Abstract
The present study aimed to investigate the prognostic importance of the neutrophil-to-lymphocyte ratio (NLR) in patients with amyotrophic lateral sclerosis (ALS). Among 322 patients diagnosed as having definite, probable, or possible ALS at a single tertiary hospital, 194 patients were included in the final analysis. Patients were divided into three groups (T1, T2, and T3) according to the tertile of their NLR. Survival rate was significantly lower in T3 compared to the other groups (log-rank test; T1 vs. T3, p = 0.009; T2 vs. T3, p = 0.008). Median survival duration was 37.0 (24.0–56.0), 32.5 (19.5–51.2), and 22.0 (17.0–38.0) months in T1, T2, and T3, respectively. In a multivariable Cox proportional hazards regression analysis, the hazard ratio of age at onset, bulbar-onset, and NLR (T3/T1) was 1.04 (1.02–1.06, p < 0.001), 1.68 (1.10–2.57, p = 0.015), and 1.60 (1.01–2.51, p = 0.041), respectively. A high baseline NLR may serve as a useful indicator for short survival duration in patients with ALS.
Highlights
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease mainly but not exclusively affecting motor neurons in the cerebral cortex, brainstem, and spinal cord
We showed that a high neutrophil-to-lymphocyte ratio (NLR) indicates short survival duration in ALS
Neutrophils may have a protective role in initiating the neuronal repair; an increase in blood neutrophils may reflect the exclusion of these cells following initiation of the repair process[27,28,29]
Summary
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease mainly but not exclusively affecting motor neurons in the cerebral cortex, brainstem, and spinal cord. The clinical presentation of the disease varies widely between patients, median survival is 3–5 years[1]. A recent study showed that an increased neutrophil to CD16- monocyte ratio was associated with disease progression in patients with ALS12. Another study reported that changes in peripheral immune cells, increased neutrophils and decreased CD4 + T-cells, had a significant correlation with disease progression, whereas monocyte count did not[7]. A significant increase in NLR was reported in patients with Alzheimer’s disease[17], its clinical importance has not yet been elucidated[18]. We hypothesised that the NLR reflects the degree of neuroinflammation in patients with ALS and can be used as a prognostic biomarker for survival
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