The Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Guillain-Barré Syndrome Independent of Infection
Article Sidebar
Main Article Content
Abstract
Objective: In the present study, we aimed to determine the predictive value of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of Guillain-Barré Syndrome (GBS).
Material and Methods: This retrospective study enrolled 94 GBS patients and a control group of 101 healthy subjects.
Results: GBS patients had significantly higher NLR, C- Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) values at presentation than the healthy control group (p < 0.001, p < 0.001, p < 0.001, respectively). Patients unresponsive to IVIg therapy had significantly higher NLR values at the time of admission in comparison to responsive patients (p=0.001). NLR was significantly and positively correlated with the disease severity, CRP and ESR. A receiver operating characteristic (ROC) analysis of the ability of NLR to predict GBS showed a cutoff value of 3.5 (sensitivity 62.8%, specificity 90.1%). The cutoff value was 11 for CRP (sensitivity 52.7%, specificity 86%) and 12.3 for ESR (sensitivity 51.3%, specificity 82%). Exclusion of patients with signs of infection at presentation gave a NLR value of 3.2, which had a sensitivity of 61.6% and a specificity of 89.8% for predicting GBS.
Conclusion: Whereas ESR and CRP lost their significance in predicting GBS. Unlike ESR and CRP, NLR might be a promising marker in GBS regardless of infection.
Downloads
Article Details
References
Hiraga A, Mori M, Ogawara K, Kojima S, Kanesaka T, Misawa S, Hattori T, Kuwabara S. Recovery patterns and long term prognosis for axonal Guillain-Barre syndrome. Journal of neurology, neurosurgery, and psychiatry.2005; 76(5):719-722.
van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barre syndrome. The Lancet Neurology.2008; 7(10):939-950.
Van der Meche FG, Van Doorn PA, Meulstee J, Jennekens FG, Centre GB-cgotDNRS.Diagnostic and classification criteria for the Guillain-Barre syndrome.European neurology .2001; 45(3):133-139.
Kieseier BC, Kiefer R, Gold R, Hemmer B, Willison HJ, Hartung HP. Advances in understanding and treatment of immune-mediated disorders of the peripheral nervous system. Muscle & nerve.2004; 30(2):131-156.
Hughes RA, Hadden RD, Gregson NA, Smith KJ.Pathogenesis of Guillain-Barre syndrome.Journal of neuroimmunology.1999; 100(1-2):74-97.
Hughes RA, Raphael JC, Swan AV, van Doorn PA.Intravenous immunoglobulin for Guillain-Barre syndrome.The Cochrane database of systematic reviews.2006(1);CD002063.
Efficiency of plasma exchange in Guillain-Barre syndrome role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barre syndrome.Annals of neurology .1987; 22(6):753-761.
Akil E, Bulut A, Kaplan I, Ozdemir HH, Arslan D, Aluclu MU.The increase of carcinoembryonic antigen (CEA), high-sensitivity C-reactive protein, and neutrophil/lymphocyte ratio in Parkinson's disease.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology .2015; 36(3):423-428.
Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, YurekliVA.The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. The International journal of neuroscience.2015;126(8)1-7.
Gokhan S, Ozhasenekler A, Mansur Durgun H, Akil E, Ustundag M, Orak M. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. European review for medical and pharmacological sciences.2013; 17(5):653-657.
Tokgoz S, Kayrak M, Akpinar Z, Seyithanoglu A, Guney F, Yuruten B. Neutrophil lymphocyte ratio as a predictor of stroke. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association.2013; 22(7):1169-1174.
Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Annals of neurology.1990; 27 Suppl:S21-24.
Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, Swan AV. Electrophysiological classification of Guillain-Barre syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barre Syndrome Trial Group. Annals of neurology.1998; 44(5):780-788.
van Koningsveld R, Steyerberg EW, Hughes RA, Swan AV, van Doorn PA, Jacobs BC.A clinical prognostic scoring system for Guillain-Barre syndrome.The Lancet Neurology.2007; 6(7):589-594.
Dirican N, Anar C, Kaya S, et al. The clinical significance of hematologic parameters in patients with sarcoidosis.The clinical respiratory journal. 2014;doi: 10.1111/crj.12178.
Sen BB, Rifaioglu EN, Ekiz O, et al. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutaneous and ocular toxicology. 2014;33(3):223-227.
Osei-Bimpong A, Meek JH, Lewis SM. ESR or CRP? A comparison of their clinical utility. Hematology. 2007;12(4):353-357.
Assasi N, Blackhouse G, Campbell K, et al. Comparative Value of Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Testing in Combination Versus Individually for the Diagnosis of Undifferentiated Patients With Suspected Inflammatory Disease or Serious Infection: A Systematic Review and Economic Analysis. Ottawa (ON) 2015.
Arbel Y, Finkelstein A, Halkin A, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225(2):456-460.
Fletcher DD, Lawn ND, Wolter TD, et al. Long-term outcome in patients with Guillain-Barre syndrome requiring mechanical ventilation. Neurology. 2000;54(12):2311-2315.