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Objective <p>The aim of this study was to evaluate the diagnostic value of the cerebrospinal fluid (CSF) κ-free light chain (KFLC) index during initial assessment of suspected multiple sclerosis (MS), compared to CSF restricted oligoclonal bands (OCB) and conventional measures, and to examine the performance of KFLC in the 2017 and 2024 McDonald criteria.</p> Methods <p>We enrolled 112 consecutive individuals referred for suspected MS evaluation. OCB were analyzed in paired serum and CSF samples using isoelectric focusing, followed by immunofixation. KFLC concentrations in serum and CSF were measured with an immunonephelometric assay. For all participants, the 2017 McDonald criteria were applied based on clinical, MRI, and CSF findings.</p> Results <p>After evaluation, 64 (57.1%) of participants met the 2017 revision of the McDonald’s criteria. Participants who met the 2017 revision of the McDonald criteria had a statistically significantly higher percentage of CSF-restricted OCBs (96.9% vs. 10.4%, <i>p</i> &lt; 0.001) and a higher KFLC index [46.50 (14.50-133.15) vs. 2.10 (1.73–2.88), <i>p</i> &lt; 0.001] compared to participants who did not fulfill the 2017 revision of the McDonald criteria. KFLC index negatively correlated with age (<i>r</i>=-0.334, <i>p</i> &lt; 0.001). Receiver operating characteristic analysis showed an AUC of 0.965 (95% CI 0.927–1.000, <i>p</i> &lt; 0.001) for the KFLC index to distinguish pwRMS from MS mimics. At the optimal cut-off of 5.60, sensitivity was 90.6%, specificity 95.9%, yielding a Youden’s index J = 0.865.</p> Conclusions <p>Our results confirm that the KFLC index is a highly accurate and dependable biomarker for distinguishing MS from non-MS conditions, showing strong concordance with OCBs.</p>

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CSF κ-Free light chain index in suspected multiple sclerosis: diagnostic performance vs. Oligoclonal bands and alignment with 2017/2024 McDonald criteria

  • 期刊论文

  • 发表日期：

    2026年1月20日

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  • Laura Zanetti,
  • Željka Vogrinc,
  • Josip Sremec,
  • Katarina Tešija,
  • Mašan Sredanović,
  • Dora Vogrinc,
  • Ljiljana Zaninović,
  • Ana Turčić,
  • Magdalena Krbot Skorić,
  • Mario Habek

摘要

Objective

The aim of this study was to evaluate the diagnostic value of the cerebrospinal fluid (CSF) κ-free light chain (KFLC) index during initial assessment of suspected multiple sclerosis (MS), compared to CSF restricted oligoclonal bands (OCB) and conventional measures, and to examine the performance of KFLC in the 2017 and 2024 McDonald criteria.

Methods

We enrolled 112 consecutive individuals referred for suspected MS evaluation. OCB were analyzed in paired serum and CSF samples using isoelectric focusing, followed by immunofixation. KFLC concentrations in serum and CSF were measured with an immunonephelometric assay. For all participants, the 2017 McDonald criteria were applied based on clinical, MRI, and CSF findings.

Results

After evaluation, 64 (57.1%) of participants met the 2017 revision of the McDonald’s criteria. Participants who met the 2017 revision of the McDonald criteria had a statistically significantly higher percentage of CSF-restricted OCBs (96.9% vs. 10.4%, p < 0.001) and a higher KFLC index [46.50 (14.50-133.15) vs. 2.10 (1.73–2.88), p < 0.001] compared to participants who did not fulfill the 2017 revision of the McDonald criteria. KFLC index negatively correlated with age (r=-0.334, p < 0.001). Receiver operating characteristic analysis showed an AUC of 0.965 (95% CI 0.927–1.000, p < 0.001) for the KFLC index to distinguish pwRMS from MS mimics. At the optimal cut-off of 5.60, sensitivity was 90.6%, specificity 95.9%, yielding a Youden’s index J = 0.865.

Conclusions

Our results confirm that the KFLC index is a highly accurate and dependable biomarker for distinguishing MS from non-MS conditions, showing strong concordance with OCBs.