Prediction of apolipoprotein A-I and high-density lipoprotein cholesterol in the neurological impairment and relapse of neuromyelitis optica spectrum disorder

Yanyan Wang¹Feng Wang²TENG HUANG³Ziling Zeng⁴Li Jiao⁴Hao Sun⁵Xiaoyu Zhang⁴Baojie Wang⁴Rujia Liu⁶Shougang Guo^4*

• ¹Department of Neurology,Shandong Provincial Hospital,Shandong University, Jinan City, China
• ²Department of Neurology,Rongcheng People's Hospital Affiliated to Jining Medical University, Weihai, China
• ³Department of Neurology,Shandong Second Provincial General Hospital, Jinan City, China
• ⁴Department of Neurology,Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, China
• ⁵Department of Neurology, Liaocheng People’s Hospital, Liaocheng, China
• ⁶Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University Medical College, Yantai, China

Background and purpose:Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare inflammatory demyelinating disorder of the central nervous system, frequently resulting in irreversible neurological deficits such as blindness and paralysis.Emerging evidence suggests that dyslipidemia is associated with increased disability and poorer outcomes in autoimmune diseases. The purpose of the study is to investigate the associations between lipid profile with neurological impairment and relapse.Methods:This study retrospectively collected data from 130 hospitalized patients with AQP4-IgG positive NMOSD.Based on the Expanded Disability Status Scale (EDSS) scores at admission, patients were categorized into a mild-to-moderate group (EDSS ≤ 2 5.5) and a severe group (EDSS ≥ 6). All included patients were followed for at least one year, and were further divided into relapse and non-relapse groups based on whether a relapse occurred during the follow-up period. Logistic regression analysis was used to identify independent risk factors associated with the severity of neurological impairment and relapse. Receiver operating characteristic (ROC) curve analysis was conducted to determine the cutoff value of apolipoprotein A-I(ApoA-I) in predicting severe neurological impairment. Spearman correlation analysis was performed to assess the relationships among ApoA-I, high-density lipoprotein cholesterol(HDL-C) and CRP.Resulets:Multivariate binary logistic regression analysis revealed that ApoA-Iand the number of spinal cord lesion segments were independent risk factors for the severity of neurological impairment.The area under the ROC curve (AUC) for ApoA-I in predicting the severity of neurological impairment was 0.647 (95% CI: 0.542-0.751), with a cutoff value of 1.165.Multivariate logistic regression analysis identified HDL-C ，clinical phenotype-specifically, compared to optic neuritis, myelitis -as well as the use of subsequent monoclonal antibody therapy as independent protective factors against relapse.Spearman correlation analysis showed that ApoA-I and HDL-C were significantly negatively correlated with CRP (r = -0.230, P = 0.008; r = -0.310, P < 0.001, respectively).Reduced levels of ApoA-I and HDL-C were associated with more severe neurological deficits and an increased risk of relapse.