Inflammatory biomarker panels in peripheral blood: association with myasthenia gravis onset and severity

To investigate the association between peripheral blood inflammatory biomarkers and the clinical phenotypes, severity, and prognosis of myasthenia gravis (MG).

This retrospective study analyzed 134 MG patients (including 23 with myasthenic crisis [MC]) and 58 age- and sex-matched healthy controls hospitalized at the Second Affiliated Hospital of Soochow University (August 2016-March 2024). Peripheral blood inflammatory markers were compared across subgroups. Infection was strictly excluded based on clinical and laboratory criteria. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify risk factors and diagnostic value.

Compared to controls, MG patients exhibited significantly elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) (all p < 0.05). Patients with MC were characterized by a higher prevalence of generalized MG (GMG) and thymoma, as well as elevated leukocyte counts, NLR, and SIRI compared to non-MC patients. Multivariate analysis identified elevated PLR [OR: 1.01, 95% CI: 1.00-1.02] as independent risk factors associated with MG onset, while elevated NLR [OR: 1.20, 95% CI: 1.05-1.41] and the presence of thymoma [OR: 13.44, 95% CI: 4.42-48.54] were independently associated with MC. Furthermore, inflammatory indices (NLR, PLR, and SII) were significantly higher in GMG and moderate-to-severe cases (MGFA III-V) compared to ocular and mild cases.

Systemic inflammatory biomarkers, particularly PLR and NLR, are significantly elevated in MG and correlate with disease severity and clinical subtypes. While PLR is associated with MG onset, NLR and thymoma are potential indicators for myasthenic crisis. These readily available markers may facilitate risk stratification in clinical practice.