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学术急诊医学档案

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  3. 卷 14 编号 1 (2026): Continuous volume
  4. Review Article

卷 14 编号 1 (2026)

十月 2025

Neutrophil to Lymphocyte Ratio as a Predictive Factor of Unfavorable Outcomes in Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis

  • Amirreza Peyrovinasab
  • Hamed Zarei
  • Mahrokh Janmohamadi
  • Mehra Fekri
  • Farzin Tahmasbi Arashlow
  • Alireza Ghorbani
  • Pantea Gharin
  • Pardis Soroush
  • Saeed Safari
  • Mahmoud Yousefifard

学术急诊医学档案, 卷 14 编号 1 (2026), 1 十月 2025 , 第 e4 页
https://doi.org/10.22037/aaem.v14i1.2766 已出版: 2025-11-22

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摘要

Introduction: There are a number of biomarkers connected to inflammation that affect spinal cord injury (SCI) outcomes. This systematic review and meta-analysis was conducted to evaluate the prognostic value of the Neutrophil-to-lymphocyte ratio (NLR) in patients diagnosed with traumatic SCI.

Methods: Observational studies evaluating the association between baseline NLR and severity or neurological improvement in traumatic SCI patients were systematically identified using Medline, Embase, Scopus, and Web of Science databases on March 4, 2025. The risk of bias among the included studies was assessed using the National Heart, Lung, and Blood Institute (NHLBI) tool. A random-effects model was employed for meta-analyses. Effects sizes were reported as odds ratios (ORs) or standardized mean difference (SMD), along with their 95% confidence intervals (CIs).

Results: Six retrospective cohort studies involving 1,564 participants were included, with five eligible for meta-analysis. Blood samples were collected within 72 hours of admission. Meta-analysis showed that patients without neurological improvement had significantly higher NLR values (SMD: 0.98; 95% CI: 0.08–1.87; I² = 94.36%). Additionally, elevated NLR was independently associated with no neurological improvement (adjusted OR: 1.12; 95% CI: 1.06–1.17; I² = 0.04%). Qualitative synthesis further indicated that higher NLR values were consistently associated with greater injury severity in acute traumatic SCI.

Conclusion: Elevated NLR is associated with greater injury severity and poorer neurological recovery in patients with acute traumatic SCI. These findings suggest that NLR may serve as a useful early prognostic biomarker in the clinical assessment of mentioned patients.

关键词:
  • Spinal Cord Injuries
  • Neutrophil-to-Lymphocyte Ratio
  • Prognosis
  • Trauma Severity Indices
  • Neurological Rehabilitation
  • Biomarkers
  • pdf (English)

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1.
Peyrovinasab A, Zarei H, Janmohamadi M, Fekri M, Tahmasbi Arashlow F, Ghorbani A, 等. Neutrophil to Lymphocyte Ratio as a Predictive Factor of Unfavorable Outcomes in Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis. Arch Acad Emerg Med [网际网络]. 2025年11月22日 [见引于 2026年7月7日];14(1):e4. 载于: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2766
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参考

1. Liu Y, Yang X, He Z, Li J, Li Y, Wu Y, et al. Spinal cord injury: global burden from 1990 to 2019 and projections up to 2030 using Bayesian age-period-cohort analysis. fneur. 2023;14:1304153.

2. Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, et al. Spinal cord injury: the global incidence, prevalence, and disability from the global burden of disease study 2019. Spine. 2022;47(21):1532-40.

3. Barbiellini Amidei C, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022;60(9):812-9.

4. Chen X, Zhou Y-q, Chen C, Cao Y. Neutrophil-to-lymphocyte ratio at admission for early diagnosis, severity assessment, and prognosis of acute traumatic spinal cord injury. Spinal Cord. 2024;62(2):59-64.

5. Liu Y, Luo X, Le J, Wang C, Xu C. Prognostic Value of Magnetic Resonance Imaging Variables Combined with Neutrophil-to-Lymphocyte Ratio in Patients with Cervical Traumatic Spinal Cord Injury. World Neurosurg. 2024;190:e684-e93.

6. Zhou W, Mao Z, Wang Z, Zhu H, Zhao Y, Zhang Z, et al. Diagnostic and Predictive Value of Novel inflammatory markers of the severity of Acute traumatic spinal cord Injury: a retrospective study. World Neurosurg. 2023;171:e349-e54.

7. Kyritsis N, Torres-Espín A, Schupp PG, Huie JR, Chou A, Duong-Fernandez X, et al. Diagnostic blood RNA profiles for human acute spinal cord injury. JEM. 2021;218(3):e20201795.

8. Naseri Alavi SA, Habibi MA, Naseri Alavi SH, Zamani M, Kobets AJ. The Neutrophil-to-Lymphocyte Ratio in Patients with Spinal Cord Injury: A Narrative Review Study. Medicina. 2024;60(10):1567.

9. Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic spinal cord injury: an overview of pathophysiology, models and acute injury mechanisms. Frontiers in neurology. 2019;10:282.

10. Zhuo M, Deng Z, Yuan L, Mai Z, Zhong M, Ye J-M. Association of systemic inflammatory response index and clinical outcome in acute traumatic spinal cord injury patients. Sci. Rep. 2024;14(1):19085.

11. Neirinckx V, Coste C, Franzen R, Gothot A, Rogister B, Wislet S. Neutrophil contribution to spinal cord injury and repair. J. Neuroinflammation. 2014;11(1).

12. He S, Zhao Z, Yu X, Kong C, Li W, Gu H, et al. Prognostic analysis of traumatic spinal cord injury-related factors. 2023. URL: https://doi.org/10.21203/rs.3.rs-2705748/v1

13. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. bmj. 2021;372.

14. Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017 May;475(5):1499-504.

15. Zhao J-L, Lai S-T, Du Z-Y, Xu J, Sun Y-R, Yuan Q, et al. Circulating neutrophil-to-lymphocyte ratio at admission predicts the long-term outcome in acute traumatic cervical spinal cord injury patients. BMC Musculoskelet. Disord. 2020;21(1).

16. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int. J. Mol. Sci. 2022;23(7):3636.

17. Mittal M, Siddiqui MR, Tran K, Reddy SP, Malik AB. Reactive oxygen species in inflammation and tissue injury. ARS. 2014;20(7):1126-67.

18. Kumar BV, Connors TJ, Farber DL. Human T cell development, localization, and function throughout life. Immunity. 2018;48(2):202-13.

19. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017;8(34):57489.

20. Chen W, Yang J, Li B, Peng G, Li T, Li L, et al. Neutrophil to lymphocyte ratio as a novel predictor of outcome in patients with severe traumatic brain injury. JHTR. 2018;33(1):E53-E9.

21. Spiess MR, Müller RM, Rupp R, Schuld C, van Hedel HJ. Conversion in ASIA impairment scale during the first year after traumatic spinal cord injury. J. Neurotrauma. 2009;26(11):2027-36.

22. Feng Z, Min L, Liang L, Chen B, Chen H, Zhou Y, et al. Neutrophil Extracellular Traps Exacerbate Secondary Injury via Promoting Neuroinflammation and Blood–Spinal Cord Barrier Disruption in Spinal Cord Injury. Front. immunol. 2021;12.

23. Zivkovic S, Ayazi M, Hammel G, Ren Y. For Better or for Worse: A Look Into Neutrophils in Traumatic Spinal Cord Injury. Front. cell. neurosci. 2021;15.

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