Immunoglobulin subclass 4 for the diagnosis of immunoglobulin subclass 4-associated diseases in an unselected liver and pancreas clinic population

AbstractAimsThe diagnosis of autoimmune pancreatitis (AIP) and immunoglobulin subclass 4 (IgG4)-associated cholangitis (IAC) is based on imaging studies, serology, histology and a response to steroid therapy. The major serological finding is an elevation of the serum IgG4 concentration. Previous studies have shown that its sensitivity is about 70% and its specificity exceeds 90% at a cut-off of 140mg/dl in selected patient populations. The aim of the present study was to assess the performance of serum IgG4 as a diagnostic parameter in an unselected liver and pancreas clinic population.Methods and resultsIgG4 was prospectively determined in 1412 patients and clinical diagnoses were recorded from a review of patient charts. The prevalence of AIP or IAC in the entire cohort was 1.1% (n= 15). The sensitivity of IgG4 for the diagnosis of AIP and IAC was 80% and the specificity was 86% at a cut-off value of ≥135mg/dl. The positive predictive value and the negative predictive value were 6% and 99.7%, respectively. The most common differential diagnosis in patients with elevated IgG4 was liver cirrhosis.ConclusionIgG4 has a reasonable sensitivity and specificity in a liver and pancreas clinic population, where liver cirrhosis appears to be the most frequent differential diagnosis for elevated IgG4 concentrations