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Rigshospitalet - en del af Københavns Universitetshospital
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A multicentre study to improve clinical interpretation of proteinase-3 and myeloperoxidase anti-neutrophil cytoplasmic antibodies

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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  4. Assessment of Disease Activity in Large-vessel Vasculitis: Results of an International Delphi Exercise

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Xavier Bossuyt
  • Niels Rasmussen
  • Pieter van Paassen
  • Bernard Hellmich
  • Bo Baslund
  • Pieter Vermeersch
  • Daniel Blockmans
  • Jan-Willem Cohen Tervaert
  • Elena Csernok
  • Jan Damoiseaux
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Objective: The objective of this multicentre study was to improve the clinical interpretation of PR3- and MPO-ANCAs as an adjunct for the diagnosis of ANCA-associated vasculitis (AAV) by defining thresholds and test result intervals based on predefined specificities and by calculating test result interval-specific likelihood ratios (LRs).

Methods: Eight different PR3- and MPO-ANCA immunoassays from seven companies were evaluated using 251 diagnostic samples from AAV patients and 924 diseased controls.

Results: Thresholds for antibody levels were determined based on predefined specificities (95, 97.5, 99 and 100%) and used to delimit test result intervals. Test result interval-specific LRs were determined. For all assays, the LR for AAV increased with increasing antibody level. For all but one immunoassay, high antibodies levels (associated with LR >55) were found in a substantial fraction (>65%) of patients. The area under the curve (AUC) of receiver operating characteristics analysis of a diagnostic approach in which positive results were confirmed by IIF or another immunoassay was not substantially higher than the AUC of performing immunoassay only. The highest AUC was found when immunoassay was combined with another immunoassay or with IIF.

Conclusion: To diagnose AAV based on PR3- and MPO-ANCA, it is useful to define thresholds for antibody levels and to assign test result interval-specific LRs. Higher antibody levels are associated with a higher likelihood for disease. Such information improves clinical interpretation.

OriginalsprogEngelsk
TidsskriftRheumatology (Oxford, England)
Vol/bind56
Udgave nummer9
Sider (fra-til)1533-1541
Antal sider9
ISSN1462-0324
DOI
StatusUdgivet - 1 sep. 2017

ID: 52381903