Top

European Journal of Medical Research

Published in:

Open Access 01-12-2023 | Neuromyelitis Optica Spectrum Disease | Research

Factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorders

Authors: Lili Shi, Dawei Li, Yunxiu Zhang, Jinling Wang, Jingxuan Fu, Xia Liu, Peichang Wang

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Objective

To investigate the factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorder (NMOSD) and provide evidence for disease monitoring and clinical intervention.

Methods

Eighty-four patients with NMOSD at Xuanwu Hospital Capital Medical University were enrolled in this retrospective study. Before treatment, blood was collected from all patients, and their expanded disability status scores were assessed.

Results

Of the 84 patients assessed, 66 (78.57%) had an expanded disability status scale score < 7, and 18 (21.43%) had scores ≥ 7. The univariate analysis showed that the total bilirubin (TBil), cerebrospinal fluid albumin (CSF ALB), cerebrospinal fluid immunoglobulin G (CSF IgG), QALB, and QIgG levels in the group with scores ≥ 7 were significantly different from those with scores < 7 (P < 0.05). In addition, Spearman’s correlation analysis showed a significant correlation between ALB and expanded disability status scores in patients with NMOSD (P < 0.05), and the multivariate logistic regression analysis showed that TBil was an independent factor influencing the degree of disability in patients with NMOSD (P < 0.05). The receiver operating characteristic curve was constructed using TBil values; the area under the curve of TBil was 0.729 (P < 0.01), and the best cut-off value was 11.015 g/L. Its sensitivity in predicting the severity of disability in NMOSD patients was 51.5% while its specificity was 88.9%.

Conclusion

TBil is an independent factor that influences the severity of disability in patients with NMOSD. In addition, ALB is closely related to NMOSD severity, and some factors associated with the BBB are significantly increased in severely disabled NMOSD patients.

Available only for authorised users

Eskandarieh S, Nedjat S, Abdollahpour I, Azimi AR, Moghadasi AN, Asgari N, Sahraian MA. Environmental risk factors in neuromyelitis optica spectrum disorder: a case-control study. Acta Neurol Belg. 2018;118:277–87. https://doi.org/10.1007/s13760-018-0900-5.CrossRefPubMed

Bejerot S, Hesselmark E, Mobarrez F, Wallen H, Hietala MA, Nybom R, Wetterberg L. Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report. J Med Case Rep. 2019;13:27. https://doi.org/10.1186/s13256-018-1929-z.CrossRefPubMedPubMedCentral

Shi Z, Du Q, Chen H, Zhang Y, Qiu Y, Zhao Z, Wang J, Yan C, Zhang Q, Yang M, Zhou H. Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study. J Neurol. 2020;267:913–24. https://doi.org/10.1007/s00415-019-09649-7.CrossRefPubMed

Chen B, Qin C, Tao R, Dong YJ, Ma X, Chen M, Wu LJ, Bu BT, Tian DS. The clinical value of the albumin quotient in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord. 2020;38:101880. https://doi.org/10.1016/j.msard.2019.101880.CrossRefPubMed

Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG. The spectrum of neuromyelitis optica. Lancet Neurol. 2007;6:805–15. https://doi.org/10.1016/S1474-4422(07)70216-8.CrossRefPubMed

Bukhari W, Prain KM, Waters P, Woodhall M, O’Gorman CM, Clarke L, Silvestrini RA, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee WJ, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson A, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Killpatrick T, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell R, Mason DF, Mccombe PA, Pender MP, Pereira JA, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Wilson RJ, Vincent A, Broadley SA. Incidence and prevalence of nmosd in australia and new zealand. J Neurol Neurosurg Psychiatry. 2017;88:632–8. https://doi.org/10.1136/jnnp-2016-314839.CrossRefPubMed

Papp V, Illes Z, Magyari M, Koch-Henriksen N, Kant M, Pfleger CC, Roemer SF, Jensen MB, Petersen AE, Nielsen HH, Rosendahl L, Mezei Z, Christensen T, Svendsen K, Hyldgaard JP, Lydolph MC, Heegaard N, Frederiksen JL, Sellebjerg F, Stenager E, Petersen T. Nationwide prevalence and incidence study of neuromyelitis optica spectrum disorder in denmark. Neurology. 2018;91:e2265–75. https://doi.org/10.1212/WNL.0000000000006645.CrossRefPubMedPubMedCentral

