The Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Guillain-Barré Syndrome Independent of Infection

Year 2016, Volume: 3 Issue: 8, 305 - 11, 15.08.2016

Sirma Geyik , Hakan Bozkurt Münife Neyal Remzi Yigiter Samiye Kuzudisli Seval Kul

https://doi.org/10.17546/msd.90383

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.

Keywords

Guillain-Barré Syndrome, neutrophil to lymphocyte ratio; C reactive protein; erythrocyte sedimentation rate

The Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Guillain-Barré Syndrome Independent of Infection

Abstract

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.