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Neutrophil-to-Lymphocyte Ratio: a Marker of Neuro-inflammation in Multiple Sclerosis Patients: a Meta-analysis and Systematic Review

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Abstract

Multiple sclerosis (MS) is a prevalent chronic inflammatory disease of the CNS. There is a growing need for a reliable marker for MS diagnosis and disease monitoring. We aimed to assess the potential of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for MS diagnosis as well as the prediction of relapses and disability. We searched MEDLINE, Scopus, Web of Science, and Embase for relevant studies. The main outcome was the mean difference in NLR between MS patients and healthy controls and different subtypes of MS. We also calculated the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for NLR for diagnosis of MS and MS activity and disability. NLR was significantly higher in MS patients than in healthy controls (MD = 0.69; 95% CI, 0.48–0.9). Also, NLR was significantly higher during relapse than remission (MD = 1.26; 95% CI, 0.37–2.16). Regarding the performance of NLR as a marker for MS activity, its pooled sensitivity and specificity were 0.56 (95% CI 0.52–0.76) and 0.92 (95% CI 0.86–0.95), respectively; also, positive likelihood ration and negative likelihood ratio were 9.85 (95% CI 1.87–51.94) and 0.39 (95% CI 0.28–0.54) respectively. NLR can serve as an adjunctive biomarker for diagnosing MS and identifying relapse periods. However, the clinical utility of NLR in MS is yet to be confirmed by future large, prospective studies with longer follow-ups.

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Authors and Affiliations

  1. Department of Medicine, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt

    Anas Elgenidy, Mostafa Atef, Abdelrahman Nassar, Abdullah Emad, Islam Salah & Yousef Sonbol

  2. Department of Medicine, King Edward Medical University, Lahore, Pakistan

    Huzaifa Ahmad Cheema

  3. Department of Gastroenterology, Hepatology and Nutrition Diseases, Texas University MD Anderson Cancer Center, Houston, USA

    Ahmed M. Afifi

  4. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Sherief Ghozy

  5. Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC Program), Oxford University, Oxford, UK

    Sherief Ghozy

  6. Department of Neurology, Faculty of Medicine, Kasr-Alainy, Cairo University, Cairo, Egypt

    Amr Hassan

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  1. Anas Elgenidy
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Contributions

• Anas Elgenidy: data collection, analysis, screening, and scientific writing.

• Mostafa Atef, Abdelrahman Nasar, and Huzaifa: screening, data collection, and scientific writing.

• Abdullah Emad, and Islam salah: data collection, and scientific writing.

• Yousef Sonbol, Ahmed M. Afifi, Sherief Ghozy, and Amr Hassan: scientific writing, revision, and drafting of the manuscript.

Corresponding authors

Correspondence to Sherief Ghozy or Amr Hassan.

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Supplementary Information

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Appendix 1.

Search strategy (DOCX 16 kb)

Appendix 2.

Quality assessment of cohort studies (NIH Quality Assessment tool). Appendix 3. Risk of bias assessment for Case control studies (Newcastle–Ottawa Quality Assessment Scale criteria). Appendix 4. Quality assessment of Randomized controlled trials (NIH Quality Assessment tool) (DOCX 29 kb)

Appendix 5.

DTA for diagnosis MS (PNG 78 kb)

High resolution image (TIFF 403 kb)

Appendix 6.

DTA for MS activity (PNG 53 kb)

High resolution image (TIFF 141 kb)

Appendix 7.

DTA for MS disability (PNG 67 kb)

High resolution image (TIFF 249 kb)

Appendix 8.

Leave-one-out for analysis comparing MS VS HC (PNG 235 kb)

High resolution image (TIFF 73 kb)

Appendix 9.

Sensitivity analysis (PNG 59 kb)

High resolution image (TIFF 281 kb)

Appendix 10.

Leave-one-out for analysis comparing Relapes VS Remission (PNG 81 kb)

High resolution image (TIFF 164 kb)

Appendix 11.

funnel plot for MS VS HC. (PNG 86 kb)

High resolution image (TIFF 96 kb)

Appendix 12.

References for the included studies (DOCX 17 kb)

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Elgenidy, A., Atef, M., Nassar, A. et al. Neutrophil-to-Lymphocyte Ratio: a Marker of Neuro-inflammation in Multiple Sclerosis Patients: a Meta-analysis and Systematic Review. SN Compr. Clin. Med. 5, 68 (2023). https://doi.org/10.1007/s42399-022-01383-y

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