Age-specific Cut-off Values Research Articles

MPS 16-06 Validation of age-specific Korean cut-off values for echocardiographic left ventricular hypertrophy in a Korean rural population

Objective: For left ventricular hypertrophy (LVH), the genetic or ethnic difference in left ventricular response to hemodynamic and/or humoral stress is suggested. Recently, new cut-off values to diagnose LVH which are specific to age and sex categories. It is largely unknown how age and gender affect the prevalence of LVH in general population. Design and Method: For 2295 subjects living in rural area, Yangpyeong County, Gyunggi-do, South Korea, who do not taking antihypertensive medication were analyzed. Cut-off values to diagnose LVH by mean + 2SD were 97/89 g/m2 for 40 s, 101/100 g/m2 for 50 s, 104/105 g/m2 for 60 s, and 106/109 g/m2 for 70 s for male and female, respectively. Local sex specific criteria for LVH were 117/105 g/m2 for male and female, respectively. Results: Age was categorized as 192/252/33/178 (n = 959) in male and 363/358/429/186 (n = 1336) in female for 40 s/50 s/60 s/70 s, respectively. Systolic blood pressure (BP) and diastolic BP were 121.6 ± 16.9/77.7 ± 11.5mmHg and BMI was 24.2 ± 3.1 kg/m2. Hypertension was noticed in 19.5% and obesity was 39.5%. The prevalence of LVH were 47.9%/48.0%/38.5%/35.9% in male (p = 0.0135, p for trend = 0.0026) and 33.3%/24.0%/32.8%/31.7% in female for their 40 s/50 s/60 s/70 s (p = 0.02, p for trend = 0.79), respectively. By local criteria, LVH were noticed in 14.1%17.1%/15.7%/21.3% in male (p = 0.26) and 9.9%/14.8%/32.8%/39.2% in female (p < 0.0001, p for trend < 0.0001) for age categories. In multiple regression analyses, male(OR:1.605), eGFR(OR:1.020), hypertension(OR:2.125), and obesity(OR:1.551) were significant factors for LVH but age was not independent factors. These results were contrasted with the results by sex-specific criteria where age was independent factor for LVH. ORs for LVH were 1.576, 3.357, and 5.212 for their 50 s/60 s/70 s compared to 40 s. Conclusions: New age specific Korean cut-off values for LVH seems to be valid in adjusting the effect of age on the prevalence of LVH. And our study also suggests that the difference in the prevalence from LVH by locally determined criteria should be overcome by outcome driven criteria for LVH.

Lowest Acceptable Bladder Capacity for Interpretation of Uroflowmetry Tests in Children.

To determine the age-specific lowest acceptable value of bladder capacity (LABC) for interpretation of uroflowmetry tests in children. From September 2008 through July 2012, healthy children aged 4-9 years were enrolled. All children were asked to have two sets of uroflowmetry and post-void residual (PVR) tests. We selected the tests with lower bladder capacity (voided volume+ PVR) of each child to analyze the LABC. Only bell shaped curves were regarded as normal. PVR >20 mL and Qmax <15 mL/s in children aged 4-6 years, and PVR >10 mL, Qmax <15.0 mL/s in children aged 7-9 years were defined as abnormal, respectively. Receiver operative characteristic curves were used to determine the age-specific cut-off value of LABC. The upper boundary of optimal bladder capacity (OBC) for interpretation of uroflowmetry was defined at 115% expected bladder capacity, and LABC as lower boundary. Linear regression was used to establish the relationship between age and LABC. Totally, 930 children were eligible for analysis of LABC. Through ROC curve analysis and regression analysis, the best fitted age specific LABC defined though differentiating low Qmax is 52.08 mL + age in years × 4.78 mL. For simplicity, the proposed LABC is age in years × 5 + 50. Good reproducibility of normal flow pattern, Qmax and PVR in each child were observed in the uroflowmetry tests within OBC. Through the large scale study for uroflowmetry tests in children, we proposed the age-specific lowest acceptable bladder capacity for interpretation of uroflowmetry tests as age in years × 5 + 50 mL.

Age-Specific Cutoff Value for the Application of Percent Free Prostate-Specific Antigen (PSA) in Chinese Men with Serum PSA Levels of 4.0-10.0 ng/ml.

