Predictive Factors Of Response To High-dose Corticosteroids Therapy In Acute Attacks Of Neuromyelitis Optica Spectrum Disorders

Objective: To investigate factors that predict a response to high-dose steroids pulse therapy in patients with Neuromyelitis Optica Spectrum Disorders(NMOSD),so as to help clinicians quickly identify NMOSD patients with poor response to high-dose steroids pulse therapy and initiate alternatives such as plasma exchange as soon as possible.Methods: In this study,217 patients with NMOSD were recruited retrospectively,including152 patients who were sensitive to high-dose steroids(response to high-dose steroids group)and 65 patients with poor response to high-dose steroids(resistant to high-dose steroids group).Through the statistics and comparison of the basic data,test data and imaging data of the two groups,the factors with difference trend between the two groups were preliminarily screened out,and then Logistic regression analysis was used to further explore the correlation between these factors and the response to high-dose steroids pulse therapy in NMOSD patients.Results: The factors with difference trend between the response to high-dose steroids group and resistant to high-dose steroids group are as follows: age at onset(42 years old vs 46.8 years old,p=0.018),average systolic blood pressure(121.2 mm Hg vs 126.4 mm Hg,p=0.071),pre-treatment Expanded Disability Status Scale(EDSS)score(4 vs 5,p=0.091),7days post-treatment EDSS score(3 vs 5,p<0.001),low density lipoprotein cholesterol(LDLc)(2.7mmol/L vs 3.0 mmol/L,p=0.061),cerebrospinal fluid(CSF)LDH(21.9 U/L vs31.6U/L,p=0.033),CSF Ig M(2.0mg/L vs 3.1mg/L,p=0.063),active lesion on brain stem(4.6% vs 12.3%,p=0.040).Multivariate Logistic analysis showed that the response to high-dose corticosteroid therapy in NMOSD patients was correlated with age at onset(odds ratio=2.441,95% confidence interval=1.080-5.521;p=0.032)and active lesion on brain stem(odds ratio=3.294,95% confidence interval=1.011-10.731;p=0.048).Conclusion: The response to high-dose corticosteroid therapy in NMOSD patients was related to the age at onset and the active lesions on brainstem.NMOSD patients with older age at onset and presence of active lesion on brainstem will have a poor response to high-dose corticosteroid therapy.