Neutrophil-To-Lymphocyte Ratio as a Prominent Systemic Inflammatory Indicator of Poor Functional Outcomes in Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis

Cerebral venous thrombosis (CVT) is considered a form of venous thromboembolism, with potential inflammatory pathways that lead to the formation of blood clotting and subsequent neurological damage. This systematic review and meta-analysis synthesized the current evidence on systemic inflammatory biomarkers related to poor functional outcomes in patients with CVT. A comprehensive search strategy was conducted based on the PRISMA statement across seven databases, including PubMed/Medline, Scopus, EBSCOhost, Web of Science, Cochrane Library, CNKI, and Wanfang, covering literature up to December 21, 2024. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale. Twenty studies involved 4330 participants (65.91% female) for final analysis. The modified Rankin Scale (mRS) was used to evaluate functional outcomes. Sixty-five percent of studies (n = 13) defined poor outcomes as mRS ≥ 3. Eighty-five percent of the studies achieved a score of 7–9/9 on the Newcastle–Ottawa Scale. The neutrophil-to-lymphocyte ratio (NLR) was the most frequently reported biomarker (n = 9) among five others (ANC, ALC, WBC, CRP, and infection), showing a significant association with poor outcomes (InOR = 1.76, 95% CI: 0.95–2.97, p = 0.000). Meta-regression revealed that the NLR increased with higher mRS scores (Wald χ2, p < 0.001), and younger age showed stronger modulation (Wald χ2, p = 0.033). This systematic review provides a comprehensive overview of the role of systemic inflammation in predicting functional outcomes in patients with CVT and provides potential targets for future clinical intervention. © 2025 Elsevier B.V., All rights reserved.