Endocrine Abstracts

Oxidative stress (OX) is relevant in the pathogenesis of Graves’ ophthalmopathy (GO) an inflammatory- autoimmune disease. Hypercholesterolemia is one of the most relevant clinical conditions related to OX and it has been demonstrated to be involved in clinical presentation and activity of GO. Low density lipoproteins cholesterol (LDLc) levels evaluated before parenteral glucocorticoids (GC) administration are related to GO clinical outcome to GC. Monocyte to high-density lipoprotein cholesterol (HDL) ratio (MHR), is a putative inflammatory biomarker and it seems to be relevant to the clinical outcome of cardiovascular diseases. Aim of our study was to evaluate the role of MHR to the clinical outcome of active moderate to severe GO (MSGO) to parenteral glucocorticoids respect to some conditions related to OX.

Methods: we studied n 115 patients, n 86 females, n 29 males, with active MSGO that were treated with a cumulative dose 47.5 (DS 17.4) mg/kg in 12 weeks of parenteral metilprednisolon. GO clinical activity and the clinical outcome of GO to GC was evaluated by seven points Clinical Activity Score according to EUGOGO suggestions. LDLc, age, sex, early response to GC, BMI, TRAbs levels and MHR were evaluated by univariate analysis and as covariates respect the outcome by some multivariate analysis models.

Results: 90 GO patients were responders and 25 were non responders at weeks 12. Baseline MHR was significantly increased in patients non responders respect to responder: MRH 0.0091 (0.0069-0.0122) responders vs MRH 0.0115 (0.0073-0.0155) non responders P = 0.043 (Mann -Whitney U test) According to univariate analysis there were differences respect to LDLc between the two groups of GO patients LDLc 115.8 mg/dl (94.9-135.2) responders vs 135.9 mg/dl (108.7-162.4) non responders, P = 0.019 (Mann -Whitney U test). Female gender was associated to Improved outcome at week 12 (83.7% vs 62.1%, females vs males, P = 0.015, Chi square test). No statistical differences were found for age, BMI, TRAb, thyroid hormones, History of Hypertension (HoH). By a multivariate analysis model (M1) baseline MRH and baseline LDL were significantly and independently related to the clinical outcome of GO to GS at 12 weeks: P = 0.024 and P = 0.012 respectively.

Conclusions: Some clinical conditions related to OX can modulate the clinical outcome of GO to GC, MRH might be an additive marker of the inflammatory state that could modulate the clinical outcome of GO to GC.