Neutrophil-lymphocyte ratio in Guillain-Barré syndrome: A prognostic biomarker of severe disease and mechanical ventilation in Bangladesh

In addition to cellular and humoral immunity, inflammatory markers play an important role in the pathogenesis of Guillain-Barré syndrome (GBS) and are used to predict prognosis in many autoimmune diseases. The aim of this study was to identify whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and monocyte-lymphocyte ratio in the early stages of GBS have prognostic value for severe disease, mechanical ventilation (MV) and poor long-term outcome. A prospective cohort study of 140 adult patients with GBS and 140 healthy controls (HC) was performed in Bangladesh during 2019–2022. Clinicodemographic characteristics of the patients were recorded, and hematological parameters were measured using an automated hematology analyzer. Median patient age was 35 (44–23) years; 71% were male; 88% were severely affected (GBS Disability Score> 3); 32% required MV. Patients had higher NLR than HC (P<.0001). Among patients, elevated NLR was associated with severe GBS and MV (P=.001 and <.0001, respectively) and moderately positively correlated with poor outcomes at 4 weeks (r = 0.423). Multiple logistic regression revealed NLR was an independent risk factor for severe GBS (OR = 5.2, 95% CI = 1.6–17.4) and MV (OR = 1.5 1.1–2.1). No significant association was observed between elevated NLR and the long-term outcome of GBS. Receiver operating characteristic curves revealed NLR cut-off values of ≥ 2.432 and ≥ 4.4423 predicted severe disease (sensitivity = 71%, specificity = 75%, AUC = 0.750, 95% CI = 0.651–0.849, P =.001) and MV (sensitivity = 65.9%, specificity = 81.7%, AUC = 0.804, 95% CI=0.724–0.884; P<.001). The NLR in the early stage of GBS may represent an independent prognostic factor of severe GBS and the requirement for MV.