Xie Haojie, Zhao Yi, Pan Chunyang, Zhang Jinwei, Zhou Yongyan, Li Yanfei, Duan Ranran, Yao Yaobing, Gong Zhe, Teng Junfang, Jia Yanjie
Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
BMC Neurol. 2021 Oct 8;21(1):389. doi: 10.1186/s12883-021-02432-0.
To investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and prognosis after the first attack of optic neuromyelitis optica spectrum disorder (NMOSD).
In this retrospective study, we included the medical records of 324 patients with first episode NMOSD and collected data on clinical parameters. Follow-up extended disability status scale (EDSS) score and relapse rate were analyzed using logistic regression models to determine the independent effect of NLR on outcomes; receiver operating characteristic (ROC) curves were applied to analyze the predictive value of NLR for the prognosis of NMOSD. Interaction and stratification analyses were used to explore the association between NLR and prognosis of patients with NMOSD, and Kaplan-Meier analysis was used to investigate the relationship between NLR and outcome. The association between NLR level with relapse rate and poor recovery was assessed by a Cox regression analysis.
Patients in the high-NLR group had significantly higher EDSS scores and relapse rates at follow-up (both, P < 0.001) than did those in the low-NLR group. Univariate analysis showed revealed that NLR was significantly associated with relapse (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.16-1.41, P < 0.001) and poor recovery (OR = 1.32, 95% CI: 1.20-1.46, P < 0.001), and these associations remained significant, even after multifactorial analysis (OR = 1.33, 95% CI: 1.11-1.59, P = 0.002; OR = 1.23, 95% CI: 1.06-1.43, P = 0.007, respectively). Stratified analysis showed that sex, platelet-to-lymphocyte ratio (PLR) level, and lymphocyte-to-monocyte technical ratio (LMR) level were strongly associated with relapse owing to elevated NLR; Kaplan-Meier survival curve analysis showed that the median time to relapse was significantly lower in the high-NLR group than in the low-NLR group (P < 0.001). A multivariate analysis showed a significant relationship between NLR level with relapse (HR = 1.07, 95%CI: 1.03-1.10, P = 0.001) and poor recovery (HR = 1.08, 95%CI: 1.04-1.11, P = 0.001).
NLR may be used as a prognostic indicator for first onset NMOSD, and a high NLR may be significantly associated with high relapse rates and poor recovery.
探讨视神经脊髓炎谱系障碍（NMOSD）首次发作后中性粒细胞与淋巴细胞比值（NLR）与预后的关系。
在这项回顾性研究中，我们纳入了324例首次发作NMOSD患者的病历，并收集了临床参数数据。使用逻辑回归模型分析随访扩展残疾状态量表（EDSS）评分和复发率，以确定NLR对结局的独立影响；应用受试者工作特征（ROC）曲线分析NLR对NMOSD预后的预测价值。采用交互作用和分层分析探讨NLR与NMOSD患者预后的关联，采用Kaplan-Meier分析研究NLR与结局的关系。通过Cox回归分析评估NLR水平与复发率及恢复不良之间的关联。
高NLR组患者随访时的EDSS评分和复发率均显著高于低NLR组（均P < 0.001）。单因素分析显示，NLR与复发（比值比[OR] = 1.28，95%置信区间[CI]：1.16 - 1.41，P < 0.001）和恢复不良（OR = 1.32，95% CI：1.20 - 1.46，P < 0.001）显著相关，即使在多因素分析后，这些关联仍具有显著性（OR分别为1.33，95% CI：1.11 - 1.59，P = 0.002；OR = 1.23，95% CI：1.06 - 1.43，P = 0.007）。分层分析显示，性别、血小板与淋巴细胞比值（PLR）水平和淋巴细胞与单核细胞技术比值（LMR）水平因NLR升高与复发密切相关；Kaplan-Meier生存曲线分析显示，高NLR组的复发中位时间显著低于低NLR组（P < 0.001）。多变量分析显示，NLR水平与复发（HR = 1.07，95%CI：1.03 - 1.10，P = 0.001）和恢复不良（HR = 1.08，95%CI：1.04 - 1.11，P = 0.001）之间存在显著关系。
NLR可作为首次发作NMOSD的预后指标，高NLR可能与高复发率和恢复不良显著相关。
