Neutrophil-to-lymphocyte ratio as a prognostic biomarker in spinal cord injury: a systematic review

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Abstract Background Traumatic spinal cord injury (TSCI) results in significant long-term disability and poses a major clinical burden. Recent studies have explored the neutrophil-to-lymphocyte ratio (NLR) as a potential early biomarker for prognosis in TSCI due to its reflection of the systemic inflammatory response. Objective To systematically review the evidence on the prognostic value of NLR in patients with spinal cord injury, particularly in relation to neurological recovery, complications, and clinical outcomes. Methods This review followed PRISMA 2020 guidelines. A comprehensive search was conducted across PubMed, SCOPUS, Cochrane Library, and ScienceDirect up to June 10, 2025. Studies were included if they evaluated NLR in SCI patients and reported outcomes such as neurological improvement, mortality, or complications. Two reviewers independently screened and extracted data. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Cohort Studies. Results Six retrospective studies involving 1,940 patients were included. Most studies reported that elevated admission NLR values were significantly associated with poor neurological recovery and increased risk of complications, particularly infections. NLR was also shown to correlate with initial injury severity in several cohorts. The proposed cut-off values for high-risk NLR ranged from 10 to 14. However, significant methodological heterogeneity and variable outcome definitions precluded a formal quantitative analysis; therefore, a qualitative synthesis was performed. Conclusion Admission NLR is a promising, accessible, and cost-effective biomarker that may aid in early risk stratification of SCI patients. Despite encouraging findings, standardization of NLR measurement timing and cutoff values is needed. As these findings are preliminary, NLR should currently be used as a supplementary prognostic tool rather than a sole clinical indicator. Large-scale, prospective studies are warranted to validate its clinical utility.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.