Gilgun-Sherki Y, Melamed E, Offen D. The role of oxidative stress in the pathogenesis of multiple sclerosis: the need for effective antioxidant therapy. J Neurol. 2004;251:261–8. https://doi.org/10.1007/s00415-004-0348-9.CrossRefPubMed

Penton-Rol G, Cervantes-Llanos M, Martinez-Sanchez G, Cabrera-Gomez JA, Valenzuela-Silva CM, Ramirez-Nunez O, Casanova-Orta M, Robinson-Agramonte MA, Lopategui-Cabezas I, Lopez-Saura PA. Tnf-alpha and il-10 downregulation and marked oxidative stress in neuromyelitis optica. J Inflamm (Lond). 2009;6:18. https://doi.org/10.1186/1476-9255-6-18.CrossRefPubMed

10.

Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, de Seze J, Fujihara K, Greenberg B, Jacob A, Jarius S, Lana-Peixoto M, Levy M, Simon JH, Tenembaum S, Traboulsee AL, Waters P, Wellik KE, Weinshenker BG. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177–89. https://doi.org/10.1212/WNL.0000000000001729.CrossRefPubMedPubMedCentral

11.

Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology. 2006;66:1485–9. https://doi.org/10.1212/01.wnl.0000216139.44259.74.CrossRefPubMed

12.

Uher T, Horakova D, Tyblova M, Zeman D, Krasulova E, Mrazova K, Seidl Z, Vaneckova M, Krasensky J, Weinstock-Guttman B, Ramanathan M, Havrdova E, Zivadinov R. Increased albumin quotient (qalb) in patients after first clinical event suggestive of multiple sclerosis is associated with development of brain atrophy and greater disability 48 months later. Mult Scler. 2016;22:770–81. https://doi.org/10.1177/1352458515601903.CrossRefPubMed

13.

Harding KE, Wardle M, Carruthers R, Robertson N, Zhu F, Kingwell E, Tremlett H. Socioeconomic status and disability progression in multiple sclerosis: a multinational study. Neurology. 2019;92:e1497–506. https://doi.org/10.1212/WNL.0000000000007190.CrossRefPubMed

14.

Zhang J, Li Y, Zhou Y, Wang K, Pan C, Zhao Y, Xie H, Duan R, Gong Z, Jia Y. Monocyte to high-density lipoprotein ratio: a novel predictive marker of disease severity and prognosis in patients with neuromyelitis optica spectrum disorders. Front Neurol. 2021;12:763793. https://doi.org/10.3389/fneur.2021.763793.CrossRefPubMedPubMedCentral

15.

Conradsson D, Ytterberg C, von Koch L, Johansson S. Changes in disability in people with multiple sclerosis: a 10-year prospective study. J Neurol. 2018;265:119–26. https://doi.org/10.1007/s00415-017-8676-8.CrossRefPubMed

16.

Wu Y, Yang M, Gao P, Wang Z, Wu J, Wang J, Xu Q, Zhou H, Wu T, Wu W, Wei S, Hu YH. Incidence of neuromyelitis optica spectrum disorders in china: a large cohort study using claim data. Bmj Open. 2022;12:e48942. https://doi.org/10.1136/bmjopen-2021-048942.CrossRef

17.

Peng F, Yang Y, Liu J, Jiang Y, Zhu C, Deng X, Hu X, Chen X, Zhong X. Low antioxidant status of serum uric acid, bilirubin and albumin in patients with neuromyelitis optica. Eur J Neurol. 2012;19:277–83. https://doi.org/10.1111/j.1468-1331.2011.03488.x.CrossRefPubMed

18.

dos Santos BH, de R Almeida CM, Skare TL. Systemic lupus erythematosus activity and serum bilirubins. Acta Reumatol Port. 2013;38:242–6.PubMed

19.

Vitek L, Muchova L, Jancova E, Pesickova S, Tegzova D, Peterova V, Pavelka K, Tesar V, Schwertner H. Association of systemic lupus erythematosus with low serum bilirubin levels. Scand J Rheumatol. 2010;39:480–4. https://doi.org/10.3109/03009741003742748.CrossRefPubMed

20.

