P421/1709: The neutrophil-to-lymphocyte ratio is a marker of acute inflammation but does not predict relapses or disease severity in a UK cohort of people with MOGAD and NMOSD

Abstract

Introduction: Neutrophil-to-lymphocyte ratio (NLR) is a blood marker of systemic inflammation. Two studies from China have recently proposed NLR as biomarker of disease severity in people with oligodendrocyte glycoprotein associated disease (MOGAD) and neuromyelitis optica spectrum disorder (NMOSD), with higher NLR in NMOSD compared to MOGAD. Objectives/Aims: To assess if NLR predicts relapse risk and worse disability in a group of patients with MOGAD and NMOSD from the East Midlands of England. Method(s): We extracted demographic, clinical and biology data of people with MOGAD and NMOSD aquaporin4 IgG positive, attending the NMOSD/MOGAD specialist clinic at the Queen's Medical Centre in Nottingham, UK. We compared NLR in relapse and remission, and how NLR correlates with relapse rate, risk of early relapses (<6 months, considered marker of risk of recurrence in MOGAD), disease course (monophasic vs relapsing), and disability accumulation (EDSS). Two-tailed student t-test, Mann- Whitney U test, Chi-Square or Fisher's exact tests were used for detecting the differences. Receiver operator curve (ROC) analysis was used to assess the ability of NLR to distinguish between MOGAD and NMOSD aquaporin4 IgG positive. Binary logistic regression analysis was used to evaluate potential risk factors for disease recurrence. Estimates of the probability of relapse were obtained using a univariate Cox Proportional Hazards model. Result(s): We collected data of 28 patients with MOGAD (16 women; average age 33.4y; 13 relapsing MOGAD) and 37 patients with NMOSD AQP4IgG+(33 women; average age 45y) with a mean duration of follow-up of 8.6y (median 7.5y) and 9.8y (median 6.8y) respectively. NLR was higher in relapse than in remission in both MOGAD and NMOSD, but did not differentiate between the two conditions. NLR at disease onset had no predictive value in discerning the event of relapse < 6 months from onset. NLR at diagnosis (at first attack) or in remission had no association with the event of first relapse after diagnosis, number of relapses and disability accumulation for any of the two conditions, and could not differentiate between monophasic and relapsing forms of MOGAD. Conclusion(s): NLR is merely a marker of acute inflammation in MOGAD and NMOSD and cannot serve as predictor for risk of relapse or disability accumulation.