Operating Characteristics Curve Analysis Research Articles

Single-item depression screening with the Neurobehavioral Symptom Inventory (NSI): Do scores assist clinicians with predicting need for mental health interventions?

The purpose of this study was to examine the relationship between a single item for depression from the Neurobehavioral Symptom Inventory (NSI) and a common depression screening measure to predict need for further mental health consultation for veterans with traumatic brain injury (TBI). Three hundred eighty veterans referred to a Veterans Affairs Health Care System TBI clinic for evaluation were administered the NSI and a common depression screening measure (Beck Depression Inventory-Second Edition; BDI-II). Receiver Operating Characteristic (ROC) curve analyses were conducted to determine best cutoff scores on the BDI-II corresponding with a single item of the NSI item pertaining to depression (i.e., "depressed or sad"). Using multiclass ROC curve analyses, results suggested that a minimum score of 3 (severe) on the specific NSI item indicated need for further mental health referral without warranting additional screening for depression. Analyses further demonstrated that removal of invalid NSI protocols did not significantly change ROC curve findings. Therefore, the NSI item for depression can still be used for making clinical decisions despite the protocol being considered otherwise invalid. Implications for treatment and recommendations for screening are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparison of efavirenz levels in blood and hair with pharmacy refills as measures of adherence and predictors of viral suppression among people living with HIV in Nigeria

BackgroundStrategies to support adherence are constrained by the lack of tools to objectively monitor medication intake in low-resource settings. Pharmacologic measures are objective, but pharmacy refill data is more accessible and cost-efficient. This study compared short-term and long-term efavirenz (EFV) drug levels with pharmacy refill adherence data (PRA) and evaluated their ability to predict viral suppression among people living with HIV in Nigeria.MethodsPaired hair and dried blood spot (DBS) samples were obtained from 91 adults living with HIV receiving 600 mg EFV-based antiretroviral therapy (ART) and EFV concentrations were measured via validated methods using liquid-chromatography-mass-spectrometry. PRA was estimated from pharmacy records, based on the number of days a patient collected medication before or after the scheduled pick-up date. PRA was categorized into ≤ 74%, 75–94% and ≥ 95%, defined as poor, medium and high adherence, respectively. HIV viral loads closest to the hair sampling time (within 6 months) were also abstracted. Receiver Operating Characteristics (ROC) curve analyses compared the ability of adherence metrics to predict viral suppression.ResultsBased on PRA, 81% of participants had high adherence while 11% and 8% had medium and poor adherence, respectively. The median (IQR) EFV concentrations were 6.85 ng/mg (4.56–10.93) for hair and 1495.6 ng/ml (1050.7–2365.8) for DBS. Of the three measures of adherence, hair EFV concentration had the highest Area Under Curve (AUC) to predict viral suppression. Correlations between EFV concentrations in DBS and hair with PRA were positive (r = 0.12, P = 0.27 and r = 0.21, P = 0.05, respectively) but not strong.ConclusionsEFV concentrations in hair were the strongest predictor of viral suppression and only weakly correlated with pharmacy refill adherence data in Nigeria. This study suggests that resource-limited settings may benefit from objective adherence metrics to monitor and support adherence.

Correlation of Biochemical Abnormalities with the Severity of Hospitalized Covid-19 Patients

Background: Coronavirus Disease-19 (COVID-19) has a global impact. The laboratory assessments in Covid-19 illness help in better understanding the disease pathophysiology useful in screening asymptomatic individuals to diagnosis, prognosis and monitoring the affected patients. The aim of the study:To observe the association between biochemical and inflammatory parameters among the hospitalised COVID-19 patients of different clinical severity. Materials and methods: This was a retrospective study carried out with the approval of the Institutional Ethics Committee. The study included patients over 18 years, hospitalised with COVID-19 infection, grouped into three severity groups, admitted to ward, high dependency unit or intensive care unit between May to September 2020. Data collection was carried out by manual perusal of inpatient case sheets, computerised patient data system and transcription database for discharge summaries. The biochemical and inflammatory markers like plasma glucose, renal function tests, serum electrolytes, liver function tests, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), d-dimer, ferritin, Lactate dehydrogenase (LDH) at the time of admission were collected. Data was expressed as mean and standard deviation or median and range. ANOVA test followed by post hoc (Tukey) test, Pearson correlation and Receiver Operating Characteristics (ROC) Curve analysis were performed. Results: Significant correlations were observed between the mild and moderate-severe illness groups with respect to fasting plasma glucose, blood urea nitrogen, creatinine, direct bilirubin, total protein, albumin, ferritin and LDH. The AUC was the highest for LDH at 0.64 followed by blood urea nitrogen to creatinine ratio at 0.62. Conclusion: High levels of renal function parameters were potential predictors of acute kidney injury among patients with COVID-19. Fasting plasma glucose, serum albumin, LDH, Blood urea nitrogen (BUN) and BUN-creatinine ratio are better indicators of the severity of the disease with multiorgan dysfunction.