ObjectiveThe influence of age on the performance of percent free prostate-specific antigen (%fPSA) in diagnosing prostate cancer (PCa) in East Asians is controversial. We tested the diagnostic performance of %fPSA in a multi-center biopsy cohort in China and identified the proper age-specific cutoff values to avoid unnecessary biopsies.MethodsConsecutive patients with a prostate-specific antigen (PSA) level of 4.0–10.0 ng/ml or 10.1–20.0 ng/ml who underwent transrectal ultrasound-guided or transperineal prostate biopsy were enrolled from 22 Chinese medical centers from Jan 1, 2010 to Dec 31, 2013. The diagnostic accuracy of PSA and %fPSA was determined using the area under the receiver operating characteristic (ROC) curve (AUC). Age-specific cutoff values were calculated using ROC curve analysis.ResultsThe median %fPSA was much lower in younger patients compared with older patients with a PSA level of 4.0–10.0 ng/ml or 10.1–20.0 ng/ml. The AUC of %fPSA was higher than PSA only in older patients. In patients aged 50 to 59 years, %fPSA failed to improve the diagnosis compared with PSA in these two PSA ranges. Age-specific cutoff values were 24%, 27% and 32% for patients aged 60–69, 70–79 and ≥80 years, respectively, to reduce unnecessary biopsies in men with PSA levels of 4.0–10.0 ng/ml to detect 90% of all PCa.ConclusionsThe effectiveness of %fPSA is correlated with age in the Chinese population. Age-specific cutoff values would help avoid unnecessary biopsies in the Chinese population.

WITHDRAWN: The lowest acceptable bladder capacity for interpretation of uroflowmetry tests in children

Summary Introduction Under- or overdistended bladder is associated with impaired bladder emptying. Therefore, uroflowmerty of low bladder capacity is regarded as irrelevant for interpretation. However, is no general consensus with regard to the lowest acceptable value of bladder capacity (LABC) for interpretation of uroflowmetry in children. Objective The objective was to determine the age-specific lowest acceptable value of bladder capacity in children. Study design From September 2008 to July 2012, healthy children aged 4–9 years were enrolled for analysis. An uroflowmeter was placed in the toilets at each kindergarten or elementary school. All post-void residual urine (PVRs) was assessed within 5 minutes after voiding by suprapubic ultrasound, and estimated by the equation of height × width × depth × 0.52 mL. All children were asked to have two sets of uroflowmetry and PVR tests. Two pediatric urologists reviewed the uroflow patterns and classified the uroflow patterns as bell-shaped, intermittent, tower, plateau, and staccato-shaped. We selected tests of lower bladder capacity (voided volume + PVR) from each child to analyze the optimal cut-off value for defining the LABC. Only bell-shaped curves were regarded as normal. PVR > 20 mL and Q max 10 mL, Q max Q max and high PVR, receiver operative characteristic curves (ROC) were used to determine the age-specific cut-off value of LABC. The upper boundary of optimal bladder capacity for interpretation of uroflowmetry was defined at 115% expected bladder capacity (EBC, age in years × 30 + 30 mL), and LABC as the lower boundary. Linear regression was used to establish the relationship between age and LABC. Results In total, 930 children were eligible for analysis of LABC. Through ROC curve analysis and regression analysis, the best-fitted age-specific LABC defined by differentiating low Q max (A) and high PVR (B) is 52.08 mL + age in years × 4.78 and 85.79 mL + age in years × 7.64 mL, respectively. For simplicity, the proposed LABC- Q max (A) and LABC-PVR (B) is age in years × 5 + 50 (LABC- Q max ) and age in year × 7.5 + 85 mL (LABC-PVR), respectively. Better reproducibility of normal flow pattern, Q max and PVR in each child were observed in the uroflowmetry tests both performed below the 115% EBC and above the LABC- Q max . Therefore, we chose LABC- Q max as the preferred lowest acceptable bladder capacity for interpretation of uroflowmetry tests. Discussion The current study used a physiological approach to determine the lowest acceptable values of bladder capacity that urinary bladder can have adequate performance for normal flow pattern, good peak flow rate, and low PVR. Within the optimal bladder capacity (upper boundary as 115% expected bladder capacity and lower boundary as LABC- Q max ), the reproducibility of uroflowmetry tests is good which improved the reliability of uroflowmetry tests. Conclusions Through the large scale study for uroflowmetry tests in children, we proposed the age specific lowest acceptable bladder capacity for interpretation of uroflowmetry tests as age in years × 5 +50 mL.

