{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:56:59Z","timestamp":1783997819420,"version":"3.55.0"},"reference-count":16,"publisher":"Walter de Gruyter GmbH","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2020-1286_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The value of the serum protein gap (PG, difference between total protein and albumin) in the detection of hyper- or hypogammaglobulinemia is not well established. We assessed the performance of PG for the detection of hyper- or hypogammaglobulinemia in a large sample of patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-1286_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We reviewed all paired measurements of serum total protein, albumin, quantitative immunoglobulins, and serum protein electrophoresis tested between March 2014 and June 2017 at the Eastern Ontario Regional Laboratory Association. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios of PG at thresholds between 18 and 44\u00a0g\/L for the detection of hyper- and hypogammaglobulinemia were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-1286_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 19,575 and 5,426 simultaneous paired data points to assess hyper- and hypogammaglobulinemia identified by serum protein electrophoresis (SPE) and nephelometry, respectively. The mean PG was 36.3\u00a0g\/L (SD 8.6). The prevalence of hypergammaglobulinemia (&gt;16\u00a0g\/L by SPE) and hypogammaglobulinemia (IgG &lt;7\u00a0g\/L) was 21.9 and 5.5%, respectively. High PG (\u226538\u00a0g\/L) had sensitivity and specificity of 76.2 and 71.5% respectively for hypergammaglobulinemia. PG\u00a0\u226538\u00a0g\/L had a negative predictive value (NPV) of 93.1% for monoclonal, and 96.9% for polyclonal gammopathy. A PG threshold of\u00a0\u226418\u00a0g\/L had of sensitivity of 0.4%, specificity of 100%, PPV of 100% and\u00a0NPV of 80.1% to detect hypogammaglobulinemia (IgG\u00a0&lt;7\u00a0g\/L).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2020-1286_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>High and low PG values were not sensitive in detecting hyper- or hypogammaglobulinemia, although negative predictive values were high for both. Performance of PG should be further evaluated prospectively in specific populations at risk of for abnormal IgG levels.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2020-1286","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T21:13:43Z","timestamp":1606770823000},"page":"869-874","source":"Crossref","is-referenced-by-count":4,"title":["Evaluation of the protein gap for detection of abnormal serum gammaglobulin level: an imperfect predictor"],"prefix":"10.1515","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2585-1982","authenticated-orcid":false,"given":"Adam","family":"Suleman","sequence":"first","affiliation":[{"name":"Faculty of Medicine , University of Toronto , Ottawa , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. William","family":"Cameron","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program , The Ottawa Hospital Research Institute , Ottawa , Canada"},{"name":"Department of Medicine , Division of Infectious Diseases, University of Ottawa , Ottawa , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Corrales-Medina","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program , The Ottawa Hospital Research Institute , Ottawa , Canada"},{"name":"Department of Medicine , Division of Infectious Diseases, University of Ottawa , Ottawa , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"McCudden","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine , The Eastern Ontario Laboratory Association (EORLA), University of Ottawa , Ottawa , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6648-5109","authenticated-orcid":false,"given":"Juthaporn","family":"Cowan","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program , The Ottawa Hospital Research Institute , Ottawa , Canada"},{"name":"Department of Medicine , Division of Infectious Diseases, University of Ottawa , Ottawa , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"key":"2023033113430156720_j_cclm-2020-1286_ref_001","doi-asserted-by":"crossref","unstructured":"Jolles, S, Borrell, R, Zouwail, S, Heaps, A, Sharp, H, Moody, M, et al.. 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