The admission neutrophil-to-lymphocyte ratio improves early prediction of poor functional outcome beyond the modified Rankin Scale in viral encephalitis: a cohort study
- 1Department of Clinical Laboratory, Xuanwu Hospital, Capital Medical University
- 2Department of Medical Laboratory Technology, Capital Medical University
Abstract
Background: The admission modified Rankin Scale (mRS) strongly predicts outcome in viral encephalitis (VE) but does not capture the systemic inflammatory response of severe disease. We tested whether the neutrophil-to-lymphocyte ratio (NLR) improves early prediction of poor functional outcome beyond the admission mRS.
Methods: We studied 200 patients admitted with VE at a single center; the primary outcome was a poor functional outcome at discharge (mRS 3-6). Among routine admission blood tests we identified the markers most strongly associated with poor outcome and selected the leading one, the NLR, by LASSO logistic regression. Incremental value beyond the admission mRS was assessed primarily by a likelihood-ratio test (LRT) for the nested models and supported by the change in discrimination (ΔAUC), reclassification, and decision curve analysis. We predefined a stratified analysis of whether the NLR predicted outcome within bands of admission mRS. The final model was internally validated with 1000 bootstrap resamples, without repeating the initial marker selection.
Results: Forty patients (20.0%) had a poor outcome. After correction, 12 of 16 candidate variables were associated with poor outcome, dominated by inflammatory indices. The admission mRS alone discriminated poor outcome with an apparent AUC of 0.884; adding NLR raised it to 0.912. The gain was significant by LRT ( χ ² = 8.5, p = 0.004; NLR odds ratio 1.14 per unit, 95% CI 1.03–1.25), with a ΔAUC of 0.029 (95% CI 0.012–0.046). In the mRS 3–5 stratum, where 39/40 poor outcomes occurred, NLR remained incrementally predictive ( n = 133; odds ratio 1.15, 95% CI 1.04–1.27, p = 0.007). The two-variable model was well calibrated (bootstrap-corrected slope 0.97) and showed greater net benefit than the mRS alone.
Conclusion: In VE, adding the admission NLR to the admission mRS modestly but significantly improves early prediction of poor outcome at discharge, with the increment persisting within admission-severity strata (mRS 3–5). A simple two-variable nomogram (a development-stage tool) is presented for early in-hospital risk flagging. Further analysis suggested that this gain was primarily driven by increased confidence in identifying patients with favorable outcomes, rather than by earlier detection of those who would eventually have poor prognosis.
Related
- Admission White Blood Cell Count and Neutrophil‐to‐Lymphocyte Ratio for Early Risk Stratification after Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study
- Admission blood glucose and neutrophil-to-lymphocyte ratio provide independent and complementary prognostic value for in-hospital mortality in acute type A aortic dissection
- Nonlinear associations of the neutrophil-to-lymphocyte ratio and derived neutrophil-to-lymphocyte ratio with asthma–COPD overlap prevalence: a cross-sectional study
- Neutrophil-to-Lymphocyte Ratio Identifies a Pulmonary Vascular High-Risk Phenotype in Heart Failure with Preserved Ejection Fraction
- Prognostic value of the neutrophil-to-lymphocyte ratio in patients with colorectal cancer undergoing chemotherapy: a systematic review and meta-analysis
BibTeX
@article{fu2026admission,
title = {{The admission neutrophil-to-lymphocyte ratio improves early prediction of poor functional outcome beyond the modified Rankin Scale in viral encephalitis: a cohort study}},
author = {Jingxuan Fu and Dequan Tian and Bowen Wang and Yanyan Wu and Wenna Liu and Diandian Chen and He Lan and Can Wang and Peichang Wang and Jingrong Cao},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1948837},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1948837/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The admission neutrophil-to-lymphocyte ratio improves early prediction of poor functional outcome beyond the modified Rankin Scale in viral encephalitis: a cohort study
AU - Jingxuan Fu
AU - Dequan Tian
AU - Bowen Wang
AU - Yanyan Wu
AU - Wenna Liu
AU - Diandian Chen
AU - He Lan
AU - Can Wang
AU - Peichang Wang
AU - Jingrong Cao
PY - 2026
DA - 2026/10/15
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1948837
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1948837/full
AB - Background: The admission modified Rankin Scale (mRS) strongly predicts outcome in viral encephalitis (VE) but does not capture the systemic inflammatory response of severe disease. We tested whether the neutrophil-to-lymphocyte ratio (NLR) improves early prediction of poor functional outcome beyond the admission mRS. Methods: We studied 200 patients admitted with VE at a single center; the primary outcome was a poor functional outcome at discharge (mRS 3-6). Among routine admission blood tests we identified the markers most strongly associated with poor outcome and selected the leading one, the NLR, by LASSO logistic regression. Incremental value beyond the admission mRS was assessed primarily by a likelihood-ratio test (LRT) for the nested models and supported by the change in discrimination (ΔAUC), reclassification, and decision curve analysis. We predefined a stratified analysis of whether the NLR predicted outcome within bands of admission mRS. The final model was internally validated with 1000 bootstrap resamples, without repeating the initial marker selection. Results: Forty patients (20.0%) had a poor outcome. After correction, 12 of 16 candidate variables were associated with poor outcome, dominated by inflammatory indices. The admission mRS alone discriminated poor outcome with an apparent AUC of 0.884; adding NLR raised it to 0.912. The gain was significant by LRT ( χ ² = 8.5, p = 0.004; NLR odds ratio 1.14 per unit, 95% CI 1.03–1.25), with a ΔAUC of 0.029 (95% CI 0.012–0.046). In the mRS 3–5 stratum, where 39/40 poor outcomes occurred, NLR remained incrementally predictive ( n = 133; odds ratio 1.15, 95% CI 1.04–1.27, p = 0.007). The two-variable model was well calibrated (bootstrap-corrected slope 0.97) and showed greater net benefit than the mRS alone. Conclusion: In VE, adding the admission NLR to the admission mRS modestly but significantly improves early prediction of poor outcome at discharge, with the increment persisting within admission-severity strata (mRS 3–5). A simple two-variable nomogram (a development-stage tool) is presented for early in-hospital risk flagging. Further analysis suggested that this gain was primarily driven by increased confidence in identifying patients with favorable outcomes, rather than by earlier detection of those who would eventually have poor prognosis.
SN - 1664-2295
ER -