Work

The limited clinical utility of neutrophil-to-lymphocyte ratio in systemic lupus erythematosus: A meta-analysis with external validation

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: OBJECTIVE: To evaluate the diagnostic and discriminative value of the neutrophil-to-lymphocyte ratio (NLR) in systemic lupus erythematosus (SLE). METHODS: A meta-analysis was conducted using literature from inception to January 2026. Pooled estimates were calculated, and external validation was provided by a single-center study (n = 290). RESULTS: Forty studies were included. NLR was significantly higher in SLE patients than healthy controls (SMD = 0.850). Patients with lupus nephritis (LN) and active disease also exhibited elevated NLR. A positive correlation was found between NLR and SLEDAI scores (pooled r = 0.330); however, this decreased to 0.200 after trim-and-fill adjustment for publication bias, a finding consistent with external validation (r = 0.210). Its discriminatory accuracy was generally limited (AUC 0.668-0.757), with ethnicity and treatments being major sources of heterogeneity. CONCLUSION: NLR is elevated in SLE, LN, and active disease, showing a weak positive correlation with disease activity. However, its clinical utility is influenced by ethnicity and treatment, indicating that it should not be used as an independent biomarker but may have a role as part of a combined assessment.

Source: Human Immunology

DOI: 10.1016/j.humimm.2026.111683