Nutrition Intervention Program Improves Serum Lipid Profile of Obese Children in Select Schools from Chennai

Objective: The objective of this study was to devise an intervention program to improve body mass index (BMI) and serum lipid profile of obese school children in the age group of 10 to 15 years. Materials and Methods: The study comprised of a survey and pretest and posttest experimental design and was conducted over the course of a year. The total of 4289 children from 11 schools were screened for obesity based on age and gender specific cut-off values for BMI. Of the 193 children found to be obese, 49 children enrolled for the intervention program and were assigned to three specific groups using purposive sampling. Group I (Control), Group II (Nutrition Counseling) and Group III (Nutrition counseling and Exercise) comprised of 13, 19, and 17 children-at-risk, respectively. Descriptive analysis was used for assessing details regarding their dietary and physical activity pattern. Paired t-test was used to assess data pertaining to anthropometric measurements such as height, body weight, BMI, waist circumference and serum lipid parameters (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], very low-density lipoprotein cholesterol, ratio of TC/HDL-C and serum triglycerides). Results: Post intervention, BMI was found to be stable, and there was a significant increase (P < 0.01) in serum HDL-C levels and a significant decrease (P < 0.01) in the ratio of TC/HDL-C in Group III and a significant increase (P < 0.05) in serum HDL-C levels alone in Group II subjects. Conclusion: The intervention study highlights the maintenance of BMI and improvement in serum lipid parameters of children-at-risk who received periodic nutrition counseling.

Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy.

During the first trimester of pregnancy, thyroid-stimulating hormone (TSH) >2.5 mIU/L has been suggested as the universal criterion for subclinical hypothyroidism. However, TSH levels change continuously during pregnancy, even in the first trimester. Therefore the use of a fixed cut-off value for TSH may result in a different diagnosis rate of subclinical hypothyroidism according to gestational age. The objective of this study was to obtain the normal reference range of TSH during the first trimester in Korean gravida and to determine the diagnosis rate of subclinical hypothyroidism using the fixed cut-off value (TSH >2.5 mIU/L). The study population consisted of pregnant women who were measured for TSH during the first trimester of pregnancy (n=492) and nonpregnant women (n=984). Median concentration of TSH in pregnant women was lower than in non-pregnant women. There was a continuous decrease of median TSH concentration during the first trimester of pregnancy (median TSH concentration: 1.82 mIU/L for 3+0 to 6+6 weeks; 1.53 mIU/L for 7+0 to 7+6 weeks; and 1.05 mIU/L for 8+0 to 13+6 weeks). Using the fixed cut-off value of TSH >2.5 mIU/L, the diagnosis rate of subclinical hypothyroidism decreased significantly according to the gestational age (GA) at TSH (25% in 3+0 to 6+6 weeks, 13% in 7+0 to 7+6 weeks, and 9% for 8+0 to 13+6 weeks, P<0.001), whereas the diagnosis rate was 5% in all GA with the use of a GA-specific cut-off value (P=0.995). Therefore, GA-specific criteria might be more appropriate for the diagnosis of subclinical hypothyroidism.

Handgrip strength cutoff values for undernutrition screening at hospital admission.

There is increasing evidence showing that handgrip strength (HGS) is an indicator of nutrition status and a promising undernutrition screening tool. However, HGS cutoff values for inpatient undernutrition screening remain to be studied. The present study aims to define gender- and age-specific HGS cutoff values for undernutrition screening of hospitalized patients at admission. A cross-sectional study was conducted in a university hospital. Gender- and age-specific receiver operating characteristic curves were constructed to evaluate the performance of HGS for correctly screening undernourished patients on the basis of their classification by Patient-Generated Subjective Global Assessment. Sensitivity, specificity, areas under the curves (AUCs) and positive likelihood ratios (LRs) were calculated. The study sample was composed of 712 participants between the ages of 18 and 91 years old, median (interquartile range) of 58 (22) years. For women, HGS cutoff values, sensitivities and specificities were as follows: 18-44 years, 20.2 kgf, 0.741 and 0.556; 45-64 years, 19.2 kgf, 0.795 and 0.522. For men, these values were as follows: 18-44 years, 41.7 kgf, 0.923 and 0.520; 45-64 years, 37.9 kgf, 0.817 and 0.402; ⩾65 years, 30.2 kgf, 0.736 and 0.567. The AUCs varied between 0.642 and 0.778 and LRs from 1.37 to 1.92. This study provides HGS cutoff values for men aged 18-91 years and for women aged 18-64 years.

