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Clinical science
Clinical predictive factors for diagnosis of MOG-IgG and AQP4-IgG related paediatric optic neuritis: a Chinese cohort study
  1. Mo Yang1,2,
  2. Yiqun Wu3,
  3. Mengying Lai1,4,
  4. Honglu Song1,5,
  5. Hongen Li1,
  6. Mingming Sun1,
  7. Lindan Xie1,
  8. Huanfen Zhou1,
  9. Quangang Xu1,
  10. Shihui Wei1,
  11. Weiping Wu2
  1. 1 Department of Ophthalmology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
  2. 2 Department of Neurology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
  3. 3 Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
  4. 4 Shantou University Medical College, Shantou, China
  5. 5 Department of Ophthalmology, Bethune International Peace Hospital, Shijiazhuang, China
  1. Correspondence to Weiping Wu, Department of Neurology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China; wuwp{at}vip.sina.com and
  2. Shihui Wei, Department of Ophthalmology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China; weishihui706{at}hotmail.com

Abstract

Background Different glial-autoantibodies-related paediatric optic neuritis (ON) are associated with different clinical characteristics and prognosis that require different treatments. Because glial autoantibody detection is not available in some parts of the world and there is often a delay in obtaining results, clinical factors that can be used to predict the subtype of paediatric ON are needed.

Methods This was a single-centre retrospective cohort study. Children who presented with their first ON attack and with complete clinical data were included in the analysis. Single and multiple parameters for predicting paediatric myelin oligodendrocyte glycoprotein immunoglobin-associated ON (MOG-ON) and aquaporin-4 immunoglobin-related ON (AQP4-ON) were calculated.

Results 78 paediatric patients had their first ON attack from January 2016 to December 2019, of whom 69 were included in the final analysis, including 33 MOG-ON cases, 17 AQP4-ON cases and 19 Seronegative-ON cases. For predicting paediatric MOG-ON, the most sensitive predictors were ‘male or optic disc swelling (ODS) or bilateral’ (sensitivity 0.97 (95% CI 0.82 to 1.00)) and ‘follow-up visual acuity (VA) ≤0.1 logMAR or ODS’ (sensitivity 0.97 (95% CI 0.82 to 1.00)), and the most specific factor was ‘Age ≤11 y and simultaneous CNS involvement’ (specificity 0.97 (95% CI 0.84 to 1.00)). For predicting paediatric AQP4-ON, the most sensitive predictor was ‘Female or without ODS’ (sensitivity 1.00 (95% CI 0.77 to 1.00)), and the most specific factors were Neurological history (sensitivity 0.94 (95% CI 0.83 to 0.98)) and follow-up VA >1.0 logMAR (sensitivity 0.96 (95% CI 0.86 to 0.99)).

Conclusion According to our data from a Chinese paediatric cohort, using multiple parameters increases the sensitivity and specificity of diagnosing paediatric MOG-ON and AQP4-ON. These can assist clinicians in diagnosing and treating paediatric ON when glial autoantibody status is not available.

  • Child health (paediatrics)
  • Optic Nerve
  • Diagnostic tests/Investigation

https://doi.org/10.1136/bjophthalmol-2020-317524

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    Footnotes

    • MY, YW and ML are contributed equally.

    • Contributors MY, YW and ML are co-first authors and contributed equally. The study was designed and conducted by MY, HS, SW and WW. Collection of the data was performed by ML. Analysis, management and interpretation of the data was performed by YW. The manuscript was prepared by MY, YW and ML. Critical revision of the manuscript was performed by HL, LX, MS, HZ and QX.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The institutional review board at the Chinese People’s Liberation Army General Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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