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Volume 15
Issue 12
10.3390/jcm15124539
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Longitudinal Changes in Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios During Multiple Sclerosis Relapse

by
Marta Konieczna
1,
Przemysław Puz
1,2,*,
Michał Gałuszewski
3,
Jan Olszewski
3,
Karolina Jankowska
3,
Alicja Gierlach
3,
Krzysztof Wójcik
3 and
Anetta Lasek-Bal
1,2
1
Department of Neurology, Upper Silesian Medical Center, Medical University of Silesia, 40-635 Katowice, Poland
2
Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziolowa 45, 40-635 Katowice, Poland
3
Students’ Scientific Association, Department of Neurology, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(12), 4539; https://doi.org/10.3390/jcm15124539
Submission received: 27 April 2026 / Revised: 3 June 2026 / Accepted: 9 June 2026 / Published: 11 June 2026
(This article belongs to the Special Issue Multiple Sclerosis: Current Diagnosis, Treatment, and Future Options)
Versions Notes

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) reflect the balance between innate and adaptive immunity and may indicate systemic inflammation. Objectives: To evaluate longitudinal changes in NLR and MLR in MS patients during relapse compared with relapse-free controls. Methods: In this retrospective single-center observational study, patients with MS were followed for 2 years. Individuals with at least one relapse and complete blood count data at predefined time points were included. Controls without relapse were selected in a 2:1 ratio and matched for age, sex, disease duration, EDSS score, and disease-modifying therapy category. NLR and MLR were assessed 3 months before relapse (or index date), during relapse, and 3 months after. Results: The study included 34 patients with relapse and 68 controls. During relapse, patients showed higher neutrophil and monocyte counts, lower lymphocyte counts, and elevated NLR and MLR compared with controls (all p < 0.001). NLR increased from 2.75 pre-relapse to 3.62 during relapse, then decreased to 2.67 (p = 0.0002). MLR rose from 0.45 to 0.54 and declined to 0.40 (p = 0.002). No significant changes were observed in controls. Conclusions: NLR and MLR demonstrated dynamic changes during MS relapse. These non-specific indices may serve as exploratory, complementary markers of relapse-associated inflammation, but require validation in larger prospective studies including MRI correlates.
Keywords: multiple sclerosis; relapse; neutrophil-to-lymphocyte ratio; monocyte-to-lymphocyte ratio multiple sclerosis; relapse; neutrophil-to-lymphocyte ratio; monocyte-to-lymphocyte ratio

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MDPI and ACS Style

Konieczna, M.; Puz, P.; Gałuszewski, M.; Olszewski, J.; Jankowska, K.; Gierlach, A.; Wójcik, K.; Lasek-Bal, A. Longitudinal Changes in Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios During Multiple Sclerosis Relapse. J. Clin. Med. 2026, 15, 4539. https://doi.org/10.3390/jcm15124539

AMA Style

Konieczna M, Puz P, Gałuszewski M, Olszewski J, Jankowska K, Gierlach A, Wójcik K, Lasek-Bal A. Longitudinal Changes in Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios During Multiple Sclerosis Relapse. Journal of Clinical Medicine. 2026; 15(12):4539. https://doi.org/10.3390/jcm15124539

Chicago/Turabian Style

Konieczna, Marta, Przemysław Puz, Michał Gałuszewski, Jan Olszewski, Karolina Jankowska, Alicja Gierlach, Krzysztof Wójcik, and Anetta Lasek-Bal. 2026. "Longitudinal Changes in Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios During Multiple Sclerosis Relapse" Journal of Clinical Medicine 15, no. 12: 4539. https://doi.org/10.3390/jcm15124539

APA Style

Konieczna, M., Puz, P., Gałuszewski, M., Olszewski, J., Jankowska, K., Gierlach, A., Wójcik, K., & Lasek-Bal, A. (2026). Longitudinal Changes in Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios During Multiple Sclerosis Relapse. Journal of Clinical Medicine, 15(12), 4539. https://doi.org/10.3390/jcm15124539

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