Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis
Background Despite many studies suggesting an association between serum IgG4 and IgG4-related diseases (IgG4-RD), the evidence of the utility of serum IgG4 titres in differentiating between IgG4-RD and non-IgG4-RD remains uncertain.Methods The primary analysis was based on published studies. Data we...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-12-01
|
| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/4/e003498.full |
| _version_ | 1797359824682352640 |
|---|---|
| author | Kuang-Hui Yu Tien-Ming Chan Che-Tzu Chang Han-Hua Yu |
| author_facet | Kuang-Hui Yu Tien-Ming Chan Che-Tzu Chang Han-Hua Yu |
| author_sort | Kuang-Hui Yu |
| collection | DOAJ |
| description | Background Despite many studies suggesting an association between serum IgG4 and IgG4-related diseases (IgG4-RD), the evidence of the utility of serum IgG4 titres in differentiating between IgG4-RD and non-IgG4-RD remains uncertain.Methods The primary analysis was based on published studies. Data were pooled by means of a random-effect model, and sensitivity, specificity, positive likelihood ratios (LR+), negative likelihood ratios (LR–), diagnostic ORs (DOR) and summary receiver operating characteristic curve (SROC) were calculated. Subgroup analyses were performed based on the racial/ethnic distribution of these studies.Results A total of 27 studies with 1691 (8.6%) IgG4-RD cases and 17 944 non-IgG4-RD subjects were included. Moreover, 1462 (86.5%) of the 1691 IgG4-RD patients had elevated serum IgG4 levels whereas 10.5% (1,882 of 17,944) of the non-IgG4-RD subjects had elevated serum IgG4 levels. The pooled sensitivity of serum IgG4 was 86% (85%–88%), specificity was 90% (89%–90%), LR+ was 9.19 (7.16–11.78), LR– was 0.17 (0.12–0.24), and the DOR was 60.8 (40.9–90.4), respectively. The area under the SROC curve for the differential diagnosis between IgG4-RD and non-IgG4-RD was 0.95 (0.94–0.97). Ethnic subgroup analyses revealed different findings with respect to DOR for Asian (103.8; 95% CI 63.3 to 170.2), and Caucasian (25.7; 95% CI 17.6 to 37.5) populations.Conclusions Overall, elevated serum IgG4 levels were associated with IgG4-RD. The results revealed a moderate-to-high sensitivity (86%, 85%–88%) and high specificity (90%, 89%–90%). Subgroup analyses in serum IgG4 diagnostic performance revealed differences among Asian and Caucasian populations. |
| first_indexed | 2024-03-08T15:29:20Z |
| format | Article |
| id | doaj.art-4e287480edff476d8cbbaa93437a3927 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-08T15:29:20Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-4e287480edff476d8cbbaa93437a39272024-01-10T06:50:09ZengBMJ Publishing GroupRMD Open2056-59332023-12-019410.1136/rmdopen-2023-003498Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysisKuang-Hui Yu0Tien-Ming Chan1Che-Tzu Chang2Han-Hua Yu3Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanDivision of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanDivision of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanDivision of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou, Taoyuan, TaiwanBackground Despite many studies suggesting an association between serum IgG4 and IgG4-related diseases (IgG4-RD), the evidence of the utility of serum IgG4 titres in differentiating between IgG4-RD and non-IgG4-RD remains uncertain.Methods The primary analysis was based on published studies. Data were pooled by means of a random-effect model, and sensitivity, specificity, positive likelihood ratios (LR+), negative likelihood ratios (LR–), diagnostic ORs (DOR) and summary receiver operating characteristic curve (SROC) were calculated. Subgroup analyses were performed based on the racial/ethnic distribution of these studies.Results A total of 27 studies with 1691 (8.6%) IgG4-RD cases and 17 944 non-IgG4-RD subjects were included. Moreover, 1462 (86.5%) of the 1691 IgG4-RD patients had elevated serum IgG4 levels whereas 10.5% (1,882 of 17,944) of the non-IgG4-RD subjects had elevated serum IgG4 levels. The pooled sensitivity of serum IgG4 was 86% (85%–88%), specificity was 90% (89%–90%), LR+ was 9.19 (7.16–11.78), LR– was 0.17 (0.12–0.24), and the DOR was 60.8 (40.9–90.4), respectively. The area under the SROC curve for the differential diagnosis between IgG4-RD and non-IgG4-RD was 0.95 (0.94–0.97). Ethnic subgroup analyses revealed different findings with respect to DOR for Asian (103.8; 95% CI 63.3 to 170.2), and Caucasian (25.7; 95% CI 17.6 to 37.5) populations.Conclusions Overall, elevated serum IgG4 levels were associated with IgG4-RD. The results revealed a moderate-to-high sensitivity (86%, 85%–88%) and high specificity (90%, 89%–90%). Subgroup analyses in serum IgG4 diagnostic performance revealed differences among Asian and Caucasian populations.https://rmdopen.bmj.com/content/9/4/e003498.full |
| spellingShingle | Kuang-Hui Yu Tien-Ming Chan Che-Tzu Chang Han-Hua Yu Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis RMD Open |
| title | Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis |
| title_full | Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis |
| title_fullStr | Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis |
| title_full_unstemmed | Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis |
| title_short | Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis |
| title_sort | diagnostic utility of serum igg4 level in igg4 related diseases a comprehensive systematic review and meta analysis |
| url | https://rmdopen.bmj.com/content/9/4/e003498.full |
| work_keys_str_mv | AT kuanghuiyu diagnosticutilityofserumigg4levelinigg4relateddiseasesacomprehensivesystematicreviewandmetaanalysis AT tienmingchan diagnosticutilityofserumigg4levelinigg4relateddiseasesacomprehensivesystematicreviewandmetaanalysis AT chetzuchang diagnosticutilityofserumigg4levelinigg4relateddiseasesacomprehensivesystematicreviewandmetaanalysis AT hanhuayu diagnosticutilityofserumigg4levelinigg4relateddiseasesacomprehensivesystematicreviewandmetaanalysis |