An algorithm to predict intrathecal IgM synthesis in multiple sclerosis patients: optimizing the use of oligoclonal band testing
Year: 2025
Type: article
Study design: Observational Study
Abstract: Objectives: We aimed to develop a simple, cost-effective algorithm to predict the presence of oligoclonal IgM bands (OCMB) in patients with multiple sclerosis (MS), using surrogate markers such as the IgM Index (IgMi) and the Free Kappa Light Chains Index (FKLCi), with the aim of reducing the need for OCMB testing while maintaining high diagnostic accuracy. Methods: A retrospective study was conducted using paired serum and cerebrospinal fluid samples from patients diagnosed with MS at disease onset at Hospital Universitari i Politècnic La Fe. Receiver operating characteristic (ROC) curve analyses were performed for IgMi and FKLCi to evaluate their ability to predict OCMB positivity. Several combinations of cutoff values prioritizing high specificity and positive predictive value (PPV) were tested, and the best-performing threshold combination was selected. Results: A total of 97 patients were included. The optimal model defined OCMB positivity as having either IgMi≥0.2 or FKLCi≥250. Applying this algorithm reduced the need for OCMB testing by 33 %, while achieving a specificity of 90 % and a PPV of 85 %. Conclusions: IgMi and FKLCi may serve as reliable predictors of OCMB positivity in MS, potentially reducing unnecessary testing and laboratory workload.
Authors: Jordi Tortosa-Carreres, Laura Cubas-Núñez, Jéssica Castillo-Villalba, Lorena Forés-Toribio, Mónica Piqueras, Raquel Gasque-Rubio, Sara Carratalà-Boscà, Carlos Quintanilla-Bordás, David Gorriz-Romero, Bonaventura Casanova, Begoña Laiz-Marro, Francisco Carlos Pérez-Miralles
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Awards: Búsqueda de biomarcadores para la identificación de pacientes con alto riesgo de infecciones graves a lo largo de los tratamientos que inducen la depleción de linfocitos B en la esclerosis múltiple., G4109886431, G4145062930, Procesos inmunológicos implicados en el desarrollo de la progresión en la esclerosis múltiple e impacto en el tratamiento
OpenAlex ID: W7108712706