Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis

Fatemeh Tabatabaei, Hossein Tahernia, Arshin Ghaedi, Aida Bazrgar, Shokoufeh Khanzadeh
BMC women's health · 2023 · vol. 23(1) , pp. 576 · doi:10.1186/s12905-023-02692-7 · PMID:37936116 · PMC10631181 · W4388494655
meta-analysis OA: gold CC0 ⤵ 5 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review and meta-analysis found that elevated neutrophil-to-lymphocyte ratio (NLR) is associated with endometriosis, demonstrating a pooled sensitivity of 0.67 and specificity of 0.68.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review and meta-analysis searched PubMed, Web of Science, and ProQuest for studies published before January 2, 2023 to evaluate whether neutrophil-to-lymphocyte ratio (NLR) differs between people with endometriosis and comparator groups, using standardized mean differences and random-effects pooling with Newcastle-Ottawa quality assessment. Across 18 included studies (2507 endometriosis patients and 2179 healthy controls), endometriosis patients had higher NLR than healthy controls (SMD = 0.79, 95% CI 0.33–1.25), and NLR was also higher versus other benign tumors (SMD = 0.85, 95% CI 0.17–1.53), while comparisons by stage (III/IV vs I/II), peritoneal lesion status, endometrioma presence, and deep lesion status showed no significant differences. The pooled diagnostic performance reported sensitivity of 0.67 and specificity of 0.68, but the analysis explicitly states substantial heterogeneity across studies, which motivated the random-effects model. This paper is centrally about endometriosis—specifically, it synthesizes evidence on NLR’s diagnostic significance for predicting endometriosis.

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Abstract

BACKGROUND: The purpose of this systematic review and meta-analysis was to compile existing evidence on the significance of the NLR in predicting endometriosis in order to aid clinical decision-making and outcomes. METHODS: We searched ProQuest, Web of Science, and PubMed for related studies published before January 2, 2023. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported for each outcome. Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used Newcastle-Ottawa Scale (NOS) for quality assessment. RESULTS: Overall, 18 article with were included in the analysis. A random-effect model revealed that patients with endometriosis had elevated levels of NLR compared to healthy controls (SMD = 0.79, 95% CI = 0.33 to 1.25, P < 0.001). Patients with endometriosis had elevated levels of NLR compared to those with other benign tumors (SMD = 0.85, 95% CI = 0.17 to 1.53, P = 0.014). In addition, NLR level of patients with stage III and IV endometriosis was not different from that of patients with stage I and II endometrioma (SMD = 0.30, 95% CI = -0.14 to 0.74, P = 0.18). However, NLR level was not different between endometriosis patients with and without peritoneal lesions (SMD = -0.12, 95% CI = -0.34to 0.10, P = 0.28), between patients with and without endometrioma (SMD = 0.20, 95% CI = -0.15 to 0.55, P = 0.26) and between endometriosis patients with and without deep lesions (SMD = 0.04, 95% CI = -0.20 to 0.28, P = 0.72). The pooled sensitivity of NLR was 0.67 (95% CI = 0.60-0.73), and the pooled specificity was 0.68 (95% CI, 0.62-0.73). CONCLUSIONS: NLR might be utilized in clinics as a possible predictor to help clinicians diagnose endometriosis in affected women.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Peritoneal Diseases Peritoneal Diseases

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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