The neutrophil-lymphocyte ratio is significantly higher in patients with neuromyelitis optica spectrum disorder (NMOSD) compared to healthy controls, found a new systematic review and meta-analysis of the literature published in PLoS One. It can, therefore, be a valuable biomarker for the disease. Moreover, the researchers reported that it could also be an indicator of poor prognosis “with low to moderate certainty”.

The neutrophil-lymphocyte ratio is often used as a biomarker to assess inflammatory stress and prognosis in a number of diseases. 

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Here, a team of researchers from Peru led by Carlos Alva-Díaz MD, MSc, conducted a systematic review and meta-analysis of the literature to analyze the current evidence on the ability of the neutrophil-lymphocyte ratio to be a biomarker in NMOSD.

The researchers identified 6 studies that included a total of 1036 patients about the neutrophil-lymphocyte ratio and NMOSD.

They found that there was a significant increase in the neutrophil-lymphocyte ratio in patients with NMOSD compared to healthy controls “with high heterogeneity”. 

They also found that the rate of disease relapse was related to the neutrophil-lymphocyte ratio, but with low certainty.

Finally, the researchers reported an association between the neutrophil-lymphocyte ratio and an Expanded Disability Status Scale (EDSS) score of 4 or more and the occurrence of lesions on magnetic resonance imaging (MRI) with moderate certainty.

“Based on our results, with high certainty, the mean [neutrophil-lymphocyte ratio] is higher in NMOSD patients than in healthy controls,” the researchers concluded.

“Furthermore, with low to moderate certainty, we found that the [neutrophil-lymphocyte ratio] could be a prognostic factor for relapse, disability (EDSS≥4), and appearance of new lesions on MRI. Future prospective studies in different populations and development of prognostic models that take the [neutrophil-lymphocyte ratio] into account are needed,” they added.


Cabanillas-Lazo M, Cruzalegui-Bazán C, Pascual-Guevara M, et al. Clinical and imagenologic significance of the neutrophil-to-lymphocyte ratio in neuromyelitis optica spectrum disorder: a systematic review with meta-analysis. PLoS One. Published online February 9, 2023. doi:10.1371/journal.pone.0281064