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CSF albumin and immunoglobulin analyses in childhood neurologic disorders.

Hacohen Y, Singh R, Forsyth V, Absoud M, Lim M - Neurol Neuroimmunol Neuroinflamm (2014)

Bottom Line: CSF-restricted OCBs were found in 20/104 (19%) of the inflammatory group compared with 4/85 (5%) of the noninflammatory group (p= 0.0036).Mirrored OCBs were found in 13/104 (12.5%) of the inflammatory group compared with 5/85 (6%) of the noninflammatory group (p = 0.14).IgG index and QAlb were significantly higher in patients with an inflammatory etiology.

View Article: PubMed Central - PubMed

Affiliation: Children's Neuroscience, Evelina London Children's Hospital at Guy's & St Thomas' NHS Trust, King's Health Partners AHSC, Lambeth Palace Road, London.

ABSTRACT

Objective: To evaluate the utility of qualitative and quantitative analyses of CSF immunoglobulins as part of the diagnostic workup of CNS inflammatory conditions.

Methods: One hundred eighty-nine children who underwent CSF investigation for their neurologic condition had CSF and serum testing to (1) qualitatively identify oligoclonal band (OCB) patterns and (2) quantitatively measure the immunoglobulin (Ig) G index and albumin quotient (QAlb). Case notes were retrospectively reviewed and patients were grouped according to whether their primary diagnosis was due to an inflammatory (n = 104) or noninflammatory (n = 85) etiology.

Results: CSF-restricted OCBs were found in 20/104 (19%) of the inflammatory group compared with 4/85 (5%) of the noninflammatory group (p= 0.0036). Mirrored OCBs were found in 13/104 (12.5%) of the inflammatory group compared with 5/85 (6%) of the noninflammatory group (p = 0.14). IgG index and QAlb were significantly higher in patients with an inflammatory etiology. However, a raised IgG index (>0.85) and QAlb (>0.049) were seen in both groups, with QAlb abnormalities seen more frequently in the inflammatory group (p = 0.0028).

Conclusions: Both methods were informative in identifying inflammatory mechanisms. Abnormalities were more commonly, but not exclusively, seen in primary inflammatory conditions. The qualitative and quantitative evaluation collectively revealed additional positive results than when done in isolation.

No MeSH data available.


Related in: MedlinePlus

IgG index (A) and QAlb (B) results in patients with inflammatory and noninflammatory conditions stratified according to the presence or absence of abnormal oligoclonal band patternImmunoglobulin (Ig) G index and albumin quotient (QAlb) abnormalities were seen in all 4 groups. Vertical bars represent mean and SD. Abnormal quantitative results (both IgG index and QAlb) were seen in patients with normal oligoclonal band (OCB) pattern. Abn = abnormal; inf = inflammatory; N = normal; non-inf = non-inflammatory.
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Figure 1: IgG index (A) and QAlb (B) results in patients with inflammatory and noninflammatory conditions stratified according to the presence or absence of abnormal oligoclonal band patternImmunoglobulin (Ig) G index and albumin quotient (QAlb) abnormalities were seen in all 4 groups. Vertical bars represent mean and SD. Abnormal quantitative results (both IgG index and QAlb) were seen in patients with normal oligoclonal band (OCB) pattern. Abn = abnormal; inf = inflammatory; N = normal; non-inf = non-inflammatory.

Mentions: The qualitative and quantitative CSF and sera IgG abnormalities and QAlb are reported in table 1, stratified by presence of a primary inflammatory pathology. Patients with an inflammatory condition were significantly more likely to have abnormal results (51/104 [49%] compared to 26/85 [31%]; p = 0.012, Fisher exact test). Abnormal qualitative results were identified in 33/104 (32%) and 9/85 (11%), respectively (p = 0.0007, Fisher exact test). Intrathecal CSF OCBs (types 2 + 3) were found in 20/104 (19%) (type 2, n = 10; type 3, n = 10) of the inflammatory group compared with 4/85 (5%) (type 2, n = 3; type 3, n = 1) of the noninflammatory group (p = 0.0036, Fisher exact test). Mirrored OCBs (type 4) were found in 13/104 (12.5%) of the inflammatory group compared with 5/85 (6%) of the noninflammatory group (p = 0.14, Fisher exact test). The quantitative analyses are reported in table 2 and illustrated in the figure. The absolute measures of IgG index and QAlb are significantly higher in patients with an inflammatory etiology (table 2, p = 0.048 and p = 0.0098, respectively; Mann-Whitney test). Raised IgG index (>0.85) was seen in both groups (table 2), whereas QAlb (>0.049) abnormalities were seen more frequently in the inflammatory group (p = 0.0028, Fisher exact test). The qualitative and quantitative evaluation collectively revealed additional positive results than when done in isolation (figure 1, A and B), Overall, the likelihood ratio of a positive test (type 2–4 pattern vs type 1 pattern) to help differentiate inflammatory from noninflammatory causes was 3.1 (95% confidence interval 1.6–6.0).


