Neutrophil–lymphocyte ratio tracks AIDP severity, but albumin does not

The findings come from an observational cohort study of 69 patients with AIDP, published as an open access article in BMC Neurology.

While acute-phase proteins such as albumin and newer inflammatory markers such as the NLR are known to fluctuate during the disease course, their association with AIDP severity and outcomes has remained unclear, which motivated the new analysis.

The study enrolled 69 patients diagnosed with AIDP who were admitted to the tertiary care centre for IVIG or plasmapheresis treatment. The researchers compared clinical and laboratory variables before and after treatment, including demographic data, clinical symptoms measured on the Hughes Disability Scale, serum albumin levels, neutrophil percentage, lymphocyte percentage, and the NLR. Disease severity was assessed at admission and again seven days after the start of treatment. To evaluate prognostic value, the team correlated admission albumin and NLR values with the Hughes score on the seventh day of treatment.

The patients had a mean age of 48.1 years, with a standard deviation of 16.7 years. Following treatment, the study recorded statistically significant changes across all three key measures: the median Hughes score decreased from 4 to 2 (p < 0.001), serum albumin levels increased (p < 0.001), and the NLR fell (p < 0.001). These shifts confirm that both biomarkers respond to the inflammatory changes accompanying treatment, but the more important question was whether either marker tracked how sick patients actually were.

On that question, the two markers diverged sharply. The NLR showed a significant, weak positive correlation with the Hughes severity score both before treatment (Spearman’s ρ = 0.308, p = 0.01) and after treatment (ρ = 0.349, p = 0.003). In other words, patients with a higher proportion of neutrophils relative to lymphocytes in their blood tended to have somewhat higher disability scores, although the strength of the association was modest.

Admission NLR was also significantly correlated with the Day-7 Hughes score (ρ = 0.372, p = 0.0016), suggesting a potential short-term prognostic role. However, the authors note that this association was attenuated after adjusting for admission disease severity and age, indicating that the NLR’s apparent predictive power largely overlaps with information already captured by how severely affected a patient is at presentation and how old they are.

Albumin told a different story. Admission albumin showed no correlation with severity at either time point, nor with the Day-7 outcome. This is notable because albumin rose significantly with treatment, meaning the protein responds to the disease process without serving as a useful marker of how severe the disease is or how patients will fare in the first week of therapy.

The authors conclude that serum albumin and the NLR each changed significantly with treatment, but that only the NLR showed a weak positive correlation with the Hughes Disability Scale, while albumin showed no such correlation at either time point. They suggest that the NLR, more than albumin, may be a useful indicator of disease activity and short-term outcome in AIDP.

The researchers are careful to frame these results as preliminary. Because the association between admission NLR and Day-7 outcome weakened after adjustment, and because the correlations were only weak, the study does not establish the NLR as an independent prognostic tool. The authors state that further validation is required before these biomarkers can be reliably used to predict the clinical course of AIDP. For now, the study offers a measured step toward understanding how routinely available blood markers relate to this acute neuropathy, rather than a new standard of care.

Subject of Research: The association of serum albumin and the neutrophil–lymphocyte ratio with severity and short-term outcomes in acute inflammatory demyelinating polyneuropathy.

Article Title: Analysis of albumin levels and the neutrophil–lymphocyte ratio in acute inflammatory demyelinating polyneuropathy

Article References: Thampi, G., & Rao, S. (2026). Analysis of albumin levels and the neutrophil–lymphocyte ratio in acute inflammatory demyelinating polyneuropathy. BMC Neurology. https://doi.org/10.1186/s12883-026-05518-9

Image Credits: AI Generated

DOI: 10.1186/s12883-026-05518-9

Keywords: AIDP, Guillain–Barré syndrome, neutrophil–lymphocyte ratio, serum albumin, Hughes Disability Scale, IVIG, plasmapheresis, biomarkers, neurology, inflammation, observational cohort study, BMC Neurology