Salimi M, Khanzadeh S, Lucke-Wold B, Ghaedi A, Stone AV. Role of neutrophil to lymphocyte ratio in osteoarthritis: A systematic review and meta-analysis. World J Orthop 2025; 16(5): 106145 [DOI: 10.5312/wjo.v16.i5.106145]
Corresponding Author of This Article
Austin V Stone, MD, PhD, Associate Professor, Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Suite K401, 740 S Limestone, Lexington, KY 40536, United States. austin.stone@uky.edu
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2025; 16(5): 106145 Published online May 18, 2025. doi: 10.5312/wjo.v16.i5.106145
Role of neutrophil to lymphocyte ratio in osteoarthritis: A systematic review and meta-analysis
Maryam Salimi, Shokoufeh Khanzadeh, Brandon Lucke-Wold, Arshin Ghaedi, Austin V Stone
Maryam Salimi, Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, TX 77030, United States
Shokoufeh Khanzadeh, Student Research Committee, Tabriz University of Medical Sciences, Tabriz 5166614711, Iran
Brandon Lucke-Wold, Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
Arshin Ghaedi, Trauma Research Center, School of Medicine, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz 956256708, Iran
Austin V Stone, Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40536, United States
Author contributions: Salimi M contributed to the design and implementation of the study and the writing of the manuscript; Khanzadeh S and Ghaedi A contributed to the statistical analyses and the writing of the manuscript; Stone AV contributed to the revision of the manuscript; Lucke-Wold B contributed to the performance of the research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Austin V Stone, MD, PhD, Associate Professor, Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Suite K401, 740 S Limestone, Lexington, KY 40536, United States. austin.stone@uky.edu
Received: February 19, 2025 Revised: March 25, 2025 Accepted: April 17, 2025 Published online: May 18, 2025 Processing time: 88 Days and 7 Hours
Abstract
BACKGROUND
Osteoarthritis (OA) involves low-grade inflammation. The neutrophil-to-lymphocyte ratio (NLR) may serve as a simple biomarker, but its role in OA remains unclear.
AIM
To review the existing scientific literature on the role of NLR in OA, a classic age-related disorder, to perform a meta-analysis of the available data.
METHODS
The electronic databases PubMed, ProQuest, and Scopus were systematically searched from inception to March 1, 2024. The inclusion criteria were retrospective and prospective case-control studies involving human subjects with OA and healthy controls. The included studies needed to provide NLR levels for both OA patients and healthy controls and perform a comparative analysis of NLR levels between these groups.
RESULTS
According to the PRISMA guidelines, fifteen articles were included in the meta-analysis after multiple screenings. The pooled results demonstrated a significant overall elevation of NLR in OA patients compared to healthy controls. (standardized mean difference = 0.39, 95% confidence interval: 0.03-0.75, P = 0.03). However, the subgroup analysis shows no significant differences in NLR levels when considering study design (retrospective vs prospective) and OA severity (severe vs mild-moderate). This suggests variability and potential limitations in using NLR as a consistent marker across different study types and OA severity.
CONCLUSION
Our study found that OA patients have higher NLR than healthy individuals. However, NLR did not significantly differ by study type or disease severity, suggesting its limited use in indicating OA severity.
Core Tip: This systematic review and meta-analysis evaluate the role of the neutrophil-to-lymphocyte ratio (NLR) in osteoarthritis (OA). Our findings indicate that OA patients have significantly higher NLR levels than healthy controls, suggesting its potential as an inflammatory biomarker. However, NLR does not significantly correlate with OA severity or study design, limiting its utility in assessing disease progression. Further research is needed to clarify NLR’s clinical relevance in OA diagnosis and management.
