Multiple sclerosis and related disorders · 2026
Correlation and diagnostic accuracy of kappa free light chain index and Oligoclonal bands in multiple sclerosis and other neurological diseases.
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Bilgili Semih, Kilic Ahmet Kasim, Cakir Madenci Ozlem
Аннотация
OBJECTIVE: Demonstrating intrathecal immunoglobulin synthesis is critical for Multiple Sclerosis (MS) diagnosis. We evaluated the diagnostic performance of cerebrospinal fluid (CSF) Kappa Free Light Chain (KFLC) Index compared to conventional Oligoclonal Bands (OCB) and IgG Index.
MATERIALS AND METHODS: In this single-center retrospective study, 73 MS patients and 214 controls (n = 287) were evaluated via Mann-Whitney U test and Receiver Operating Characteristic (ROC) analysis.
RESULTS: The median KFLC Index was significantly higher in MS (45.81, IQR: 26.36-144.54) than controls (2.27, IQR: 1.74-3.11; p < 0.0001). The KFLC Index AUC was 0.978 (95% CI: 0.961-0.995), outperforming the IgG Index (AUC: 0.845). While non-inflammatory controls consistently exhibited low KFLC Index values, elevated levels were detected in a subset of non-MS inflammatory controls. In sex-stratified analysis, the optimal cut-off was ≥11.39 for females (AUC: 0.989, 95% CI: 0.975-1.000) and ≥7.49 for males (AUC: 0.964, 95% CI: 0.938-0.990). Globally, a cut-off of ≥7.49 yielded 100% sensitivity and 93% specificity. KFLC Index elevation strongly correlated with OCB patterns (p < 0.0001).
CONCLUSION: The KFLC Index provides exceptional quantitative sensitivity and specificity in MS diagnosis. The cut-off of 7.49 demonstrates excellent rule-out performance. We recommend integrating the KFLC Index into routine clinical practice as a reliable, standardizable alternative or complementary tool to conventional OCB analysis.
MATERIALS AND METHODS: In this single-center retrospective study, 73 MS patients and 214 controls (n = 287) were evaluated via Mann-Whitney U test and Receiver Operating Characteristic (ROC) analysis.
RESULTS: The median KFLC Index was significantly higher in MS (45.81, IQR: 26.36-144.54) than controls (2.27, IQR: 1.74-3.11; p < 0.0001). The KFLC Index AUC was 0.978 (95% CI: 0.961-0.995), outperforming the IgG Index (AUC: 0.845). While non-inflammatory controls consistently exhibited low KFLC Index values, elevated levels were detected in a subset of non-MS inflammatory controls. In sex-stratified analysis, the optimal cut-off was ≥11.39 for females (AUC: 0.989, 95% CI: 0.975-1.000) and ≥7.49 for males (AUC: 0.964, 95% CI: 0.938-0.990). Globally, a cut-off of ≥7.49 yielded 100% sensitivity and 93% specificity. KFLC Index elevation strongly correlated with OCB patterns (p < 0.0001).
CONCLUSION: The KFLC Index provides exceptional quantitative sensitivity and specificity in MS diagnosis. The cut-off of 7.49 demonstrates excellent rule-out performance. We recommend integrating the KFLC Index into routine clinical practice as a reliable, standardizable alternative or complementary tool to conventional OCB analysis.