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


  • Edwin Steven Vargas Cañas Department of Neuromuscular Diseases, Instituto Nacional de Neurología Manuel Velasco Suárez
  • Miriam Marcela Hernandez Sanchez Department of Neurology, Instituto Nacional de Neurología Manuel Velasco Suárez.
  • Javier Andres Galnares Olalde Department of Neuromuscular Diseases, Instituto Nacional de Neurología Manuel Velasco Suárez
  • Adib Jorge de Sarachaga Department of Neuromuscular Diseases, Instituto Nacional de Neurología Manuel Velasco Suárez
  • Ana Lissette Bazán Rodríguez Department of Neuromuscular Diseases, Instituto Nacional de Neurología Manuel Velasco Suárez
  • Raul Nathanael May Mas Department of Neuromuscular Diseases, Instituto Nacional de Neurología Manuel Velasco Suárez
  • Juan Carlos López-Hernández Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez



Guillaín-Barre syndrome, invasive mechanical ventilation, risk factors, neutrophil-lymphocyte ratio, leuko-glycemic ratio


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.


- López-Hernández JC, Colunga-Lozano LE, Garcia-Trejo S, Gomez-Figueroa E, Delgado-Garcia G, Bazán-Rodríguez L, Cervantes-Uribe R, Burgos-Centeno J, Fernandez-Valverde F, Vargas-Cañas ES. Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience. J Clin Neurosci. 2020, 80:292-297. doi: 10.1016/j.jocn.2020.04.059. DOI:

- van den Berg B, Storm EF, Garssen MJP, Blomkwist-Markens PH, Jacobs BC. Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation. J Neurol Neurosurg Psychiatry. 2018 Sep;89(9):949-954. doi: 10.1136/jnnp-2018-317968. DOI:

- Walgaard C, Lingsma HF, Ruts L, Drenthen J, van Koningsveld R, Garssen MJ, van Doorn PA, Steyerberg EW, Jacobs BC. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann Neurol. 2010 Jun;67(6):781-7. doi: 10.1002/ana.21976. DOI:

- Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001 Jun;58(6):893-8. doi: 10.1001/archneur.58.6.893. DOI:

- Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, Leibowitz-Amit R, Sonpavde G, Knox JJ, Tran B, Tannock IF, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014 May 29;106(6):dju124. doi: 10.1093/jnci/dju124. DOI:

- Erre GL, Paliogiannis P, Castagna F, Mangoni AA, Carru C, Passiu G, Zinellu A. Meta-analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in rheumatoid arthritis. Eur J Clin Invest. 2019 Jan;49(1):e13037. doi: 10.1111/eci.13037. DOI:

-Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018 Feb;52:131-136. doi: 10.1016/j.clinbiochem.2017.11.008. DOI:

- Giede-Jeppe A, Bobinger T, Gerner ST, Sembill JA, Sprügel MI, Beuscher VD, Lücking H, Hoelter P, Kuramatsu JB, Huttner HB. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis. 2017;44(1-2):26-34. doi: 10.1159/000468996. DOI:

-Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, Yurekli VA. The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. Int J Neurosci. 2016 Aug;126(8):700-6. doi: 10.3109/00207454.2015.1050492. DOI:

- Martini R, Willison H. Neuroinflammation in the peripheral nerve: Cause, modulator, or bystander in peripheral neuropathies? Glia. 2016 Apr;64(4):475-86. doi: 10.1002/glia.22899. DOI:

-Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27 Suppl:S21-4. DOI:

- M. Singer et al., “The third international consensus definitions for sepsis and septic shock (sepsis-3),” JAMA - J. Am. Med. Assoc., vol. 315, no. 8, pp. 801–810, 2016.

- Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, Swan AV. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998 Nov;44(5):780-8. DOI:

- Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, Vickers AJ, Ransohoff DF, Collins GS. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015 Jan 6;162(1):W1-73. doi: 10.7326/M14-0698. DOI:

-Hagen KM, Ousman SS. The Neuroimmunology of Guillain-Barré Syndrome and the Potential Role of an Aging Immune System. Front Aging Neurosci. 2021 Jan 13;12:613628. doi: 10.3389/fnagi.2020.613628. DOI:

-Orlikowski D, Sharshar T, Porcher R, Annane D, Raphael JC, Clair B. Prognosis and risk factors of early onset pneumonia in ventilated patients with Guillain-Barré syndrome. Intensive Care Med. 2006;32(12):1962–1969. DOI:

- Wang Y, Ju M, Chen C, Yang D, Hou D, Tang X, Zhu X, Zhang D, Wang L, Ji S, Jiang J, Song Y. Neutrophil-to-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2018 Jan;10(1):273-282. doi: 10.21037/jtd.2017.12.131. DOI:

-Yu S, Arima H, Bertmar C, Clarke S, Herkes G, Krause M. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci. 2018 Apr 15;387:115-118. doi: 10.1016/j.jns.2018.02.002. DOI:

-Ozdemir HH. Analysis of the albumin level, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in Guillain-Barré syndrome. Arq Neuropsiquiatr. 2016 Sep;74(9):718-722. doi: 10.1590/0004-282X20160132. DOI:

- Huang Y, Ying Z, Quan W, Xiang W, Xie D, Weng Y, Li X, Li J, Zhang X. The clinical significance of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in Guillain-Barré syndrome. Int J Neurosci. 2018 Aug;128(8):729-735. doi: 10.1080/00207454.2017.1418342. DOI:

-Ning P, Yang B, Yang X, Huang H, Shen Q, Zhao Q, Xie D, Lu H, Xu Y. Lymphocyte-based ratios for predicting respiratory failure in Guillain-Barré syndrome. J Neuroimmunol. 2021 Apr 15;353:577504. doi: 10.1016/j.jneuroim.2021.577504. DOI:

-Edriss H, Selvan K, Sigler M, Nugent K. Glucose Levels in Patients With Acute Respiratory Failure Requiring Mechanical Ventilation. J Intensive Care Med. 2017 Dec;32(10):578-584. doi: 10.1177/0885066616636013. DOI:

-Wang Y, Li G, Yang S, Gu X, Li X, Liu M, Wu X, Guan Y, Press R, Zhu J, Zhang HL. Fasting Glucose Levels Correlate with Disease Severity of Guillain-Barré Syndrome. PLoS One. 2015 Dec 18;10(12):e0145075. doi: 10.1371/journal.pone.0145075. DOI:

-Zaeem Z, Siddiqi ZA, Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: an update. Clin Auton Res. 2019 Jun;29(3):289-299. doi: 10.1007/s10286-018-0542-y. DOI:

-León-Aliz E, Moreno-Martínez FL, Pérez-Fernández GA, Vega-Fleites LF, Rabassa-López-Calleja MA. Índice leuco-glucémico como marcador pronóstico de la evolución intrahospitalaria en pacientes con infarto agudo de miocardio con elevación del ST [Leuko-glycemic index as an in-hospital prognostic marker in patients with ST-segment elevation myocardial infarction]. Clin Investig Arterioscler. 2014 Jul-Aug;26(4):168-75. Spanish. doi: 10.1016/j.arteri.2014.01.002. DOI:

- Hernández-Sánchez MM, Lozano- Nuevo JJ, Suárez-Cuenca JA, Mendoza-Portillo E y col. Índice leuco-glucémico asociado con complicaciones en isquemia cerebral aterotrombótica. Med Int Méx. 2019 enero-febrero;35(1):39-44. htt ps : // v35i1.2180

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How to Cite

Vargas Cañas, E. S., Hernandez Sanchez, M. M., Galnares Olalde, J. A., Jorge de Sarachaga, A., Bazán Rodríguez, A. L., May Mas, R. N., & López-Hernández, J. C. (2023). Neutrophil-lymphocyte and leuko-glycemic indices as predictive markers for ventilatory support in patients with Guillain-Barre syndrome. Archivos De Neurociencias, 28(2).



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