Yang Z, Liang Y, Li C, Xi W, Zhong R. Bilirubin levels in patients with systemic lupus erythematosus: increased or decreased? Rheumatol Int. 2012;32:2423–30. https://doi.org/10.1007/s00296-011-1977-9.CrossRefPubMed

21.

Liu Y, Li P, Lu J, Xiong W, Oger J, Tetzlaff W, Cynader M. Bilirubin possesses powerful immunomodulatory activity and suppresses experimental autoimmune encephalomyelitis. J Immunol. 2008;181:1887–97. https://doi.org/10.4049/jimmunol.181.3.1887.CrossRefPubMed

22.

Mancuso C, Pani G, Calabrese V. Bilirubin: an endogenous scavenger of nitric oxide and reactive nitrogen species. Redox Rep. 2006;11:207–13. https://doi.org/10.1179/135100006X154978.CrossRefPubMed

23.

Stocker R, Yamamoto Y, Mcdonagh AF, Glazer AN, Ames BN. Bilirubin is an antioxidant of possible physiological importance. Science. 1987;235:1043–6. https://doi.org/10.1126/science.3029864.CrossRefPubMed

24.

Mirshafiey A, Mohsenzadegan M. Antioxidant therapy in multiple sclerosis. Immunopharmacol Immunotoxicol. 2009;31:13–29. https://doi.org/10.1080/08923970802331943.CrossRefPubMed

25.

Liu Y, Zhu B, Wang X, Luo L, Li P, Paty DW, Cynader MS. Bilirubin as a potent antioxidant suppresses experimental autoimmune encephalomyelitis: implications for the role of oxidative stress in the development of multiple sclerosis. J Neuroimmunol. 2003;139:27–35. https://doi.org/10.1016/s0165-5728(03)00132-2.CrossRefPubMed

26.

Oertel FC, Havla J, Roca-Fernandez A, Lizak N, Zimmermann H, Motamedi S, Borisow N, White OB, Bellmann-Strobl J, Albrecht P, Ruprecht K, Jarius S, Palace J, Leite MI, Kuempfel T, Paul F, Brandt AU. Retinal ganglion cell loss in neuromyelitis optica: a longitudinal study. J Neurol Neurosurg Psychiatry. 2018;89:1259–65. https://doi.org/10.1136/jnnp-2018-318382.CrossRefPubMed

27.

Sedlak TW, Saleh M, Higginson DS, Paul BD, Juluri KR, Snyder SH. Bilirubin and glutathione have complementary antioxidant and cytoprotective roles. Proc Natl Acad Sci U S A. 2009;106:5171–6. https://doi.org/10.1073/pnas.0813132106.CrossRefPubMedPubMedCentral

28.

Heo J, Kang H. Exosome-based treatment for atherosclerosis. Int J Mol Sci. 2022. https://doi.org/10.3390/ijms23021002.CrossRefPubMedPubMedCentral

29.

Liu P, Li Y, Wang R, Ren F, Wang X. Oxidative stress and antioxidant nanotherapeutic approaches for inflammatory bowel disease. Biomedicines. 2021. https://doi.org/10.3390/biomedicines10010085.CrossRefPubMedPubMedCentral

30.

Huang Z, Shi Y, Wang H, Chun C, Chen L, Wang K, Lu Z, Zhao Y, Li X. Protective effects of chitosan-bilirubin nanoparticles against ethanol-induced gastric ulcers. Int J Nanomed. 2021;16:8235–50. https://doi.org/10.2147/IJN.S344805.CrossRef

31.

Yao XY, Wu YF, Gao MC, Hong RH, Ding J, Hao Y, Zhang Y, Guan YT. Serum albumin level is associated with the severity of neurological dysfunction of nmosd patients. Mult Scler Relat Disord. 2020;43:102130. https://doi.org/10.1016/j.msard.2020.102130.CrossRefPubMed

32.

Ferrer R, Mateu X, Maseda E, Yebenes JC, Aldecoa C, De Haro C, Ruiz-Rodriguez JC, Garnacho-Montero J. Non-oncotic properties of albumin. A multidisciplinary vision about the implications for critically ill patients. Expert Rev Clin Pharmacol. 2018;11:125–37. https://doi.org/10.1080/17512433.2018.1412827.CrossRefPubMed

33.