Potential biomarkers of spinal dural arteriovenous fistula: C4BPA and C1QA

Background and purposeA major challenge in spinal dural arteriovenous fistula (SDAVF) is timely diagnosis, but no specific predictive biomarkers are known.MethodsIn the discovery cohort (case, n = 8 vs. control, n = 8), we used cerebrospinal fluid (CSF) and paired plasma samples to identify differentially expressed proteins by label-free quantitative proteomics. Further bioinformatics enrichment analyses were performed to screen target proteins. Finally, it was validated by ELISA in two of the new cohorts (case, n = 17 vs. control, n = 9), and univariate analysis, simple linear regression, and receiver operator characteristic (ROC) curve analysis were performed to evaluate the diagnostic potential.ResultsIn the discovery cohort, the most overexpressed proteins were APOB and C4BPA in CSF samples of patients. The GO/KEGG enrichment analysis indicated that the upregulated proteins were mainly involved in the acute inflammatory response and complement activation. Hub-gene analysis revealed that APP might be the key protein in the molecular interaction network. In the validation cohort, C4BPA and C1QA were significantly overexpressed in the CSF of patients, averaging 3046.9 ng/ml and 2167.2 ng/ml, respectively. Simple linear regression demonstrated that levels of C1QA and C4 were positively correlated with total protein in CSF (R2 = 0.8021, p = 0.0005; R2 = 0.7447, p = 0.0013). The areas under the ROC curves of C4BPA and C1QA were 0.86 and 1.00, respectively.ConclusionsThis study was the first to identify C4BPA and C1QA as potential biomarkers for the diagnosis of SDAVF and revealed that complement pathway activation might be one of the molecular mechanisms for venous hypertension myelopathy.

Application of ROC Curve Analysis for Predicting Students’ Passing Grade in a Course Based on Prerequisite Grades

Determining prerequisite requirements is vital for successful curriculum development and student on-schedule completion of the course of study. This study adapts the Receiver Operating Characteristic (ROC) curve analysis to determine a threshold grade in a prerequisite course necessary for passing the next course in a sequence. This method was tested on a dataset of Calculus 1 and Calculus 2 grades of 164 undergraduate students majoring in mathematics at a private university in Kazakhstan. The results showed that while the currently used practice of setting prerequisite grade requirements is accurately identifying successful completions of Calculus 2, the ROC method is more accurate in identifying possible failures in Calculus 2. The findings also indicate that prior completion of Calculus 1 is positively associated with success in a Calculus 2 course. Thus, this study contributes to the field of mathematics education by providing a new data-driven methodology for determining the optimal threshold grade for mathematics prerequisite courses.

Validation of the 33-Item Hypomania Checklist-External Assessment in Screening Adolescents for Bipolar Disorder.

BackgroundBipolar disorder (BD) is often misdiagnosed, leading to poor treatment outcomes. Thus, accurate assessment of BD is of great importance, including in BD adolescents. The aim of the study was to explore the psychometric properties of the 33-item Hypomania Checklist-External Assessment (HCL-33-EA) in depressed adolescents.MethodsThe study was conducted between March and November 2020 in Beijing, China. Depressed adolescents aged between 13 and 17 years (N = 260) with BD (N = 147) or major depressive disorder (MDD) (N = 113) diagnosed according to the International Classification of Diseases, Tenth Revision (ICD-10) were recruited. Patients’ hypomanic symptoms were assessed by their carers using the HCL-33-EA.ResultsThe HCL-33-EA showed high internal consistency (Cronbach’s alpha = 0.82) with two factorial dimensions. The Receiver Operating Characteristic (ROC) curve analysis revealed an area under the ROC curve (AUC) value of 0.61 (95% confidence interval (CI): 0.54–0.67). The optimal cut-off score of 7 generated the best combination of sensitivity (0.81) and specificity (0.37) for discriminating between adolescents with BD and MDD.ConclusionThe HCL-33-EA, with a two-factor structure, seems to be a useful tool for screening for BD in depressed adolescents. However, the high sensitivity and low specificity of the HCL-33-EA at the optimal cut-off value of 7 indicate that the HCL-33-EA needs to be further refined for young patients.

