Abstract
Cerebrospinal fluid (CSF) kappa free light chain (KFLC) index has been described as a reliable marker of intrathecal IgG synthesis to diagnose multiple sclerosis (MS). Our aims were: (1) to compare the efficiency of KFLC through different interpretation approaches in diagnosing MS. (2) to evaluate the prognostic value of KFLC in radiologically and clinically isolated syndromes (RIS-CIS). We enrolled 133 MS patients and 240 with other neurological diseases (93 inflammatory including 18 RIS-CIS, 147 non-inflammatory). Albumin, lambda free light chain (LFLC) and KFLC were measured in the CSF and serum by nephelometry. We included two groups of markers: (a) corrected for blood-CSF barrier permeability: immunoglobulin G (IgG), KFLC and LFLC indexes. (b) CSF ratios (not including albumin and serum-correction): CSF KFLC/LFLC, CSF KFLC/IgG, CSF LFLC/IgG. KFLC were significantly higher in MS patients compared to those with other diseases (both inflammatory or not). KFLC index and CSF KFLC/IgG ratio showed high sensitivity (93% and 86.5%) and moderate specificity (85% and 88%) in diagnosing MS. RIS-CIS patients who converted to MS showed greater KFLC index and CSF KFLC/IgG. Despite OB are confirmed to be the gold-standard to detect intrathecal IgG synthesis, the KFLC confirmed their accuracy in MS diagnosis. A “kappa-oriented” response characterizes MS and has a prognostic impact in the RIS-CIS population.
Highlights
Cerebrospinal fluid (CSF) kappa free light chain (KFLC) index has been described as a reliable marker of intrathecal immunoglobulin G (IgG) synthesis to diagnose multiple sclerosis (MS)
lambda free light chain (LFLC) index and CSF LFLC/IgG ratio resulted greater in MS in other neurological conditions, but did not differ significantly among the three groups
oligoclonal bands (OB) remained the gold standard for CSF analysis in MS
Summary
Cerebrospinal fluid (CSF) kappa free light chain (KFLC) index has been described as a reliable marker of intrathecal IgG synthesis to diagnose multiple sclerosis (MS). Other parameters included to discriminated MS were: oligoclonal bands (OB) detection, IgG (or Link) index and lambda FLC (LFLC) index All these markers are corrected for blood-CSF barrier permeability: by comparison to serum for OB and by albumin ratio (serum/CSF albumin) for indexes[7]. In this study we considered measures for the excess of kappa and lambda FLC only in the CSF, called CSF ratios, that are not albumin and serum-corrected These latter values were investigated for a possible diagnostic role toward MS. The secondary aim of this work was to evaluate whether the above-mentioned markers had prognostic value in radiologically and clinically isolated syndromes (RIS-CIS) to identify which patients were at higher risk of conversion to MS
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