Peripheral Immune Cell Ratios and Clinical Outcomes in Seropositive Autoimmune Encephalitis: A Study by the Australian Autoimmune Encephalitis Consortium.
Objective
To examine the utility of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers of prognosis in seropositive autoimmune encephalitis (AE).


Methods
In this multicenter study, we retrospectively analyzed 57 cases of seropositive AE with hospital admissions between January 2008 and June 2019. The initial full blood examination was used to determine each patients' NLR and MLR. The modified Rankin Scale (mRS) was utilized to assess the patients' follow-up disability at 12 months and then at final follow-up. Primary outcomes were mortality and mRS, while secondary outcomes were failure of first line treatment, ICU admission, and clinical relapse. Univariate and multivariable regression analysis was performed.


Results
During initial hospital admission 44.7% of patients had unsuccessful first line treatment. After a median follow-up of 700 days, 82.7% had good functional outcome (mRS ≤2) while five patients had died. On multivariable analysis, high NLR was associated with higher odds of first line treatment failure (OR 1.32, 95% CI 1.03-1.69, p = 0.029). Increased MLR was not associated with any short or long-term outcome.


Conclusions
NLR on initial hospital admission blood tests may be provide important prognostic information for cases of seropositive AE. This study demonstrates the potential use of NLR as a prognostic marker in the clinical evaluation of patients with seropositive AE.
['Broadley|James|J|', 'Wesselingh|Robb|R|', 'Seneviratne|Udaya|U|', 'Kyndt|Chris|C|', 'Beech|Paul|P|', 'Buzzard|Katherine|K|', 'Nesbitt|Cassie|C|', "D'Souza|Wendyl|W|", 'Brodtmann|Amy|A|', 'Kalincik|Tomas|T|', 'Butzkueven|Helmut|H|', "O'Brien|Terence J|TJ|", 'Monif|Mastura|M|', '|||']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001315:Australia D015415:Biomarkers D019468:Disease Management D004660:Encephalitis D005260:Female D050031:Hashimoto Disease D006801:Humans D007958:Leukocyte Count D018655:Lymphocyte Count D008214:Lymphocytes D008297:Male D008875:Middle Aged D009000:Monocytes D009017:Morbidity D009026:Mortality D009504:Neutrophils D011379:Prognosis D062486:Public Health Surveillance D055815:Young Adult
autoimmune encephalitis neutrophil-to-lymphocyte ratio monocyte-to-lymphocyte ratio biomarker prognosis