Abstract Details

Title The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis

Topic Multiple Sclerosis

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-013

Objective To characterize clinical, neuroimaging, and psychological associations with NLR/MLR in persons with multiple sclerosis (MS).

Background Serum hematological indices such as the neutrophil-lymphocyte ratio (NLR) or monocyte-lymphocyte ratio (MLR) have been used as biomarkers of pathogenic inflammation and prognostication in multiple areas of medicine; recent evidence shows correlation with psychological parameters as well.

Design/Methods

We identified a large cohort of clinically well-defined patients from our longitudinal database that included MS-related outcomes, disease-modifying therapy, patient-reported outcome (PRO) measures, and quantified cerebral MRI at 1.5T. We queried hospital records for complete blood counts within 2 months of each clinic visit and excluded those obtained during clinical relapses; 483 patients met these criteria. Initial analyses assessed the association between NLR/MLR as the outcome, and psychological and demographic predictors in univariable and multivariable models controlling for age, gender and treatment. The second set of analyses assessed the association between clinical and MRI outcomes, with NLR/MLR as a predictor in univariable and multivariable models. All analyses used a mixed effects regression model with repeated measures.

Results Unadjusted analyses demonstrated significant associations between higher NLR (but not MLR) and PRO measures including greater depression (p= 0.01), fatigue (p<0.01), and decreased physical quality of life (p<0.01). Higher NLR/MLR were both strongly associated with increased MS-related disability as assessed by the Expanded Disability Status Scale, independent of demographic, clinical, treatment-related, neuroimaging, and psychosocial variables (p<0.001 for both). Lastly, higher NLR/MLR significantly discriminated progressive from relapsing status (p≤0.01), and higher MLR was associated with increased whole-brain atrophy (p<0.05) even after controlling for all clinical and demographic covariates. Sensitivity analyses using the subset of untreated patients (N=146) corroborated these results.

Conclusions

Elevated NLR/MLR may represent markers for pro-inflammatory priming of the myeloid innate immune system (numerator) in conjunction with dysregulated adaptive processes (denominator), and consequently reflect severity of MS-related neurological disability and radiological outcomes.

Authors/Disclosures
Christopher Hemond, MD (University of Massachusetts Memorial Medical Center) PRESENTER	The institution of Dr. Hemond has received research support from Consorium of Multiple Sclerosis Centers. The institution of Dr. Hemond has received research support from National Institute Of Neurological Disorders And Stroke of the National Institutes of Health. Dr. Hemond has received personal compensation in the range of $0-$499 for serving as a Member of Data Safety and Monitoring Board with National Institute Of Neurological Disorders And Stroke of the National Institutes of Health.
Bonnie Glanz (Brigham and Women'S Hospital)	The institution of Ms. Glanz has received research support from CMSC. The institution of Ms. Glanz has received research support from NIH.
Rohit Bakshi, MD, FAAN	Dr. Bakshi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Bakshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. The institution of Dr. Bakshi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neuroimaging. The institution of Dr. Bakshi has received research support from Bristol Myers Squibb. The institution of Dr. Bakshi has received research support from EMD Serono. The institution of Dr. Bakshi has received research support from Novartis.
Tanuja Chitnis, MD, FAAN (Brigham and Women's Hospital)	Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Chitnis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche-Genentech. Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octave Biosciences. Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. The institution of Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Chitnis has received research support from Novartis. The institution of Dr. Chitnis has received research support from Sanofi. The institution of Dr. Chitnis has received research support from Octave. The institution of Dr. Chitnis has received research support from Genentech-Roche. The institution of Dr. Chitnis has received research support from Tiziana Life Sciences. The institution of Dr. Chitnis has received research support from Bristol-Myers Squibb. The institution of Dr. Chitnis has received research support from Wesley Clover.
Brian C. Healy	The institution of Mr. Healy has received research support from Analysis Group. The institution of Mr. Healy has received research support from Bristol-Myers Squibb. The institution of Mr. Healy has received research support from Verily Life Sciences. The institution of Mr. Healy has received research support from Novartis. The institution of Mr. Healy has received research support from Merck Serono. The institution of Mr. Healy has received research support from Genzyme.

��ɫ��

��ɫ��