Diagnostic value of Alzheimer’s disease-related individual structural volume measurements using IBASPM

We validated the use of medial temporal volume measurements via the automated volumetric method of Individual Brain Atlases using Statistical Parametric Mapping (IBASPM) in screening for Alzheimer’s disease (AD). We also determined the optimal cut-off values for hippocampal volumes. This study included T1-weighted MRI of 89 patients with AD and 33 normal controls. To determine age-specific cut-off values we grouped subjects according to age. The regional structural volumes of each group were measured using individual atlas-based volumetry with IBASPM. The normalized value of left hippocampal volume in patients with AD was significantly lower than that of normal controls in all age groups. The area under the curve values of the left hippocampus in receiver operating characteristic curves were also the largest in the medial temporal lobe, indicating that left hippocampal volume is the most useful factor in AD screening. The optimal cut-off values of the left hippocampus for diagnosing AD were 4.06 in the 60–64year age group, 4.05 in the 65–69 group, 4.07 in the 70–74 group and 3.63 in patients older than 75. Measurements of left hippocampal volume using the IBASPM may be useful for AD screening in clinical practice, and could provide a useful biomarker for AD.

Prevalence of Abdominal Obesity in Spanish Children and Adolescents. Do We Need Waist Circumference Measurements in Pediatric Practice?

BackgroundEvidence indicates that central adiposity has increased to a higher degree than general adiposity in children and adolescents in recent decades. However, waist circumference is not a routine measurement in clinical practice.ObjectiveThis study aimed to determine the prevalence of abdominal obesity based on waist circumferences (WC) and waist to height ratio (WHtR) in Spanish children and adolescents aged 6 to 17 years. Further, the prevalence of abdominal obesity (AO) among normal and overweight individuals was analyzed.DesignData were obtained from a study conducted from 1998 to 2000 in a representative national sample of 1521 children and adolescents aged 6 to 17 years (50.0% female) in Spain. WC and WHtR measurements were obtained in addition to BMI. AO was defined as WHtR ≥0.50 (WHtR-AO), sex and age specific WC≥90th percentile (WC-AO1), and sex and age specific WC cut-off values associated with high trunk fat measured by by dual-energy X-ray absorptiometry (WC-AO2).ResultsIOTF- based overweight and obsity prevalence was 21.5% and 6.6% in children and 17.4% and 5.2% in adolescents, respectively. Abdominal obesity (AO) was defined as WHtR≥0.50 (WHtR-AO), sex- and age-specific WC≥90th percentile (WC-AO1), and sex- and age-specific WC cut-off values associated with high trunk fat measured by dual-energy X-ray absorptiometry (WC-AO2). The respective prevalence of WHtR-AO, WC-AO1, and WC-AO2 was 21.3% (24.6% boys; 17.9% girls), 9.4% (9.1% boys; 9.7% girls), and 26.8% (30.6% boys;22.9% girls) in children and 14.3% (20.0% boys; 8.7% girls), 9.6% (9.8% boys; 9.5% girls), and 21.1% (28.8% boys; 13.7% girls) in adolescents.ConclusionThe prevalence of AO in Spanish children and adolescents is of concern. The high proportion of AO observed in young patients who are normal weight or overweight indicates a need to include waist circumference measurements in routine clinical practice.

Age‐Specific 99th Percentile Cutoff of High‐Sensitivity Cardiac Troponin T for Early Prediction of Non‐ST‐Segment Elevation Myocardial Infarction (NSTEMI) in Middle‐Aged Patients

High-sensitivity cardiac troponin T (hs-cTnT) assay is used in the diagnosis and risk assessment of patients with symptoms of myocardial infarction. This study was undertaken to establish an age-specific 99th percentile cutoff value for hs-cTnT in Chinese population, and to evaluate its potential for early prediction of non-ST-segment elevation myocardial infarction (NSTEMI) in middle-aged patients. Troponin T levels in blood obtained from healthy Chinese adults were assayed using hs-cTnT. The distribution was plotted and 99th percentiles were determined by nonparametric statistics. Prediction performance at the conventional cutoff (14 ng/L) recommended by the Roche company was compared with the age-specific cutoff for NSTEMI in 100 middle-aged patients (40-60 years of age) with acute chest pain. The 99th percentile for hs-cTnT was 14 ng/L for patients ≥60 years of age and 11 ng/L for those <60. Fifty of the 100 patients were finally diagnosed with NSTEMI. The age-specific 99th percentile cutoff value of 11 ng/L identified a higher number of patients with NSTEMI than the conventional 14 ng/L cutoff (46 vs. 40 patients), although the difference was not statistically significant (P = 0.084). In addition, the sensitivity of hs-cTnT increased from 80 to 92% and the negative predictive values increased from 82.4 to 91.8%. Using 11 ng/L as a decision-making cutoff point for hs-cTnT facilitated earlier prediction of NSTEMI in middle-aged patients than the conventional 14 ng/L cutoff. Further studies are needed to confirm this finding in larger group of patients.

