NEUTROPHIL-LYMPHOCYTE RATIO IN GUILLAIN-BARRÉ SYNDROME: A PROGNOSTIC MARKER TO PREDICT MECHANICAL VENTILATION IN EARLY STAGE OF THE DISEASE

Abstract

Intro: Guillain-Barré syndrome (GBS), a life-threatening autoimmune disorder, triggered by an antecedent infection mostly by Campylobacter jejuni through molecular mimicry against host nerve gangliosides. Apart from humoral immunity, innate and cell-mediated immunity, are equally involved initiating this autoimmunity. Mechanical ventilation (MV) is required by 30% patients and 20% of patients had poor prognosis after 6 months. Identifying inflammatory markers to predict GBS severity and MV in early disease stage, lead to ameliorate disease prognosis and improve clinical management. Methods: We included 140 GBS patients in a prospective cohort study during 2019-2022 in Bangladesh. The disease severity and MV were assessed by GBS- disability score (GBS-DS) and neutrophil and lymphocyte count were measured using automated hematology analyser. Findings: The median (IQR) age was 35 (21) years with male predominance (71%); 73% patients had preceding events and 34% had cranial nerves involvement, 88% were severity affected (GBS-DS> 3) and 32% required MV. The median of neutrophil count and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients compared to mild patients (P=0.005 and 0.001), however, no differences were found for platelet lymphocyte ratio (PLR) and monocyte lymphocyte ratio (MLR). NLR and MLR revealed moderate positive correlation with disease severity at enrolment (r=0.538 and 0.417) and with poor prognosis at 4 weeks (r=0.423 and 0.429). Multiple logistic regression revealed, NLR, an autonomous risk factor with 2.9 times higher risk of increasing severity and 1.6 times for MV (95% CI=1.29-6.64 and 1.15-2.18). ROC curve revealed, cut-off value of NLR was 2.432, with 71% sensitivity and 75% specificity for predicting disease severity (AUC=0.750, 95% CI=0.651-0.849, P=0.001). The cut-off of NLR with 4.4423, can predict MV with 65.9% sensitivity, 81.7% specificity (AUC=0.804, 95% CI=0.724-0.884; P= <0.001). Conclusion: In conclusion, NLR, can be an independent predictor of the progression of disability and requirement of MV at the early stage of GBS.