Relapse risk factors analysis within 1 year after the first onset of neuromyelitis optica spectrum disorders: A two-center retrospective study

Neuromyelitis optica spectrum disorders (NMOSD) is a highly relapsing and disabling disease that causes severe neurological dysfunction in young patients and often has a poor prognosis. Our study aimed to investigate risk factors affecting NMOSD relapse and to establish a relapse prediction model within 1 year after the first onset, providing a reference for individualized diagnosis and treatment of NMOSD patients.

We retrospectively analyzed clinical data of 102 NMOSD patients admitted to the Second Affiliated Hospital of Soochow University and the Second People's Hospital of Wuxi from January 2020 to August 2023 at their initial presentation. Patients were divided into relapse and non-relapse groups based on the occurrence of relapse within 1 year post-diagnosis. Clinical data were compared between groups, and the relationship between each factor and disease relapse was assessed using single-factor analysis. Binary logistic regression analysis was applied to identify independent risk factors for relapse within 1 year after the first onset of NMOSD, and a Nomogram relapse prediction model was developed and validated.

Significant differences were observed in NLR, B lymphocyte level, NK cell count, immunosuppressant use, EDSS score, and spinal lesion segment length between the relapsed and non-relapsed groups (P < 0.05). Binary logistic regression analysis revealed that NLR, B lymphocyte level, NK cell count, non-use of immunosuppressants, and EDSS score were independent risk factors for relapse within 1 year after the first onset of NMOSD. NLR, B lymphocyte level, and EDSS score were positively correlated with the risk of disease relapse, while NK cell count was negatively correlated. A Nomogram prediction model was constructed based on these independent risk factors. The model's C index was 0.788 (95 % CI: 0.698-0.878, P = 0.000), indicating good discrimination. The Bootstrap-corrected C index was 0.787, suggesting robust calibration. Decision curve analysis confirmed the model's clinical utility.

Peripheral blood NLR, B lymphocyte level, NK cell count, non-use of immunosuppressants, and EDSS score are risk factors for NMOSD relapse within 1 year after the first onset and can serve as predictive indicators. Early identification of the high-risk relapse group is crucial for the individualized management of NMOSD patients.