The monocyte/HDLc ratio and LDLc are two independent predictors of the response of Graves' ophthalmopathy patients to parenteral glucocorticoids.

PURPOSE: Graves' ophthalmopathy (GO) is an inflammatory-autoimmune disease and parenteral glucocorticoids (IvGCs) are the first-line therapy in the moderate to severe forms. Oxidative stress (OX) and cholesterol have been related to severe forms and to the clinical outcome of GO. Recently some new biomarkers have been proposed as predictors of the clinical outcome in some cardiovascular and autoimmune diseases. We hypothesized that the monocyte-to-high-density lipoprotein cholesterol (HDL) ratio (MHR) could be a useful biomarker in GO management and aimed to evaluate the possible role of the MHR as a predictor of the clinical outcome in patients with active, moderate to severe GO treated with IvGCs.

METHODS: We retrospectively studied 115 patients, 86 females and 29 males, with active, moderate to severe GO who were treated with IvGCs for 12 weeks at our institution. GO severity was evaluated according to EUGOGO suggestions, GO clinical activity and the clinical outcome of GO to IvGCs were evaluated by the seven-point Clinical Activity Score (CAS).

RESULTS: The baseline low density lipoproteins cholesterol (LDLc) and MHR were negatively and independently related to the improvement of GO at 12 weeks (p = 0.024 and p = 0.012, respectively). The value of the MHR = 0.0095 was identified as the best cut off by ROC curve and appeared to be a potentially useful tool to help identify patients with a poor response to IvGCs.

CONCLUSIONS: The MHR might be an useful tool to manage the immunosuppressant therapy in GO patients; our study confirms the role of LDLc as a predictor of GO outcome after IvGCs treatment.