Association Between Circulating Regulator of Calcineurin 2 Concentrations With Overweight and Obesity

BackgroundRegulator of calcineurin 2 (RCAN2) has been reported to promote food intake and weight gain in animal studies. However, its effect on body weight in humans is unclear.ObjectiveThis study aimed to investigate the relationship between serum RCAN2 concentrations and participants with overweight/obesity.MethodsA cross-sectional study was performed in 872 Chinese adults, including 348 participants with normal weight (NW), 397 participants with overweight (OW), and 127 participants with obesity (OB). All participants were divided into NW, OW and OB groups according to their body mass index (BMI). Serum RCAN2 concentrations were determined by enzyme-linked immunosorbent assay.ResultsSerum RCAN2 concentrations gradually increased with the increase of BMI (p < 0.001). The percentages of OW/OB gradually increased in tandem with increasing tertiles of RCAN2 (p < 0.001). Additionally, serum RCAN2 concentrations were significantly correlated with a series of anthropometric and metabolic parameters, predominantly including body weight, BMI, SBP, DBP, total cholesterol, triglycerides, HDL-C, LDL-C (all p < 0.05). Furthermore, logistic regression analysis showed that the risk of OW/OB was significantly increased with the increase of serum RCAN2 concentrations. Receiver operation characteristic (ROC) curve analysis revealed that serum RCAN2, especially serum RCAN2/(AST/ALT) ratio, might serve as a candidate biomarker for obesity.ConclusionSerum RCAN2 concentrations were increased in subjects with OW/OB. The increased serum RCAN2 concentrations were associated with the increased risks of OW/OB.

Discovery of AMBRA1 and SQSTM1 (p62) as putative biomarkers to identify high risk subsets of patients with cutaneous squamous cell carcinoma.

e21541 Background: While surgical excision is largely curative, small subsets of patients with cSCC develop metastatic disease for which current AJCC/Brigham and Women’s Hospital staging criteria are unable to reliably identify. There is hence an unmet need for credible prognostic biomarkers to stratify patients based on personalised risk, guide the use of emerging therapeutic intervention for advanced disease and the rationalisation of current/future dermatological healthcare. AMBRA1 and SQSTM1 (p62) play a key role in autophagy and sustained keratinocyte differentiation; two vital processes disrupted in cSCC tumorigenesis, resulting in deregulated cell proliferation and autophagy-mediated tumour cell survival. While AMBRA1 expression is maintained in the normal epidermis its expression is lost in the tumour growth front of cSCCs. Conversely, p62 expression is maintained in basal keratinocytes within the normal epidermis but is lost in the peritumoural epidermis. Collectively these observations suggest tumoural AMBRA1 and peritumoural epidermal p62 expression as biomarkers of cSCC progression. The aim of the present study was to assess the immunohistochemical (IHC) expression of AMBRA1 and p62 in a retrospective cohort of localised or metastatic cSCCs and correlate expression with clinical outcome over 5 years. Methods: Automated IHC analysis of AMBRA1 and p62 expression was performed in a retrospective cohort of well, moderately or poorly differentiated non or metastatic cSCCs. Digital images were annotated prior to H-score expression analysis using optimised cytoplasmic algorithms within Aperio ImageScope software. Results: Receiving Operating Characteristic (ROC) curve analysis revealed an H score of &lt; 20 for peritumoural epidermal p62 and &lt; 60 for expression of AMBRA1 in the cSCC growth front defined cSCCs at high risk of progression while tumours with a p62 H score of ≥ 20 and/or ≥ 60 for AMBRA1 were defined as low risk. Subsequent Kaplan Meier analysis of 51 moderately/poorly differentiated cSCCs demonstrated loss of peritumoural p62 and tumour AMBRA1 expression in 7 tumours correlated with a significantly increased risk of metastasis of 85.7 % compared to 25% for 44 tumours defined as low risk (P &lt; 0.0001, HR 30.07, 95% CI 5.48-165) with an assay specificity of 97%, positive predictive value of 75%, and a negative predictive value of 86%. Conclusions: Overall these data suggest the combined use of tumoural AMBRA1 and peritumoural p62 expression as a putative prognostic biomarker for cSCC metastasis, the future validation of which may provide a valuable stratification tool to guide clinical management, therapeutic intervention and the rationalisation of healthcare resources.

