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Diagnostic performance of anti-β2 glycoprotein I and anticardiolipin assays for clinical manifestations of the antiphospholipid syndrome

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Abstract

The objective of the present study was to analyse the performance of the tests for detection of anti-β2 glycoprotein I (β2 GP I) and anticardiolipin (aCL) antibodies for identification of clinical manifestations of the antiphospholipid syndrome (APS). Patients with systemic lupus erythematosus (SLE) as well as carriers of infectious diseases such as Kala-azar, syphilis and leptospirosis were studied. Particular interest was given to the presence of clinical complications related to APS. Anticardiolipin and anti-β2 GP I antibodies were searched using an enzyme-linked immunosorbent assay (ELISA) assay. Clinical manifestations of APS were observed in 34 of the 152 patients (22.3%) with SLE and no patient with infectious disease had such manifestations. Antibodies to cardiolipin in moderate or high levels and anti-β2 GP I were detected in 55 of 152 (36.1%) and 36 of 152 (23.6%) patients with SLE, respectively, and in 2 of 30 (6.6%) and 16 of 30 (53.3%) patients with Kala-azar, in 9 of 39 (23%) and 6 of 34 (17.6%) patients with leptospirosis, and 14 of 74 (18.9%) and 8 of 70 (11.4%) cases of syphilis, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR) of the anti-β2 GP I test for the identification of the clinical manifestation of APS were, respectively, 29% [95% confidence interval (CI)=24%–34%], 78% (95% CI=73–83%), 15% (95% CI=11–19%), 89% (95%CI=85–93%) and 1.38. Regarding the aCL assay, the figure was 29% (95% CI=24–34%), 76% (95% CI=71–81%), 14% (95% CI=10–18%), 89% (95% CI=86–92%) and 1.26. As the validity and performance of the anti-β2 GP I assay were similar to the aCL in demonstrating the presence of clinical phenomena associated with APS and due to the difficulties in performing as well as the lack of standardisation of the anti-β2 GP I test, we suggest that the test for aCL should continue to be the first one performed when the presence of APS is suspected.

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Acknowledgements

Support for this project was provided by the Brazilian National Research Council (CNPq) (grants 52.1229/98–7) and FINEP (4196086200).

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Authors and Affiliations

  1. Escola Bahiana de Medicina e Saúde Pública, Núcleo de Reumatologia do Serviço de Clínica Médica do Hospital Santa Izabel, Praça Almeida Couto, 500, CEP 40.000–000, Nazaré, Salvador, Bahia, Brazil

    Mittermayer Santiago

  2. Faculdade de Medicina da UFBa, Salvador, Bahia, Brazil

    Reinaldo Martinelli & Rogério de Jesus

  3. Centro de Pesquisas Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Bahia, Brazil

    Mitermayer G. Reis, Eliana Almeida Reis & Albert Ko

  4. Weill Medical College, New York, NY, USA

    Albert Ko

  5. COAS/DST/SESAB, Salvador, Bahia, Brazil

    Roberto Dias Fontes

  6. PIEJ/SESAB, Jequié, Brazil

    Moacir Paranhos Silva & Eliane Goes Nascimento

  7. Morehouse School of Medicine, Atlanta, GA, USA

    Silvia Pierangeli, Ricardo Espinola & Azzudin Gharavi

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  1. Mittermayer Santiago
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  2. Reinaldo Martinelli
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  3. Mitermayer G. Reis
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  4. Eliana Almeida Reis
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  5. Albert Ko
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  6. Roberto Dias Fontes
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  7. Moacir Paranhos Silva
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  8. Eliane Goes Nascimento
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  9. Rogério de Jesus
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  10. Silvia Pierangeli
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  11. Ricardo Espinola
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  12. Azzudin Gharavi
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Correspondence to Mittermayer Santiago.

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Santiago, M., Martinelli, R., Reis, M.G. et al. Diagnostic performance of anti-β2 glycoprotein I and anticardiolipin assays for clinical manifestations of the antiphospholipid syndrome. Clin Rheumatol 23, 485–489 (2004). https://doi.org/10.1007/s10067-004-0924-5

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  • DOI: https://doi.org/10.1007/s10067-004-0924-5

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