Prognostic Biomarkers in Guillain-Barré Syndrome: Lymphocyte-Based Ratio and Albumin Level

Background Guillain–Barré syndrome (GBS) is an acute immune-mediated polyneuropathy with a variable clinical course. Early identification of patients at risk for respiratory failure or poor functional outcomes remains challenging. This study aimed to evaluate the prognostic value of clinical features and readily available serologic biomarkers, with a particular focus on lymphocyte-based inflammatory ratios and serum albumin levels. Methods We retrospectively analyzed 126 patients diagnosed with GBS who were admitted to Chungnam National University Hospital between January 2012 and January 2022. Baseline clinical characteristics, neurological findings, and laboratory parameters—including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein-to-albumin ratio (CAR), and serum albumin levels—were assessed within 24 hours of admission. Serum albumin levels at two weeks after immunotherapy were collected when available. Disease severity and long-term outcomes were evaluated using the Hughes score. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify prognostic factors for respiratory failure and poor long-term outcomes. Results Among 126 patients (mean age 54.8 ± 16.3 years), 19 (15.1%) developed respiratory failure and 23 (18.2%) had poor functional outcomes at 3 months. Baseline NLR was significantly higher in patients with respiratory failure and was associated with a 1.4-fold increased risk in the unadjusted model (OR = 1.4; 95% CI = 1.1–1.8; p  = 0.007). Lower baseline serum albumin levels were associated with poor long-term outcomes. Persistently low serum albumin levels at two weeks after immunotherapy were independently associated with both respiratory failure and poor long-term outcomes. ROC analysis demonstrated that serum albumin levels at two weeks showed good predictive performance for poor outcomes (AUC = 0.818). Conclusions Early inflammatory markers and serum albumin levels provide complementary prognostic information in patients with GBS. Elevated NLR at admission may help identify patients at risk for respiratory failure, while persistently low serum albumin levels after treatment are strongly associated with adverse long-term outcomes. These readily available biomarkers may facilitate early risk stratification and guide timely clinical management in GBS.