Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh.
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Peripher Nerv Syst. 2023 Mar;28(1):47-57. doi: 10.1111/jns.12531. Epub 2023 Feb 8.
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.
除细胞和体液免疫外，炎症标志物在吉兰-巴雷综合征（GBS）发病机制中起重要作用，并用于预测许多自身免疫性疾病的预后。本研究旨在确定 GBS 早期的中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值和单核细胞与淋巴细胞比值是否对重症疾病、机械通气（MV）和不良长期预后具有预后价值。2019 年至 2022 年，在孟加拉国对 140 名成年 GBS 患者和 140 名健康对照者（HC）进行了前瞻性队列研究。记录了患者的临床特征，并使用自动化血液分析仪测量了血液学参数。中位患者年龄为 35（44-23）岁；71%为男性；88%为重症（GBS 残疾评分>3）；32%需要 MV。患者的 NLR 高于 HC（P<0.0001）。在患者中，升高的 NLR 与重症 GBS 和 MV 相关（P=0.001 和 <0.0001），并且与 4 周时的不良结局中度正相关（r=0.423）。多变量逻辑回归显示，NLR 是重症 GBS（OR=5.2，95%CI=1.6-17.4）和 MV（OR=1.5，1.1-2.1）的独立危险因素。升高的 NLR 与 GBS 的长期结局之间没有显著关联。ROC 曲线显示，NLR 截断值≥2.432 和≥4.4423 预测重症疾病（敏感性=71%，特异性=75%，AUC=0.750，95%CI=0.651-0.849，P=0.001）和 MV（敏感性=65.9%，特异性=81.7%，AUC=0.804，95%CI=0.724-0.884；P<0.001）。GBS 早期的 NLR 可能代表重症 GBS 和 MV 需求的独立预后因素。
