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Cerebrospinal fluid kappa free light chains for the diagnosis of multiple sclerosis: A systematic review and meta-analysis

2022; SAGE Publishing; Volume: 29; Issue: 2 Linguagem: Inglês

10.1177/13524585221134213

1477-0970

Harald Hegen, Janette Walde, Klaus Berek, Georgina Arrambide, Sharmilee Gnanapavan, Batia Kaplan, Michael Khalil, Ruba Saadeh, Charlotte E. Teunissen, Hayrettin Tumani, Luisa María Villar, Maria Alice V. Willrich, Henrik Zetterberg, Florian Deisenhammer,

Neurogenesis and neuroplasticity mechanisms

Background: Intrathecal immunoglobulin-G synthesis is a hallmark of multiple sclerosis (MS), which can be detected by oligoclonal IgG bands (OCB) or by κ-free light chains (κ-FLC) in cerebrospinal fluid. Objective: To perform a systematic review and meta-analysis to evaluate whether κ-FLC index has similar diagnostic value to identify patients with clinically isolated syndrome (CIS) or MS compared to OCB, and to determine κ-FLC index cut-off. Methods: PubMed was searched for studies that assessed diagnostic sensitivity and specificity of κ-FLC index and OCB to discriminate CIS/MS patients from control subjects. Two reviewers following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines performed study eligibility assessment and data extraction. Findings from studies were analyzed with bivariate mixed models. Results: A total of 32 studies were included in the meta-analysis to evaluate diagnostic value of κ-FLC index. Sensitivity and specificity ranged from 52% to 100% (weighted average: 88%) and 69% to 100% (89%) for κ-FLC index and from 37% to 100% (85%) and 74% to 100% (92%) for OCB. Mean difference of sensitivity and specificity between κ-FLC index and OCB was 2 and −4 percentage points. Diagnostic accuracy determined by mixed models revealed no significant difference between κ-FLC index and OCB. A discriminatory cut-off for κ-FLC index was determined at 6.1. Conclusion: The findings indicate that κ-FLC index has similar diagnostic accuracy in MS as OCB.