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Integrated Blood Inflammatory Ratios and Cerebrospinal Fluid Blood‒Brain Barrier Dysfunction Predict Relapse Risk in

Xingyue Zheng^1,2, Jing Shi², Hao Yin²

¹Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China.

Brain and Behavior

|June 13, 2026

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This study developed a new model to predict relapse risk in neuromyelitis optica spectrum disorder (NMOSD). The integrated model combines blood inflammatory markers and cerebrospinal fluid (CSF) data for better risk stratification.

Area of Science:

Neurology
Immunology
Biomarkers

Background:

Relapse is a key driver of disability in neuromyelitis optica spectrum disorder (NMOSD).
Current tools for predicting relapse risk in NMOSD are limited.
Blood-brain barrier (BBB) dysfunction and systemic inflammation are implicated in NMOSD pathophysiology.

Purpose of the Study:

To develop and validate an integrated prognostic model for predicting relapse risk in NMOSD.
To incorporate BBB integrity and systemic inflammation markers into a predictive model.
To improve individualized relapse risk stratification for NMOSD patients.

Main Methods:

Retrospective cohort study of 152 NMOSD patients.
Collected baseline peripheral inflammatory indices (neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio) and CSF parameters.

Keywords:

Cox regression blood–brain barrier dysfunction neuromyelitis optica spectrum disorder nomogram peripheral inflammatory ratios relapse risk

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Used multivariable Cox regression to identify predictors and constructed hierarchical prognostic models.

Evaluated model discrimination using ROC analysis and clinical utility via DCA.

Main Results:

Patients with relapse showed greater BBB dysfunction and systemic inflammation.
Integrated model (clinical, CSF, blood inflammatory markers) achieved an AUC of 0.850, outperforming clinical and clinical-CSF models.
The nomogram demonstrated good discrimination (C-index 0.811) and calibration.
Model retained predictive performance in AQP4-IgG seropositive subgroup, showing added value beyond serostatus.

Conclusions:

An integrated nomogram using peripheral inflammatory ratios and CSF indices predicts NMOSD relapse risk.
This model offers prognostic value beyond AQP4-IgG serostatus.
The tool may aid in risk-adapted clinical management of NMOSD.