a biomarker for Guillain-Barré Syndrome: A systematic review with meta-analysis
Miguel Cabanillas Lazo1, Carlos Quispe-Vicuña1, Claudia Cruzalegui Bazán1, Milagros Pascual-Guevara1, Nicanor Mori2, Carlos Alva-Diaz3
1Red de Eficacia Clinica y Sanitaria (REDECS), Lima, Peru., 2Servicio de Neurología. Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú., 3Universidad Señor de Sipán, Chiclayo, Perú.
Objective:
We conducted a systematic review and meta-analysis to summarize the evidence on neutrophil-lymphocyte ratio (NLR) as a potential biomarker for Guillain-Barré syndrome (GBS).
Background:
GBS is an immune-mediated neuropathy. This has raised the possibility that the NLR may be a biomarker of its activity.
Design/Methods:
We systematically searched databases (PubMed, Ovid-Medline, Embase, Scopus, Web of Science, SciELO, LILACS, and Google Scholar) until October 2021 for studies evaluating pre-treatment NLR values in GBS patients. A meta-analysis using a random-effects model to estimate pooled effects was planned for each outcome and a narrative synthesis when this was not possible. Subgroup and sensitivity analysis were planned. GRADE criteria were used to identify the certainty of evidence for each result.
Results:
We screened ten studies for full-text review from 745 in the initial search. Regarding GBS patients versus healthy controls, a meta-analysis of six studies (968 patients) demonstrated a significant increase in NLR values in GBS patients (MD: 1.76; 95% CI: 1.29, 2.24; I2 = 86%) with moderate certainty due to heterogeneity and irrespective of GBS diagnosis criteria used. Regarding GBS prognosis, assessed by Hughes Score ≥3, NLR had a sensitivity ranged 67.3 and 81.5 and a specificity between 67.3 to 87.5 with low certainty due to imprecision, and heterogeneity. In relation to respiratory failure, NLR had a sensitivity of 86.5 and specificity of 68.2 with high and moderate certainty, respectively. Regarding sensitive analysis, these suggest that the results estimated by meta-analysis were stable.
Conclusions:
With moderate certainty, mean NLR is higher in GBS patients compared to healthy controls. Furthermore, we found that NLR could be a prognostic factor for disability and respiratory failure with low and moderate certainty, respectively. These results may prove useful for NLR in GBS patients; however, further research is needed.