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Cerebrospinal fluid CD4 + /CD8 + ratio in diagnosing neurosarcoidosis
Author(s) -
Nordström Sara,
Andersson Bengt,
Malmeström Clas
Publication year - 2020
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13297
Subject(s) - neurosarcoidosis , cerebrospinal fluid , sarcoidosis , pleocytosis , medicine , bronchoalveolar lavage , cd4 cd8 ratio , differential diagnosis , cd8 , gastroenterology , likelihood ratios in diagnostic testing , pathology , confidence interval , immunology , lung , lymphocyte subsets , antigen
Objective Neurosarcoidosis affects 5%‐10% of patients with sarcoidosis. CD4 + /CD8 + ratio in bronchoalveolar lavage is included in diagnostic routine for pulmonary sarcoidosis. Previously, it has been suggested that a cerebrospinal fluid CD4 + /CD8 + ratio ≥5 can be an aid in diagnosing neurosarcoidosis. Materials and Methods This study included 66 cases where neurosarcoidosis was a differential diagnosis and hence subjected to the analysis of CSF CD4 + /CD8 + ratio by flow cytometry. Results Eleven cases of neurosarcoidosis, had a significantly higher median CSF CD4 + /CD8 + ratio than the other group, P = .024. The median CSF CD4 + /CD8 + ratio was 4.2, hence not reaching the suggested level of ≥5 for diagnosing neurosarcoidosis. When combined, the elevated CSF CD4 + /CD8 + ratio ≥5 and an elevated CSF lymphocyte count (>3 lymphocytes/uL) gave a positive predictive value of 57% and a high negative predictive value of 88%, with a specificity of 95% for neurosarcoidosis. Conclusion The study confirms that increased CSF CD4 + /CD8 + ratio is associated with neurosarcoidosis but cannot alone distinguish the conditions from other neurological diagnoses. However, a ratio below <5 combined with an absence of pleocytosis in CSF yields a negative predictive value (NPV) of 88% suggesting a role for the analysis in differential diagnosing neuroinflammatory conditions.