Routine CSF parameters as predictors of disease course in multiple sclerosis: an MSBase cohort study

扩大残疾状况量表 医学 多发性硬化 红细胞增多 队列 脑脊液 脑脊液多细胞增多 内科学 比例危险模型 队列研究 胃肠病学 免疫学
作者
Cathérine Dekeyser,Matthias Hautekeete,Melissa Cambron,Vincent Van Pesch,Francesco Patti,Jens Kühle,Samia J. Khoury,Jeanette Lechner Scott,Oliver Gerlach,Alessandra Lugaresi,Davide Maimone,Andrea Surcinelli,Pierre Grammond,Tomáš Kalinčík,Mario Habek,Barbara Willekens,Richard Macdonell,Patrice H. Lalive,Tünde Csépány,Helmut Butzkueven,Cavit Boz,Valentina Tomassini,Matteo Foschi,José Luis Sánchez-Menoyo,Ayse Altıntaş,Saloua Mrabet,Gerardo Iuliano,María José Sá,Raed Alroughani,Rana Karabudak,Eduardo Agüera,Orla Gray,Koen de Gans,Anneke van der Walt,Pamela McCombe,Norma Deri,Justin Garber,Abdullah Al‐Asmi,Olga Skibina,Pierre Duquette,Elisabetta Cartechini,Daniele Spitaleri,Riadh Gouider,Aysun Soysal,Liesbeth Van Hijfte,Mark Slee,Maria Pia Amato,Katherine Buzzard,Guy Laureys
出处
期刊:Journal of Neurology, Neurosurgery, and Psychiatry [BMJ]
卷期号:: jnnp-333307
标识
DOI:10.1136/jnnp-2023-333307
摘要

Background It remains unclear whether routine cerebrospinal fluid (CSF) parameters can serve as predictors of multiple sclerosis (MS) disease course. Methods This large-scale cohort study included persons with MS with CSF data documented in the MSBase registry. CSF parameters to predict time to reach confirmed Expanded Disability Status Scale (EDSS) scores 4, 6 and 7 and annualised relapse rate in the first 2 years after diagnosis (ARR2) were assessed using (cox) regression analysis. Results In total, 11 245 participants were included of which 93.7% (n=10 533) were persons with relapsing-remitting MS (RRMS). In RRMS, the presence of CSF oligoclonal bands (OCBs) was associated with shorter time to disability milestones EDSS 4 (adjusted HR=1.272 (95% CI, 1.089 to 1.485), p=0.002), EDSS 6 (HR=1.314 (95% CI, 1.062 to 1.626), p=0.012) and EDSS 7 (HR=1.686 (95% CI, 1.111 to 2.558), p=0.014). On the other hand, the presence of CSF pleocytosis (≥5 cells/µL) increased time to moderate disability (EDSS 4) in RRMS (HR=0.774 (95% CI, 0.632 to 0.948), p=0.013). None of the CSF variables were associated with time to disability milestones in persons with primary progressive MS (PPMS). The presence of CSF pleocytosis increased ARR2 in RRMS (adjusted R 2 =0.036, p=0.015). Conclusions In RRMS, the presence of CSF OCBs predicts shorter time to disability milestones, whereas CSF pleocytosis could be protective. This could however not be found in PPMS. CSF pleocytosis is associated with short-term inflammatory disease activity in RRMS. CSF analysis provides prognostic information which could aid in clinical and therapeutic decision-making.
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