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Diagnostic performance of anti-citrullinated peptide antibodies for the diagnosis of rheumatoid arthritis: the relevance of likelihood ratios
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Donatello Pietrapertosa
Published/Copyright:
March 19, 2010
Abstract
Background: The goal of our study was to evaluate the diagnostic performance of the anti-cyclic citrullinated peptide 2 (anti-CCP2) assay in patients with autoimmune and inflammatory disorders.
Methods: We tested the specificity and sensitivity of anti-CCP2 antibodies measured by ELISA in 787 patients with rheumatoid arthritis (RA), 1024 patients with other autoimmune/inflammatory rheumatic disease and 401 subjects without autoimmune rheumatic disease. The optimal cut-off value was defined as the value with the highest diagnostic accuracy (receiver operating characteristic curve analysis). Interval-specific likelihood ratios (LRs) were calculated for each range bounded by defined anti-CCP2 values.
Results: To distinguish between patients with RA and controls, the cut-off value with the highest diagnostic accuracy for anti-CCP2 was 2.8 U/mL. Comparing the optimal cut-off value for anti-CCP2 to that recommended by the manufacturer (5.0 U/mL), an increase in prevalence between the proportions of test-positive patients was found for RA, undifferentiated connective tissue disease and undifferentiated arthritis. Evaluating interval-specific LRs for the selected ranges bound by two anti-CCP2 values, in RA and diseased controls, the LRs were 0.40 for values <5.0 U/mL, 6.66 for 5.0–15.0 U/mL, 27.01 for 15.1–30.0 U/mL and 28.89 for >30.0 U/mL.
Conclusions: The cut-off value of 2.8 U/mL for anti-CCP2 has the highest diagnostic accuracy. A value of anti-CCP2 >15 U/mL is associated with an increase in the likelihood of RA disease.
Clin Chem Lab Med 2010;48:829–34.
Received: 2009-11-24
Accepted: 2010-1-17
Published Online: 2010-03-19
Published in Print: 2010-06-01
©2010 by Walter de Gruyter Berlin New York
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Keywords for this article
anti-CCP2;
cut-off;
diagnostic accuracy;
likelihood ratios;
rheumatoid arthritis
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- Necessity for high-quality reference materials in the harmonization of laboratory assays
- Reviews
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- Biochemical markers of muscular damage
- Minireview
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- 2010 Consensus statement on the worldwide standardization of the hemoglobin A1c measurement
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