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Open AccessArticle

Kappa Index versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders

1
Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
2
Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy
3
Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, Ospedale Civile, 41126 Modena, Italy
4
Neuroimmunology Laboratory, IRCCS Mondino Foundation, 27100 Pavia, Italy
5
Neurology Unit, Ospedale Ramazzini, Carpi, 41012 Modena, Italy
6
Neurology Unit, Ospedale G. da Saliceto, 29121 Piacenza, Italy
*
Author to whom correspondence should be addressed.
Diagnostics 2020, 10(10), 856; https://doi.org/10.3390/diagnostics10100856
Received: 30 September 2020 / Revised: 12 October 2020 / Accepted: 19 October 2020 / Published: 21 October 2020
Background: Cerebrospinal fluid (CSF) kappa free light chains (KFLC) are gaining increasing interest as markers of intrathecal immunoglobulin synthesis. The main aim of this study was to assess the diagnostic accuracy (AUC) of the kappa index (CSF/serum KFLC divided by the CSF/serum albumin ratio) compared to CSF oligoclonal IgG bands (OCB) in predicting Multiple Sclerosis (MS) or a central nervous system infectious/inflammatory disorder (CNSID). Methods: We enrolled patients who underwent a diagnostic spinal tap throughout two years. KFLC levels were determined using a Freelite assay (Binding Site) and the turbidimetric Optilite analyzer. Results: Of 540 included patients, 223 had a CNSID, and 84 had MS. The kappa index was more sensitive (0.89 versus 0.85) and less specific (0.84 versus 0.89), with the same AUC (0.87) as OCB for MS diagnosis (optimal cut-off: 6.2). Adding patients with a single CSF IgG band to the OCB-positive group slightly increased the AUC (0.88). Likewise, the kappa index (cut-off: 3.9) was more sensitive (0.67 versus 0.50) and less specific (0.81 versus 0.97), with the same AUC (0.74) as OCB, for a CNSID diagnosis. Conclusion: The kappa index and CSF OCB have comparable diagnostic accuracies for a MS or CNSID diagnosis and supply the clinician with useful, complementary information. View Full-Text
Keywords: cerebrospinal fluid; multiple sclerosis; kappa index; oligoclonal bands; free light chains cerebrospinal fluid; multiple sclerosis; kappa index; oligoclonal bands; free light chains
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MDPI and ACS Style

Ferraro, D.; Bedin, R.; Natali, P.; Franciotta, D.; Smolik, K.; Santangelo, M.; Immovilli, P.; Camera, V.; Vitetta, F.; Gastaldi, M.; Trenti, T.; Meletti, S.; Sola, P. Kappa Index versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders. Diagnostics 2020, 10, 856. https://doi.org/10.3390/diagnostics10100856

AMA Style

Ferraro D, Bedin R, Natali P, Franciotta D, Smolik K, Santangelo M, Immovilli P, Camera V, Vitetta F, Gastaldi M, Trenti T, Meletti S, Sola P. Kappa Index versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders. Diagnostics. 2020; 10(10):856. https://doi.org/10.3390/diagnostics10100856

Chicago/Turabian Style

Ferraro, Diana; Bedin, Roberta; Natali, Patrizia; Franciotta, Diego; Smolik, Krzysztof; Santangelo, Mario; Immovilli, Paolo; Camera, Valentina; Vitetta, Francesca; Gastaldi, Matteo; Trenti, Tommaso; Meletti, Stefano; Sola, Patrizia. 2020. "Kappa Index versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders" Diagnostics 10, no. 10: 856. https://doi.org/10.3390/diagnostics10100856

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