The Utility of Carotid Ultrasonography in Identifying Severe Coronary Artery Disease in Asymptomatic Type 2 Diabetic Patients Without History of Coronary Artery Disease

OBJECTIVEAlthough many studies have shown that carotid intima-media thickness (IMT) is associated with coronary artery disease (CAD), it remains inconclusive whether assessment of carotid IMT is useful as a screening test for asymptomatic but severe CAD in diabetic patients.RESEARCH DESIGN AND METHODSA total of 333 asymptomatic type 2 diabetic patients without history of CAD underwent exercise electrocardiogram or myocardial perfusion scintigraphy for detection of silent myocardial ischemia, and those whose test results were positive were subjected to coronary computed tomography angiography or coronary angiography. The ability of carotid IMT to identify severe CAD corresponding to treatment with revascularization was examined by receiver-operating characteristic (ROC) curve analyses.RESULTSAmong the 333 subjects, 17 were treated with revascularization. A multiple logistic regression analysis showed that maximum IMT was an independent predictor of severe CAD even after adjustment for conventional risk factors. ROC curve analyses revealed that the addition of maximum IMT to conventional risk factors significantly improved the prediction ability for severe CAD (from area under the curve, 0.67 to 0.79; P = 0.039). The greatest sensitivity and specificity were obtained when the cut-off value of maximum IMT was set at 2.45 mm (pretest probability, 5%; posttest probability, 11%; sensitivity, 71%). When we applied age-specific cut-off values, the sensitivity of screening further increased in both the nonelderly (pretest probability, 6%; posttest probability, 10%; sensitivity, 100%) and the elderly subjects (pretest probability, 5%; posttest probability, 15%; sensitivity, 100%).CONCLUSIONSOur study suggests that carotid maximum IMT is useful for screening asymptomatic type 2 diabetic patients with severe CAD equivalent to revascularization.

Double burden of undernutrition and obesity in Palestinian schoolchildren: a cross-sectional study

Background Previous studies of nutrition were undertaken in adolescent schoolchildren in the West Bank or Gaza Strip, occupied Palestinian territory; most of the children were selected from only a few geographical areas. We assessed factors associated with stunting (height-for-age standardised scores Methods We surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and Palestinian Government. Using UNRWA's and the government's lists, we selected 1500 students from those attending school at the time the study was undertaken. We selected a set number of students per class from the first (mean age 6·71 years [SD 0·45]), sixth (11·82 years [0·57]), and ninth grades (14·83 years [0·61]), with a 1:1 ratio of boys to girls. The number of classes in each grade was between one and five. Siblings were excluded; we selected one student per household. We stratified the lists of students attending the UNRWA and government schools by location and sex. Within each school, 42 students per grade were selected using random sampling and recruited to the study—eg, if there were two classes A and B, we randomly selected 21 students from the alphabetical list for each class. BMI was defined according to age-specific and sex-specific cutoff values reported as per the 2000 growth charts of the Centers for Disease Control and Prevention, Atlanta, GA, USA, and height and weight measures as per WHO standards. Columbia University's Institutional Review Board, New York, NY, USA, approved the study protocol in December, 2008. Written informed consent and assent were obtained from sixth and ninth grade students and their parents. Findings Data were obtained from 1484 (99%) of 1500 students. Prevalence of stunting was 97 (7%) of 1446 and underweight 94 (7%) of 1444 students. 180 (12%) of 1444 students were overweight and 86 (6%) obese. There were non-significant differences in stunting (52 [7%] of 772 vs 45 [7%] of 674; difference 0·98, 95% CI 0·67–1·44; p=0·96), underweight (25 [3%] of 771 vs 24 [4%] of 673; 0·92, 0·52–1·58; p=0·73), and overweight (99 [13%] vs 81 [12%]; 1·07, 0·81–1·40; p=0·64) between the children in government and UNRWA schools. Obesity was more prevalent in UNRWA schools than in government schools (56 [7%] vs 30 [4%]; 1·63, 1·06–2·51; p=0·0246). The hunger index, which is a composite score from the eight questions on the food insecurity questionnaire, was negatively associated with height for age (p=0·018). Factors associated with underweight were male sex (odds ratio 2·8, 1·5–5·3; p=0·002), mother being unemployed (3·0, 1·0–8·4; p=0·04), and households not having enough food to eat for at least 2 days in the past month (1·8, 1·0–3·3; p=0·05). Factors associated with obesity were age, with children in the ninth grade more likely to be obese (1·1, 1·02–1·2; p=0·01) than were younger children, and time spent watching television (1·1, 1·0–1·3; p=0·014). When overweight and obesity were combined in the analysis, they were significantly and inversely associated with increasing number of days spent playing sports (0·87, 0·77–0·98; p=0·02). Interpretation By contrast with the results of previous studies, our data do not suggest an association between birth order, birthweight, size of the household, maternal education, and the child's nutritional status. Our results show the need to target food insecurity and improve child health in the occupied Palestinian territory, partly through increased awareness and promotion of sustainable healthy lifestyle changes for the prevention and management of undernutrition and obesity. The dissemination of information about the social, emotional, and cognitive effects of regular physical activity should be integral to health and nutrition programmes. We need to focus simultaneously on food insecurity and the establishment of a simple and reliable system for the detection of malnutrition; and we need to implement programmes related to the negative effects of adverse lifestyles. Funding UNRWA, UNICEF, Juzoor for Health and Social Development, Institute of Human Nutrition, Columbia University, and Flagship Project.

