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Monday, June 13, 2011

[AlternativeAnswers] Simultaneous use of serum IgG and IgM for risk scoring of suspected early Lyme,b


Simultaneous use of serum IgG and IgM for risk
scoring of suspected early Lyme,borreliosis: graphical and
bivariate analyses.

APMIS. 2010 Apr;118(4):313-23.

Simultaneous use of serum IgG and IgM for risk scoring of
suspected early Lyme
borreliosis: graphical and bivariate analyses.

Dessau RB, Ejlertsen T, Hilden J.

Department of Clinical Microbiology, Naestved Hospital, Region
Zealand, Naestved, Denmark. ramd@regionsjaelland.dk

The laboratory diagnosis of early disseminated Lyme borreliosis
(LB) rests on IgM and IgG antibodies in serum. The purpose of
this study was to refine the statistical interpretation of IgM
and IgG by combining the diagnostic evidence provided by the two
immunoglobulins and exploiting the whole range of the
quantitative variation in test values. ELISA assays based on
purified flagella antigen were performed on sera from 815 healthy
Danish blood donors as negative controls and 117 consecutive
patients with confirmed neuroborreliosis (NB). A logistic
regression model combining the standardized units of the IgM and
IgG ELISA assays was constructed and the resulting disease risks
graphically evaluated by receiver operating characteristic and
'predictiveness' curves. The combined model improves the
discrimination between NB patients and blood donors.
Hence, it is possible to report a predicted risk of disease
graded for each individual patient, as is theoretically
preferable. The predictiveness curve, when adapted to the local
pretest probability of LB, allows high-risk and low-risk
thresholds to be defined instead of cut-offs based on the
laboratory characteristics only, and it allows the extent of
under- and over-treatment to be assessed. It is shown that an
example patient with low ELISA results in IgM and IgG, considered
negative by the conventional cut-off, has a relatively high risk
of belonging to the truly diseased population and a low risk of
being false positive. Using a 20% high-risk threshold for
advising the clinician to consider treatment, the sensitivity of
the assay is increased from 76% to 85%, while the specificity is
maintained at around 95%.

PMID: 20402677 [PubMed - in process]

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