Comparative Analysis of Classification Criteria in IgG4-Related Disease and Evaluating Diagnostic Accuracy from a Retrospective Cohort in Clinical Practice

• Published in: Diagnostics (Basel) Vol. 14; no. 22; p. 2583
• Main Authors: Lopez-Gomez, Marta, Moya-Alvarado, Patricia, Park, Hye Sang, Martín, Mar Concepción, Calleja, Sara, Codes-Mendez, Helena, Magallares, Berta, Castellví, Iván, Barros-Membrilla, Antonio J., Laiz, Ana, Diaz-Torné, César, Sainz, Luis, Bernárdez, Julia, Martínez-Martinez, Laura, Corominas, Hèctor
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.11.2024; MDPI
• Subjects: Accuracy; ACR/EULAR; Antigens; Biopsy; Classification; Clinical medicine; Clinical trials; Comparative analysis; diagnostic criteria; Disease; Diseases; Evidence-based medicine; Hospitals; IgG4; Immunoglobulin G; Immunology; Medical care; Patients; Quality management; Rheumatology; Serology; Spain; Tomography; Spain; IgG4; diagnostic criteria; ACR/EULAR
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics14222583

Introduction: We conducted a comprehensive comparative analysis of the Okazaki, Umehara, and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for diagnosing immunoglobulin G4-related disease (IgG4-RD). Materials and Methods: A retrospective study was conducted in a single tertiary hospital, using expert clinical judgment as the gold standard. We compared the diagnostic accuracy of the Okazaki, Umehara, and ACR/EULAR criteria in a cohort of 41 patients with suspected IgG4-RD. We assessed sensitivity, specificity, and positive and negative predictive values for each criterion, and conducted a separate analysis based on four IgG4-RD subtypes. Results: A total of 30 patients were confirmed to have IgG4-RD and 11 were identified as mimickers. The Umehara criteria demonstrated the highest sensitivity (83.33%), followed by the ACR/EULAR 2019 (66.67%) and Okazaki (60.0%) criteria. All three criteria exhibited 100% specificity, with overall diagnostic accuracy ranging from 70% to 88%. The areas under the curve (AUC) were 0.917 (Umehara), 0.800 (Okazaki), and 0.833 (ACR/EULAR 2019), indicating significant diagnostic effectiveness (p < 0.000). Subtype analysis revealed that the Umehara and ACR/EULAR 2019 criteria were more effective in diagnosing pancreato-hepato-biliary involvement (subtype 1), while the Okazaki and ACR/EULAR 2019 criteria were more effective in diagnosing retroperitoneal fibrosis and/or aortitis (subtype 2). Conclusions: Our study provides valuable insights into the diagnostic performance of the Okazaki, Umehara, and ACR/EULAR criteria for a cohort of patients with suspected IgG4-RD. The Umehara criterion demonstrated the highest sensitivity, suggesting its potential utility for screening purposes, while all three criteria showed consistent specificity.