Visceral Fat Area Cutoff for the Detection of Multiple Risk Factors of Metabolic Syndrome in Japanese: The Hitachi Health Study

The relationships between metabolic risk factors and abdominal fat distribution determined using computed tomography (CT) are poorly defined in large populations. We investigated the cutoff values of the visceral fat area (VFA) to detect subjects with multiple risk factors of metabolic syndrome (MS) by sex and age groups, and attempted to examine whether sex- and age-specific cutoff values are needed. The subjects of this study were 11,561 Japanese men and women who participated in the Hitachi Health Study, received CT examination, and answered questionnaires on lifestyles between 2004 and 2009. VFA and waist circumference were measured using CT. The VFA cutoff values yielding an 80% sensitivity for the detection of multiple risk factors of MS were typically smaller among men under the age of 40 years (<40 years vs. ≥40 years; 86.4 cm(2) vs. 103.9 cm(2)). The area under the receiver operator characteristic curve of VFA for the detection tended to decrease according to age (P = 0.056 and P = 0.020 for trends in men and women). Age- and sex-specific cutoff values are needed. The sensitivity of the subjects under the age of 40 years is relatively smaller (70.0% for men and 60.0% for women) compare to other age groups when the same cutoff value is used regardless of age (e.g., cutoff value calculated to correspond to 80% sensitivity for subjects of all ages). Therefore, a smaller VFA cutoff point should be used among men under the age of 40 years.

Incidental Findings in Focused Assessment With Sonography for Trauma in Hemodynamically Stable Blunt Trauma Patients: Speaking About Cost to Benefit

The purpose of this study was to identify which age-related groups of hemodynamically stable blunt trauma patients will present a positive cost-to-benefit ratio, in regard to the screening of incidental findings on Focused Assessment with Sonography for Trauma (FAST). We conducted a prospective study using retrospective data taken from the trauma registry of 6,041 consecutive hemodynamically stable blunt trauma patients who underwent FAST at our Level I urban trauma hospital during the year 2009. A receiver operating characteristic curve was used to determine whether age level is useful in detecting organ-/system-specific incidental findings in trauma patients undergoing FAST and to establish the required diagnostic cutoff value of this selected test. A cost-benefit analysis was then performed for the age-specific cutoff values of each organ/system evaluated by FAST. We found 522 incidental findings in 468 patients (7.8%). Further diagnostic workup was instructed in 35% (168 of 468) of patients with incidental findings. The cost-benefit analysis for the age-specific cutoff values found in the receiver operating characteristic curve analysis showed that the project of screening for incidental findings on FAST was viable only when the ultrasound operator additionally searches the liver/biliary tree (≥43 years) and the kidneys (≥56 years). A systematic examination of the liver and biliary tree and both kidneys of specific age groups during FAST screening of hemodynamically stable blunt trauma patients may disclose a potentially unknown pathology with a positive cost-to-benefit ratio.

