Kappa free light chains index in the differential diagnosis of Multiple Sclerosis from Neuromyelitis optica spectrum disorders and other immune-mediated central nervous system disorders

J Neuroimmunol. 2020 Feb 15:339:577122. doi: 10.1016/j.jneuroim.2019.577122. Epub 2019 Dec 3.

Abstract

The K free light chains index (K-FLC index) has been proposed as an alternative test for intrathecal immunoglobulin synthesis in MS diagnosis. Aim of the study was to assess the accuracy of the K-FLC index in differentiating MS from other immune-mediated CNS disorders and NMOSD. Data were available from a cohort of 371 patients. K-FLC index was significantly higher in MS: MS mean K-FLC index 90.897 ± 134.198; NMOSD 17.992 ± 15.103; other immune-mediated CNS disorders 12.568 ± 24.440. The overall diagnostic accuracy of the K-FLC index was similar to intrathecal oligoclonal bands detection. However, as a quantitative variable, K-FLC index allowed easier discrimination of MS from other immune-mediated CNS disorders: highest K-FLC index values (> 100) were observed almost only in MS and are therefore strongly predictive of MS, in patients with the appropriate clinical presentation.

Keywords: Cerebrospinal fluid; Free light chains; Isoelectrofocusing; K index; Multiple sclerosis; Oligoclonal bands.

MeSH terms

  • Adult
  • Autoimmune Diseases of the Nervous System / diagnosis
  • Autoimmune Diseases of the Nervous System / metabolism
  • Biomarkers / blood
  • Biomarkers / cerebrospinal fluid
  • Central Nervous System Diseases / diagnosis
  • Central Nervous System Diseases / metabolism
  • Diagnosis, Differential
  • Female
  • Humans
  • Immunoglobulin Light Chains / metabolism*
  • Male
  • Middle Aged
  • Multiple Sclerosis / diagnosis*
  • Multiple Sclerosis / metabolism*
  • Neuromyelitis Optica / diagnosis*
  • Neuromyelitis Optica / metabolism*
  • Oligoclonal Bands / metabolism

Substances

  • Biomarkers
  • Immunoglobulin Light Chains
  • Oligoclonal Bands