Ballmer PE, Imoberdorf R, Zbaren J. Immunohistochemical demonstration of interleukin-1 beta induced changes in acute-phase proteins and albumin in rat liver. Acta Histochem. 1995;97:281–9. https://doi.org/10.1016/s0065-1281(11)80190-x.CrossRefPubMed

34.

Bar-Or D, Thomas GW, Bar-Or R, Rael LT, Scarborough K, Rao N, Shimonkevitz R. Commercial human albumin preparations for clinical use are immunosuppressive in vitro. Crit Care Med. 2006;34:1707–12. https://doi.org/10.1097/01.CCM.0000217923.53680.4C.CrossRefPubMed

35.

Prajapati KD, Sharma SS, Roy N. Current perspectives on potential role of albumin in neuroprotection. Rev Neurosci. 2011;22:355–63. https://doi.org/10.1515/RNS.2011.028.CrossRefPubMed

36.

Xue H, Yang Z, Wang L, Jiang Y, Li J, Wu M, Wang G, Zhang Y, Zhang M. Factors influencing the degree of disability in patients with multiple sclerosis. Front Neurol. 2021;12:714631. https://doi.org/10.3389/fneur.2021.714631.CrossRefPubMedPubMedCentral

37.

Naegelin Y, Naegelin P, von Felten S, Lorscheider J, Sonder J, Uitdehaag B, Scotti B, Zecca C, Gobbi C, Kappos L, Derfuss T. Association of rituximab treatment with disability progression among patients with secondary progressive multiple sclerosis. Jama Neurol. 2019;76:274–81. https://doi.org/10.1001/jamaneurol.2018.4239.CrossRefPubMedPubMedCentral

38.

Wang Y, Zhu M, Liu C, Han J, Lang W, Gao Y, Lu C, Wang S, Hou S, Zheng N, Wang D, Chen Y, Zhang Y, Zhang HL, Zhu J. Blood brain barrier permeability could be a biomarker to predict severity of neuromyelitis optica spectrum disorders: a retrospective analysis. Front Neurol. 2018;9:648. https://doi.org/10.3389/fneur.2018.00648.CrossRefPubMedPubMedCentral

39.

You X, Yan L, Li X, Pang Y, Guo X, Ye J, Hu H. Disruption of blood-brain barrier integrity associated with brain lesions in Chinese neuromyelitis optica spectrum disorder patients. Mult Scler Relat Disord. 2019;27:254–9. https://doi.org/10.1016/j.msard.2018.10.114.CrossRefPubMed

40.

Liang S, Qin Q, Tang Y, Liao W, Yang Y, He J, Li L. Impact of blood-brain barrier disruption on newly diagnosed neuromyelitis optica spectrum disorder symptoms and prognosis. Ann Palliat Med. 2020;9:324–30. https://doi.org/10.21037/apm.2019.12.12.CrossRefPubMed

41.

Janzer RC, Raff MC. Astrocytes induce blood-brain barrier properties in endothelial cells. Nature. 1987;325:253–7. https://doi.org/10.1038/325253a0.CrossRefPubMed

42.

Wingerchuk DM. Neuromyelitis optica spectrum disorders. Continuum (Minneap Minn). 2010;16:105–21. https://doi.org/10.1212/01.CON.0000389937.69413.15.CrossRefPubMed

Title: Factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorders
Authors: Lili Shi
Dawei Li
Yunxiu Zhang
Jinling Wang
Jingxuan Fu
Xia Liu
Peichang Wang
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Neuromyelitis Optica Spectrum Disease
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01404-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorders

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

High mobility group box-1: a potential therapeutic target for allergic rhinitis

Association between diastolic blood pressure during the first 24 h and 28-day mortality in patients with septic shock: a retrospective observational study

Influencing factors and predictive model of live birth involving low-grade blastocyst frozen–thawed transfer: a retrospective study

Association of niacin intake with constipation in adult: result from the National Health and Nutrition Examination

Role of telitacicept in the treatment of IgA nephropathy

Screening of hub inflammatory bowel disease biomarkers and identification of immune-related functions based on basement membrane genes