Age and gender specific cut-off values to improve the performance of d-dimer assays to predict the risk of venous thromboembolism recurrence

The Prolong study shows that continuing vitamin K antagonists (VKA) in patients with abnormal D-dimer (evaluated by a qualitative assay, Clearview Simplify D-dimer) results in a significant reduction of venous thromboembolism (VTE) recurrence. The present study retrospectively analyzes a subgroup of patients enrolled in the Prolong study with a view to calculate cut-off values for six quantitative D-dimer methods to predict the risk of VTE recurrence. We measured D-dimer levels by VIDAS D-dimer Exclusion (bioMerieux), STA Liatest D-dimer (DiagnosticaStago), HemosIL D-dimer and HemosIL D-dimer HS (Instrumentation Laboratory), Innovance D-dimer (Siemens) and AutoDimer (Trinity Biotech) in frozen plasma aliquots sampled 30±10days after VKA cessation in 390 patients enrolled in the Prolong study. During follow-up (562.7years), 28 patients had recurrent VTE (7.2%, 5.0% person-years). Since D-dimer levels are positively correlated with age and significantly lower in men, we calculated method-specific cut-off values according to age and gender. The HRs for VTE recurrence calculated using method-specific cut-off values based on age and gender are higher than those using cut-off values indicated by the manufacturers for VTE exclusion in symptomatic outpatients. These data suggest that method-specific cut-off values calculated according to patient age and gender can be more accurate in identifying patients at a higher risk for VTE recurrence. These method-specific cut-off values are being evaluated in the ongoing prospective management multicenter DULCIS study.

Lack of Accuracy for the Proposed ‘Dubois Criteria’ in Alzheimer’s Disease: A Validation Study from the Swedish Brain Power Initiative

Background/Aims: Our purpose was to investigate whether the new research criteria for Alzheimer’s disease proposed in 2007 by Dubois et al. are valid in a naturalistic memory clinic sample. Method: Retrospective diagnostic analyses were carried out to compare the traditional diagnostic criteria for dementia with the new criteria suggested by Dubois et al. No patient had gone through all procedures postulated as additional features in the proposed new Dubois criteria. Material: Two independent experienced geriatricians re-examined 150 complete patients’ records. The study physicians were blinded to any of the results of the core and additional features suggested by Dubois et al. to avoid circular diagnostic bias. Results:Among our 96 patients with a clinical diagnosis of subjective cognitive impairment and/or mild cognitive impairment, 2 of the patients with subjective cognitive impairment and 5 patients with mild cognitive impairment would classify as pre-dementia Alzheimer’s disease according to the Dubois criteria. In our 23 Alzheimer patients diagnosed clinically, only 12 of the cases fulfilled the criteria for Alzheimer’s disease suggested by Dubois et al. Interpretation: The proposed new criteria for Alzheimer’s disease are valid in 55% of our patients clinically diagnosed as having full-blown Alzheimer dementia. Additionally, 7.3% ‘true’ Alzheimer cases will be identified in a group of 96 clinically non-demented patients. Our results show that there is a large heterogeneity in a clinical naturalistic sample of patients with an Alzheimer phenotype. Conclusion: There is a need to further validate the currently existing biomarkers in large unselected samples and avoid the pitfall of workup bias and circular diagnostic processes. Additionally, valid age-specific cut-off values for the diagnostic markers in question have to be defined.

Challenges for the present CKD classification system

In 2002 the Kidney Disease Outcomes Quality Initiative (K/DOQI) organization published a guideline on chronic kidney disease (CKD), which contained a classification system for CKD severity, independent of cause. This classification system was immediately widely embraced. However, soon after its introduction concerns were expressed. In this review we discuss the major points of concern that have been brought forward. Although the reliability of the Modification of Diet in Renal Disease study estimation equation for glomerular filtration rate (GFR) is disputed, it is useful for the vast majority of individuals. In cases of abnormal muscular build, however, other GFR estimations should be used. Cystatin C-based equations are promising in that respect. On the basis of recent literature we propose that the present CKD classification scheme should be adapted insofar that stage 3 CKD should be split into two, and that information on albuminuria should be added to all CKD classes. Individuals with an estimated GFR between 45 and 60 ml/min/1.73 m2 and without microalbuminuria or macroalbuminuria are in general not at risk for renal or cardiovascular disease progression and should not be labelled as having CKD. In our opinion there is no strong rationale to introduce age-specific cut-off values indicating CKD. These recent epidemiological findings will hopefully form a basis for an adaptation of the present CKD classification system that will meet broad acceptance again.

