Neutrophil to lymphocyte ratio for predicting delayed neurologic sequelae caused by carbon monoxide poisoning: A systematic review and meta-analysis.
Xiao Ting Liu, Yong Yan Han, Xiao Lu Mi et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether the neutrophil-to-lymphocyte ratio (NLR) predicts delayed neurologic sequelae (DNS) after acute carbon monoxide poisoning. Eight studies included 1757 patients; 382 (21.7%) developed DNS. Elevated NLR was associated with DNS (odds ratio = 14.67, 95% CI: 8.26-26.04, P < .001). For prediction, the pooled area under the curve was 0.88 (95% CI: 0.85-0.91), with 86% sensitivity and 72% specificity. The authors note substantial heterogeneity and that the evidence was predominantly retrospective.
Key findings
- Among 1757 patients with acute CO poisoning, 382 (21.7%) developed delayed neurologic sequelae.
- NLR was associated with DNS (odds ratio = 14.67, 95% CI: 8.26-26.04, P < .001).
- NLR prediction had an area under the curve of 0.88 (95% CI: 0.85-0.91), 86% sensitivity, and 72% specificity.
- Results showed substantial heterogeneity (I2 = 65.1%, P = .005); study design may have contributed.
Why it matters
DNS is a prognostic concern after acute CO poisoning, and these pooled findings suggest that NLR may help identify patients at increased risk. Its reported predictive performance supports further evaluation as an accessible risk-stratification marker, particularly where advanced monitoring is unavailable. However, the association and test characteristics do not establish NLR as a stand-alone diagnostic method.
What to keep in mind
The included studies were predominantly retrospective and showed substantial heterogeneity, limiting confidence in the pooled estimates; the authors call for validation in high-quality prospective studies.