A high neutrophil-to-lymphocyte ratio may be associated with a high relapse rate and poor recovery in neuromyelitis optica spectrum disorder (NMOSD), a new study published in BMC Neurology found. According to the researchers, the neutrophil-to-lymphocyte ratio could therefore be used as a prognostic indicator for the disease.

The pathogenesis of NMOSD is not fully understood, which means it is difficult to predict its prognosis. A number of prognostic biomarkers have been suggested to date; however, there are no widely unified biomarkers. 

The neutrophil-to-lymphocyte ratio has been proposed as a prognostic marker in a number of diseases, including endocrine diseases, inflammatory bowel disease, malignancies, and rheumatologic diseases.

In the present study, a team of researchers from China led by Yanjie Jia investigated the relationship between neutrophil-to-lymphocyte ratio and the prognosis of NMOSD in patients after their first attack. They reviewed the medical records of 324 patients with first-episode NMOSD and analyzed their follow-up Extended Disability Status Scale (EDSS) score, as well as the relapse rate of the disease.

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Statistical analyses revealed that patients with a high neutrophil-to-lymphocyte ratio had markedly higher EDSS scores and relapse rates at follow-up than patients with a low neutrophil-to-lymphocyte ratio. In other words, the neutrophil-to-lymphocyte ratio was significantly associated with relapse and poor recovery.

Moreover, the platelet-to-lymphocyte ratio and lymphocyte-to-monocyte technical ratio were strongly associated with relapse due to the elevated neutrophil-to-lymphocyte ratio. 

Finally, the median time to relapse was significantly lower in patients who had a high neutrophil-to-lymphocyte ratio than in those who had a low ratio.

These findings led the researchers to the conclusion that there is a significant correlation between neutrophil-to-lymphocyte ratio and NMOSD prognosis.  They wrote, “early monitoring of [neutrophil-to-lymphocyte ratio] values in patients with NMOSD is beneficial.”


Xie H, Zhao Y, Pan C, et al. Association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of first attack neuromyelitis optica spectrum disorder (NMOSD): a retrospective cohort study. BMC Neurol. 2021;21(1):389. doi:10.1186/s12883-021-02432-0