Non-invasive liver elastography (Fibroscan) for detection of cystic fibrosis-associated liver disease

Background Cystic fibrosis-associated liver disease (CFLD) is the second cause of mortality in CF. The prevalence is estimated to be 26–45%, but sensitive diagnostic tools are lacking. We investigated whether non-invasive liver elastography (Fibroscan) could serve as a screening tool. Methods Fibroscan measurements were performed in 66 CF patients. Age-specific cutoff values were determined in a control population ( n = 59). The measurements were compared to clinical data, biyearly biochemistry and ultrasound. Results Fibroscan was easy to perform in this patient population. There were 14 patients (21%) with abnormal liver stiffness measurements. Liver stiffness was significantly increased in patients with clinical CFLD (11.2 kPa versus 5.1 kPa), biochemical CFLD (7.4 kPa versus 5.4 kPa) or ultrasonographical CFLD (8.2 versus 4.3 kPa) ( p < 0.02 for all). Conclusions Fibroscan is an objective measure and is easy to perform in CF patients, even in children and could provide a valuable tool to detect, and quantify CFLD.

O.037 On-line evaluation of the CSF compensatory parameters during constant rate infusion test

Assessment of ventricular enlargement is subjective and based on the radiologist’s experience. Linear indices, such as the Evans Index (EI), have been proposed as markers of ventricular volume with an EI ≥ 0.3 indicating pathologic ventricular enlargement in any subject. However, normal range for EI measured on magnetic resonance imaging (MRI) scans are lacking in healthy elderly according to age and sex. We propose new age and sex specific cut-off values for ventricular enlargement in the elderly population.534 participants (53% women) aged 65–84 years; 226 patients with Alzheimer’s disease (AD), and 308 healthy elderly controls (CTR) from the AddNeuroMed and ADNI studies were included. The cut-off for pathological ventricular enlargement was estimated from healthy elderly categorized into age groups of 5 years range and defined as EI 97,5 percentile (mean + 2SD). Cut-off values were tested on patients with Alzheimer’s disease and a small sample of patients with probable idiopathic normal pressure hydrocephalus (iNPH) to assess the sensitivity.The range of the EI in healthy elderly is wide and 29% of the CTR had an EI of 0.3 or greater. The EI increases with age in both CTR and AD, and the overall EI for women were lower than for men (p < 0.001). New EI cut off values for male/female: 65–69 years 0.34/0.32, 70–74 years 0.36/0.33, 75–79 years 0.37/0.34 and 80–84 years 0.37/0.36. When applying the proposed cut-offs for EI in men and women aged 65–84, they differentiated between iNPH and CTR with a sensitivity of 80% and for different age and sex categories of AD and CTR with a sensitivity and specificity of 0–27% and 91–98%, respectively.The range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.

Prevalence of Childhood Obesity in Hong Kong: Comparison Between IOTF and Weight-height Cut-off Standards

Objective: To compare the prevalence of childhood obesity in Hong Kong (HK) 2006 by using two different criteria: the International Obesity Taskforce (IOTF) body mass index (BMI) cut off, and local weight-for-height reference (obesity = 120%tile weight-for-height). Method: 29,731 children aged 6-18 years participated in cross-sectional fitness surveys from 2001-2006 using stratified random sampling procedure. Body height and weight were measured by certified fitness instructors. Prevalence of obesity was analyzed using the IOTF (2000) BMI cut-off values and compared with those obtained using the local weigh-height reference values. For the IOTF criteria, age-specific BMI cut-off values for children were extrapolated from adult's BMI cut off points of 25 and 30 kg/m2 for overweight and obesity (Cole, 2000). Whereas for the local standard, those having weight above 20% of the median weight-for-height using 1993 reference values were defined as obese (Leung, 1996). RESULTS: Using local reference, prevalence of childhood obesity in HK 2006 were 22.67% and 16.88% for boys and girls, respectively. When IOTF cut off for obesity were used, the prevalence for boys and girls were 6.33% and 3.08% respectively, which were far below than those obtained from the local reference. However, when IOTF cut off for overweight were used, the prevalence of overweight children was similar to the figures of obesity using local reference. When age and gender specific figures were analyzed, prevalence of obesity using local reference were much higher than that using IOTF cut off for overweight for boys age 16 and above and girls 15 and above. CONCLUSION: IOTF cut off values were extrapolated from adult BMI cutoff of 25 and 30 for overweight and obesity, but not 23 and 25 which were suggested for Asian countries by World Health Organization (2000). Centile curves which drawn from BMI cut off point of 23 and 25 may be more applicable for Asian children. However, discrepancy existed at age after 16 and 15 for boys and girls, respectively. Further effort is needed to explore more appropriate definition of childhood overweight and obesity. It is also suggested to develop relationship between BMI and body fat percentage, morbidity and mortality, so as to provide further insights for determining definitions of obesity.