Monocytes and systemic inflammation in Guillain-Barré syndrome: Subtypes and relationship with prognosis

Abstract

Objectives: This study aimed to evaluate the role of hematological inflammation markers [monocyte count, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and C-reactive protein (CRP)] in Guillain-Barr & eacute; syndrome (GBS), compare these markers across GBS subtypes, and explore their relationship with disease prognosis. Patients and methods: This retrospective study included 65 patients (40 males, 25 females; mean age: 49.5 +/- 17.0 years; range, 18 to 89 years) with GBS (35 acute inflammatory demyelinating polyneuropathy [AIDP], 30 acute motor axonal neuropathy [AMAN] and acute motor sensory axonal neuropathy [AMSAN]) and 60 age-and sex-matched healthy controls (33 males, 27 females; mean age: 50.3 +/- 16.9 years; range, 19 to 88 years) between January 2022 and February 2025. Complete blood count parameters and CRP were recorded at diagnosis. Functional disability was assessed using the Hughes Functional Grading Scale at baseline and after three months. Results:Compared to controls, GBS patients had significantly higher monocyte counts and NLR, SII, and CRP levels (p<0.001). Among subtypes, the axonal group showed a higher monocyte count (p=0.017) and NLR (p=0.035) than the demyelinating group. No significant differences were observed in SII or CRP between subtypes. Linear regression analysis revealed that a higher NLR (beta=-0.15, p=0.018) and SII (beta=-0.529, p=0.048) were associated with less improvement in the Hughes score. Conclusion: Inflammation markers such as the monocyte count, NLR, and SII are elevated in GBS, particularly in axonal subtypes. Neutrophil-to-lymphocyte ratio and SII may serve as potential prognostic markers, with higher values indicating poorer clinical recovery.