Neutrophil-lymphocyte and leuko-glycemic indices as predictive markers for ventilatory support in patients with Guillain-Barre syndrome

Background:  Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide. Lymphocytes and neutrophils are associated with systemic inflammation and production of proinflammatory mediators. GBS, as an autoimmune disease, elicits an upregulation in inflammatory and metabolic pathways, with increased production of lymphocytes and neutrophils. Serum markers such as the neutrophil-lymphocyte (NLR) and leuko-glycemic (LGR) ratios have been studied for the severity and prognosis of non-neurological disorders. Methods: A cross-sectional study from a prospective cohort of patients with GBS was conducted, from January 2018 to February 2021. Comparison between patients with or without ventilatory support was performed with student´s t test or Mann-Whitney U test based on distribution. Chi-square for was used for categorical variables, Fisher´s exact test was applied when necessary. A logistic regression analysis was performed. Results:  One hundred and twenty-three patients were included. Logistic regression analysis demonstrated NLI to be an independent factor for mechanical ventilation in GBS, but not for LGI and OR 2.0, respectively. Both LGI and NLI demonstrated a high performance for ventilatory support prediction, with 0.70 and 0.81, respectively. Best cut-off values, according to Youden index, are for LGI 1.12 (sensitivity 0.70, specificity 0.40) and for NLI 3.59 (sensitivity 0.78, specificity 0.33).  Conclusions:  Despite the wide use of the EGRIS scale in estimating respiratory insufficiency in patients with GBS, we portray a new and easy to obtain laboratory tool that can further help non-neurologists and other clinicians to predict the risk for ventilatory support.