Serum Immunoglobulin G Level and Neutrophils to Lymphocytes Ratio Associated with the Prognosis of Neuromyelitis Optica Spectrum Disorder

Abstract

Objective: To investigate the factors related to the prognosis of Neuromyelitis Optica Spectrum Disorder (NMOSD) in cerebrospinal fluid and peripheral blood examination.

Methods: In this study, we enrolled 111 patients who were admitted to the First Affiliated Hospital of Zhengzhou University between January 2016 and January 2018 and diagnosed with NMOSD. The patients were divided into the relapse group (n = 48) and remission group (n = 67). Before treatment, all the patients underwent a routine Cerebrospinal Fluid (CSF) and peripheral blood test on the second morning of admission. The association between laboratory data and disease prognosis was evaluated.

Results: The immunoglobulin G (IgG) level in the serum showed a strong correlation with the relapse of patients, especially in the aquaporin-4-Antibody (AQP4-Ab) positive group (p < 0.01). A high level of serum IgG concentration was associated with the relapse of NMOSD, especially in the anti-AQP4 positive group. The area under the Receiver Operating Characteristic (ROC) curve of serum IgG level was 0.888 (p<0.001, 95%CI: 0.808-0.968). The ratio of Neutrophils to Lymphocytes (NLR) was associated with the disability degree of NMOSD patients in 3 years. The NLR value was a linear correlation with final Expanded Disability Status Scale (EDSS) scores; patients with a high level of NLR value presented an increased degree of disability in the following three years (R² = 0.053, p= 0.015).

Conclusion: The serum IgG level and NLR of first-attack patients were correlated with the prognosis of NMOSD.

Keywords: Immunoglobulin G; aquaporin-4.; lymphocytes; neuromyelitis optica spectrum disorder; neutrophils; prognosis; the expanded disability status scale.