Data_Sheet_1_The neutrophil-to-lymphocyte ratio as a prognostic biomarker in Guillain-Barre syndrome: a systematic review with meta-analysis.pdf

Background and objectivesGuillain-Barre syndrome (GBS) is an immune-mediated neuropathy. This has raised the possibility that the neutrophil-lymphocyte ratio (NLR) may be a biomarker of its activity. We conducted a systematic review and meta-analysis to summarize the evidence of NLR as a potential biomarker for GBS.
MethodsWe systematically searched databases (PubMed, Ovid-Medline, Embase, Scopus, Web of Science, SciELO Citation Index, LILACS, and Google Scholar) until October 2021 for studies evaluating pre-treatment NLR values in GBS patients. A meta-analysis using a random-effects model to estimate pooled effects was realized for each outcome and a narrative synthesis when this was not possible. Subgroup and sensitivity analysis were realized. GRADE criteria were used to identify the certainty of evidence for each result.
ResultsTen studies from 745 originally included were selected. Regarding GBS patients versus healthy controls, a meta-analysis of six studies (968 patients) demonstrated a significant increase in NLR values in GBS patients (MD: 1.76; 95% CI: 1.29, 2.24; I2 = 86%) with moderate certainty due to heterogeneity of GBS diagnosis criteria used. Regarding GBS prognosis, assessed by Hughes Score ≥ 3, NLR had a sensitivity between 67.3 and 81.5 and a specificity between 67.3 and 87.5 with low certainty due to imprecision, and heterogeneity. In relation to respiratory failure, NLR had a sensitivity of 86.5 and specificity of 68.2 with high and moderate certainty, respectively.
DiscussionWith moderate certainty, mean NLR is higher in GBS patients compared to healthy controls. Furthermore, we found that NLR could be a prognostic factor for disability and respiratory failure with low and moderate certainty, respectively. These results may prove useful for NLR in GBS patients; however, further research is needed.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285212.

背景与目的 吉兰-巴雷综合征（Guillain-Barre syndrome, GBS）是一种免疫介导的周围神经病，这一特性提示中性粒细胞与淋巴细胞比值（neutrophil-lymphocyte ratio, NLR）或可成为其疾病活动度的生物标志物。本研究通过系统评价与meta分析，总结NLR作为GBS潜在生物标志物的相关证据。
方法 本研究系统检索了截至2021年10月的PubMed、Ovid-Medline、Embase、Scopus、Web of Science、SciELO Citation Index、LILACS及Google Scholar数据库，筛选评估吉兰-巴雷综合征患者治疗前NLR水平的相关研究。针对各项结局指标，采用随机效应模型进行meta分析以合并效应量；若无法开展定量合成，则采用描述性综述进行总结。此外，本研究还进行了亚组分析与敏感性分析，并使用GRADE（Grading of Recommendations Assessment, Development and Evaluation）标准评估各项结果的证据确定性等级。
结果 本研究从初始纳入的745项研究中最终筛选出10项符合标准的研究。针对GBS患者与健康对照的对比，6项研究（共968例患者）的meta分析结果显示，GBS患者的NLR水平显著升高（均数差MD=1.76，95%置信区间CI：1.29~2.24；I²=86%），由于GBS诊断标准存在异质性，该结果的证据确定性为中等等级。针对以Hughes评分≥3评估的GBS预后，NLR的灵敏度介于67.3~81.5之间，特异度介于67.3~87.5之间，由于存在结果不精确性与研究异质性，该结果的证据确定性为低等级。针对呼吸衰竭结局，NLR的灵敏度为86.5，特异度为68.2，其证据确定性分别为高等级与中等等级。
讨论 本研究以中等确定性证实，GBS患者的平均NLR水平高于健康对照。此外，本研究发现NLR或可分别作为GBS患者残疾与呼吸衰竭的预后因素，其证据确定性分别为低等级与中等等级。上述结果可为GBS患者的NLR临床应用提供参考，但仍需开展更多相关研究加以验证。
系统评价注册 本系统评价已在PROSPERO平台注册，注册链接为https://www.crd.york.ac.uk/PROSPERO/，注册编号为CRD42021285212。