Monocyte to High-Density Lipoprotein Ratio: A Novel Predictive Marker of Disease Severity and Prognosis in Patients With Neuromyelitis Optica Spectrum Disorders.

Jinwei Zhang,Haojie Xie,Kaixin Wang,Chunyang Pan,Yanfei Li,Zhe Gong,Yongyan Zhou,Yi Zhao,Ranran Duan,Yanjie Jia

doi:10.3389/fneur.2021.763793

Abstract

Background and Purpose: To investigate the association of monocyte to high-density lipoprotein ratio (MHR) with disease severity and prognosis in patients with neuromyelitis optica spectrum disorders (NMOSD).Methods: This retrospective study included 125 patients with NMOSD. Demographic and clinical parameters, including the MHR, were assessed. The initial Expanded Disability Status Scale (EDSS) score and relapse rate were used to evaluate disease severity and prognosis, respectively. Correlations between MHR and disease severity and relapse rate were analyzed. The predictive value of MHR for prognosis was evaluated using receiver operating characteristic (ROC) curve analysis.Results: Compared with the low MHR group, the initial EDSS score (median 4.5 vs. 5.5%, P = 0.025) and relapse rate (51.61 vs. 30.16%, P = 0.015) were significantly higher in the high MHR group. MHR was positively correlated with the initial EDSS score (r = 0.306, P = 0.001). Multivariate analysis showed that MHR was significantly associated with severity (odds ratio = 7.90, 95% confidence interval [CI] = 1.08–57.82, P = 0.041), and it was a significant predictor of disease prognosis (hazard ratio = 3.12, 95% CI = 1.02–9.53, P = 0.046). The median relapse interval of the high MHR group was 24.40 months. When the MHR was higher than 0.565, the risk of relapse was high [sensitivity, 33.3%; specificity, 91.9%; area under the ROC curve, 0.642 (95% CI = 0.54–0.74, P = 0.007)].Conclusion: MHR is a novel predictive marker of disease severity and prognosis in patients with NMOSD. Early monitoring and reduction of MHR may allow earlier intervention and improved prognosis.

Highlights

Neuromyelitis optica is an autoimmune demyelinating disease of the central nervous system that is characterized by acute optic neuritis and transverse myelitis occurring simultaneously or continuously [1,2,3], with an estimated prevalence of 1–2 per 100,000 people
A total of 125 patients with neuromyelitis optica spectrum disorders (NMOSD) were enrolled in this cohort study (Figure 1)
The results showed that the above confounding factors had no significant influence on the experimental results and that monocyte to high-density lipoprotein ratio (MHR) was an independent risk factor for disease relapse (HR = 3.12, 95% confidence interval (95% CI) = 1.02–9.53, P = 0.046) (Figure 4B)

Summary

Introduction

Neuromyelitis optica is an autoimmune demyelinating disease of the central nervous system that is characterized by acute optic neuritis and transverse myelitis occurring simultaneously or continuously [1,2,3], with an estimated prevalence of 1–2 per 100,000 people. Patients with neuromyelitis optica spectrum disorders (NMOSD) have severe immune-mediated attacks that usually lead to severe residual disability and a high relapse rate [7]. As an important effector cell of the innate immune response, monocytes play a key role in the pathogenesis of autoimmunerelated central nervous system diseases, including NMOSD [10,11,12,13]. Studies have shown that anti-AQP4 antibodies can stimulate astrocytes to release chemokines, recruit monocytes and promote their activation, enhance the natural immune response, and destroy the blood-brain barrier, which plays a key role in accelerating the formation of NMOSD lesions [14,15,16,17]. To investigate the association of monocyte to high-density lipoprotein ratio (MHR) with disease severity and prognosis in patients with neuromyelitis optica spectrum disorders (NMOSD)

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