CSF albumin and immunoglobulin analyses in childhood neurologic disorders.

Hacohen Y, Singh R, Forsyth V, Absoud M, Lim M - Neurol Neuroimmunol Neuroinflamm (2014)

IgG index (A) and QAlb (B) results in patients with inflammatory and noninflammatory conditions stratified according to the presence or absence of abnormal oligoclonal band patternImmunoglobulin (Ig) G index and albumin quotient (QAlb) abnormalities were seen in all 4 groups. Vertical bars represent mean and SD. Abnormal quantitative results (both IgG index and QAlb) were seen in patients with normal oligoclonal band (OCB) pattern. Abn = abnormal; inf = inflammatory; N = normal; non-inf = non-inflammatory.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4202697&req=5

Figure 1: IgG index (A) and QAlb (B) results in patients with inflammatory and noninflammatory conditions stratified according to the presence or absence of abnormal oligoclonal band patternImmunoglobulin (Ig) G index and albumin quotient (QAlb) abnormalities were seen in all 4 groups. Vertical bars represent mean and SD. Abnormal quantitative results (both IgG index and QAlb) were seen in patients with normal oligoclonal band (OCB) pattern. Abn = abnormal; inf = inflammatory; N = normal; non-inf = non-inflammatory.
Mentions: The qualitative and quantitative CSF and sera IgG abnormalities and QAlb are reported in table 1, stratified by presence of a primary inflammatory pathology. Patients with an inflammatory condition were significantly more likely to have abnormal results (51/104 [49%] compared to 26/85 [31%]; p = 0.012, Fisher exact test). Abnormal qualitative results were identified in 33/104 (32%) and 9/85 (11%), respectively (p = 0.0007, Fisher exact test). Intrathecal CSF OCBs (types 2 + 3) were found in 20/104 (19%) (type 2, n = 10; type 3, n = 10) of the inflammatory group compared with 4/85 (5%) (type 2, n = 3; type 3, n = 1) of the noninflammatory group (p = 0.0036, Fisher exact test). Mirrored OCBs (type 4) were found in 13/104 (12.5%) of the inflammatory group compared with 5/85 (6%) of the noninflammatory group (p = 0.14, Fisher exact test). The quantitative analyses are reported in table 2 and illustrated in the figure. The absolute measures of IgG index and QAlb are significantly higher in patients with an inflammatory etiology (table 2, p = 0.048 and p = 0.0098, respectively; Mann-Whitney test). Raised IgG index (>0.85) was seen in both groups (table 2), whereas QAlb (>0.049) abnormalities were seen more frequently in the inflammatory group (p = 0.0028, Fisher exact test). The qualitative and quantitative evaluation collectively revealed additional positive results than when done in isolation (figure 1, A and B), Overall, the likelihood ratio of a positive test (type 2–4 pattern vs type 1 pattern) to help differentiate inflammatory from noninflammatory causes was 3.1 (95% confidence interval 1.6–6.0).

Bottom Line: CSF-restricted OCBs were found in 20/104 (19%) of the inflammatory group compared with 4/85 (5%) of the noninflammatory group (p= 0.0036).Mirrored OCBs were found in 13/104 (12.5%) of the inflammatory group compared with 5/85 (6%) of the noninflammatory group (p = 0.14).IgG index and QAlb were significantly higher in patients with an inflammatory etiology.

View Article: PubMed Central - PubMed

Affiliation: Children's Neuroscience, Evelina London Children's Hospital at Guy's & St Thomas' NHS Trust, King's Health Partners AHSC, Lambeth Palace Road, London.

ABSTRACT

Objective: To evaluate the utility of qualitative and quantitative analyses of CSF immunoglobulins as part of the diagnostic workup of CNS inflammatory conditions.

Methods: One hundred eighty-nine children who underwent CSF investigation for their neurologic condition had CSF and serum testing to (1) qualitatively identify oligoclonal band (OCB) patterns and (2) quantitatively measure the immunoglobulin (Ig) G index and albumin quotient (QAlb). Case notes were retrospectively reviewed and patients were grouped according to whether their primary diagnosis was due to an inflammatory (n = 104) or noninflammatory (n = 85) etiology.

Results: CSF-restricted OCBs were found in 20/104 (19%) of the inflammatory group compared with 4/85 (5%) of the noninflammatory group (p= 0.0036). Mirrored OCBs were found in 13/104 (12.5%) of the inflammatory group compared with 5/85 (6%) of the noninflammatory group (p = 0.14). IgG index and QAlb were significantly higher in patients with an inflammatory etiology. However, a raised IgG index (>0.85) and QAlb (>0.049) were seen in both groups, with QAlb abnormalities seen more frequently in the inflammatory group (p = 0.0028).

Conclusions: Both methods were informative in identifying inflammatory mechanisms. Abnormalities were more commonly, but not exclusively, seen in primary inflammatory conditions. The qualitative and quantitative evaluation collectively revealed additional positive results than when done in isolation.

No MeSH data available.


Related in: MedlinePlus