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Poor positive predictive value of serum immunoglobulin G4 concentrations in the diagnosis of immunoglobulin G4-related sclerosing disease.

Yun J, Wienholt L, Adelstein S - Asia Pac Allergy (2014)

Bottom Line: Eighty patients (6.4%) had elevated IgG4 concentrations greater than 1.30 g/L.The median serum IgG4 concentrations of those with and without IgG4-related sclerosing disease were 2.16 g/L and 1.86 g/L, respectively (p = 0.22).Serum IgG4 concentration has poor positive predictive value in the diagnosis of IgG4-related sclerosing disease and, therefore, the clinical significance of elevated serum IgG4 concentration alone must be interpreted with caution.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.

ABSTRACT

Background: Immunoglobulin G4 (IgG4)-related sclerosing disease is a recently described clinicopathological entity with diverse manifestations including, amongst others, autoimmune pancreatitis, sclerosing cholangitis, sclerosing sialadenitis and retroperitoneal fibrosis. Elevated serum IgG4 concentration has been described as the hallmark of this condition with reported good sensitivity and specificity.

Objective: We sought to establish the utility of serum IgG4 concentrations in the diagnosis of IgG4-related sclerosing disease by determining how many serum samples with elevated IgG4 from an unselected population would originate from patients who fulfilled criteria for this diagnosis.

Methods: The clinical features and laboratory characteristics of patients whose serum IgG4 concentration was greater than 1.30 g/L were analysed retrospectively from a total of 1,258 IgG subclass measurements performed in a tertiary hospital diagnostic laboratory.

Results: Eighty patients (6.4%) had elevated IgG4 concentrations greater than 1.30 g/L. Nine of 61 patients had the diagnosis of IgG4-related sclerosing disease, giving a poor positive predictive value of 15%. The median serum IgG4 concentrations of those with and without IgG4-related sclerosing disease were 2.16 g/L and 1.86 g/L, respectively (p = 0.22).

Conclusion: Serum IgG4 concentration has poor positive predictive value in the diagnosis of IgG4-related sclerosing disease and, therefore, the clinical significance of elevated serum IgG4 concentration alone must be interpreted with caution.

No MeSH data available.


Related in: MedlinePlus

Serum immunoglobulin G4 (IgG4) levels in patients with and without IgG4 sclerosing disease. Horizontal bar represents median values in each group.
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Figure 1: Serum immunoglobulin G4 (IgG4) levels in patients with and without IgG4 sclerosing disease. Horizontal bar represents median values in each group.

Mentions: The median serum IgG4 concentrations of those with and without IgG4-related sclerosing disease were not significantly different at 2.16 g/L and 1.86 g/L respectively (p = 0.22) (Fig. 1). To determine if patients with IgG4-related sclerosing diseases had a disproportionate increase in that subclass relative to other subclasses, we analysed the serum IgG4 to total IgG ratio in each group. The median value of serum IgG4 to total IgG ratio in those with and without IgG4-related sclerosing disease was similar at 0.121 and 0.118 respectively (p = 0.09). There were also no significant differences between the eosinophil counts, CRP, ESR, serum IgE, IgA, and IgM concentrations of two groups where the information was available (data not shown).


Poor positive predictive value of serum immunoglobulin G4 concentrations in the diagnosis of immunoglobulin G4-related sclerosing disease.

Yun J, Wienholt L, Adelstein S - Asia Pac Allergy (2014)

Serum immunoglobulin G4 (IgG4) levels in patients with and without IgG4 sclerosing disease. Horizontal bar represents median values in each group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4116044&req=5

Figure 1: Serum immunoglobulin G4 (IgG4) levels in patients with and without IgG4 sclerosing disease. Horizontal bar represents median values in each group.
Mentions: The median serum IgG4 concentrations of those with and without IgG4-related sclerosing disease were not significantly different at 2.16 g/L and 1.86 g/L respectively (p = 0.22) (Fig. 1). To determine if patients with IgG4-related sclerosing diseases had a disproportionate increase in that subclass relative to other subclasses, we analysed the serum IgG4 to total IgG ratio in each group. The median value of serum IgG4 to total IgG ratio in those with and without IgG4-related sclerosing disease was similar at 0.121 and 0.118 respectively (p = 0.09). There were also no significant differences between the eosinophil counts, CRP, ESR, serum IgE, IgA, and IgM concentrations of two groups where the information was available (data not shown).

Bottom Line: Eighty patients (6.4%) had elevated IgG4 concentrations greater than 1.30 g/L.The median serum IgG4 concentrations of those with and without IgG4-related sclerosing disease were 2.16 g/L and 1.86 g/L, respectively (p = 0.22).Serum IgG4 concentration has poor positive predictive value in the diagnosis of IgG4-related sclerosing disease and, therefore, the clinical significance of elevated serum IgG4 concentration alone must be interpreted with caution.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.

ABSTRACT

Background: Immunoglobulin G4 (IgG4)-related sclerosing disease is a recently described clinicopathological entity with diverse manifestations including, amongst others, autoimmune pancreatitis, sclerosing cholangitis, sclerosing sialadenitis and retroperitoneal fibrosis. Elevated serum IgG4 concentration has been described as the hallmark of this condition with reported good sensitivity and specificity.

Objective: We sought to establish the utility of serum IgG4 concentrations in the diagnosis of IgG4-related sclerosing disease by determining how many serum samples with elevated IgG4 from an unselected population would originate from patients who fulfilled criteria for this diagnosis.

Methods: The clinical features and laboratory characteristics of patients whose serum IgG4 concentration was greater than 1.30 g/L were analysed retrospectively from a total of 1,258 IgG subclass measurements performed in a tertiary hospital diagnostic laboratory.

Results: Eighty patients (6.4%) had elevated IgG4 concentrations greater than 1.30 g/L. Nine of 61 patients had the diagnosis of IgG4-related sclerosing disease, giving a poor positive predictive value of 15%. The median serum IgG4 concentrations of those with and without IgG4-related sclerosing disease were 2.16 g/L and 1.86 g/L, respectively (p = 0.22).

Conclusion: Serum IgG4 concentration has poor positive predictive value in the diagnosis of IgG4-related sclerosing disease and, therefore, the clinical significance of elevated serum IgG4 concentration alone must be interpreted with caution.

No MeSH data available.


Related in: MedlinePlus