Autoantibodies against C1q as a Diagnostic Measure of Lupus Nephritis: Systematic Review and Meta-analysis
|Paul Eggleton1*, Obioha C. Ukoumunne2, Isabel Cottrell1, Asma Khan1, Sidra Maqsood1, Jemma Thornes1, Elizabeth Perry1 and David Isenberg3|
|1Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK|
|2NIHR CLAHRC South West Peninsula (PenCLAHRC),University of Exeter Medical School, University of Exeter, Exeter, UK|
|3Centre for Rheumatology, Department of Medicine University College London, UK|
|Corresponding Author :||Paul Eggleton, MPhil, PhD
University of Exeter Medical School
University of Exeter, Exeter EX1 2LU, UK
Tel: +44 (0)1392 722940
E-mail: p.e[email protected]
|Received: March 14, 2014; Accepted: April 15, 2014; Published: April 22, 2014|
|Citation: Eggleton P, Ukoumunne OC, Cottrell I, Khan A, Maqsood S, et al. (2014) Autoantibodies against C1q as a Diagnostic Measure of Lupus Nephritis: Systematic Review and Meta-analysis. J Clin Cell Immunol 5:210. doi:10.4172/2155-9899.1000210|
|Copyright: © 2014 Eggleton P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Objectives: To evaluate the diagnostic accuracy of C1q autoantibodies in identifying lupus nephritis (LN) in patients with systemic lupus erythematosus (SLE).
Data sources and methods: Citation indexes were searched and 370 articles published from 1977 to 2013 were evaluated. The 31 selected studies included in the meta-analysis were cross-sectional in design. Among the 31 studies, 28 compared anti-C1q antibodies in 2769 SLE patients including those with (n=1442) and without a history of LN (n=1327). Nine studies examined anti-C1q in 517 SLE patients with active (n=249) and inactive LN (n=268). Hierarchical summary receiver operating characteristic (HSROC) random effects models were fitted to pool estimates of accuracy across the studies.
Results: Anti-C1q antibodies discriminated between patients with and without a history of LN, with a median specificity of 73.5%. The HSROC model estimated the corresponding sensitivity to be 70.4%. A hypothetical patient with a 55% prior probability of having a history of LN as opposed to no history (the median prevalence across 28 eligible studies) would have a post-test probability of 76.4% following a positive test result (positive predictive value) or 33.0% following a negative test result (negative predictive value). For differentiating active from inactive LN the median specificity of anti-C1q antibodies was 80%, with a corresponding estimated sensitivity value 75.7% based on the HSROC model. A hypothetical patient with a 56% prior probability of active as opposed to inactive LN (the median prevalence across the 9 eligible studies) would have a post-test probability of 82.8% following a positive test result or 27.9% following a negative test result.
Conclusions: Although C1q antibodies are associated with lupus nephritis the post-test probabilities are not sufficiently convincing to provide reasonable certainty of the presence or absence of history of disease/active disease.