A web-based prognostic nomogram for the cancer specific survival of elderly patients with T1-T3N0M0 renal pelvic transitional cell carcinoma based on the surveillance, epidemiology, and end results database

BackgroundAt present, there are few studies on renal pelvic transitional cell carcinoma (RPTCC) in elderly patients in the literature. The study aims to establish a new nomogram of cancer-specific survival (CSS) in elderly patients with T1-T3N0M0 RPTCC and validate its reliability.MethodsThis study downloaded the data of 1375 elderly patients with T1-T3N0M0 RPTCC in the Surveillance, Epidemiology, and Final Results (SEER) database from 2004 to 2018. Patients were randomly divided into training cohort (n = 977) and validation cohort (n = 398). Proportional subdistribution hazard analyse was applied to determine independent prognostic factors. Based on these factors, we constructed a compting risk model nomogram. We use the calibration plots, the area under the receiver operating characteristics curve (AUC), concordance index (C-index), and decision curve analysis (DCA) to validate predictive performance and clinical applicability. Patients were divided into low-risk group and high-risk group based on nomogram risk score. Kaplan–Meier curve was applied to analyze the difference in survival curve between the two groups of patients.ResultsWe found that the risk factors affecting CSS in elderly patients with T1-T3N0M0 RPTCC are surgery, AJCC stage, laterality, tumor size, histological grade, and tumour laterality. Based on these factors, we established a nomogram to predict the CSS of RPTCC patients at 1-, 3-, and 5-year. The calibration plots showed that the predicted value was highly consistent with the observed value. In the training cohort and validation cohort, the C-index of the nomogram were 0.671(95% CI 0.622–0.72) and 0.679(95% CI 0.608–0.750), respectively, the AUC showed similar results. The DCA suggests that namogram performs better than the AJCC stage system. The Kaplan–Meier curve showed that CSS of patients was significantly higher in the low-risk group.ConclusionsIn this study, the SEER database was used for the first time to create and validate a new nomogram prediction model for elderly patients with T1-T3N0M0 RPTCC. Compared with the traditional AJCC stage system, our new nomogram can more accurately predict the CSS of elderly patients with T1-T3N0M0 RPTCC, which is helpful for patient prognosis assessment and treatment strategies selection.

B cell subsets were associated with prognosis in elderly patients with community acquired pneumonia

BackgroundThe role of B cell subsets remained to be elucidated in a variety of immune diseases, though which was used as an effective biomarker for anti-inflammatory or antiviral response. This study aimed to evaluate the early changes of B cell subtypes distribution in elderly patients with community acquired pneumonia (CAP), as well as the association between B cell subtypes and prognosis.MethodsThis prospective study included elderly patients with CAP, severe CAP (sCAP) and healthy elderly subjects between April 2016 and March 2018. Flow cytometry was used to detect CD3, CD20, HLA-DR, CD24, CD27, CD38, IgM, and IgD. CD20+ B cells were further divided into naïve B cells (Bn), IgM/D+ memory B cells (IgM+ Bm), switched B cells (SwB), and transitional B cells (Btr).ResultsA total of 22 healthy controls, 87 patients with CAP and 58 patients with sCAP were included in the study. Compared to CAP, sCAP was characterized by significantly lower absolute number of B cells, Bn and Btr, significantly lower Btr and Bn subset percentage, while percentage of IgM+ Bm was significantly higher. Heat map showed Bn and Btr on day 3 and day 7 was negatively correlated with activated partial prothrombin time (APTT), international normalized ratio (INR), sequential organ failure assessment score (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II). After 28-day follow-up, Btr percentage in survival group was significantly higher. Receiver operator characteristic (ROC) curve analysis found that Btr count showed sensitivity of 48.6% and specificity of 87.0% for predicting the 28-day survival, with an area under the ROC curves of 0.689 (p = 0.019).ConclusionsSeverity and prognosis of CAP in elderly people is accompanied by changes in the B cell subsets. Btr subsets could play prognostic role for a short-term mortality of elderly CAP patients.

Development of a new antigen-based microarray platform for screening and detection of human IgG antibodies against SARS-CoV-2

Strategies to contain the current SARS-CoV-2 pandemic rely, beside vaccinations, also on molecular and serological testing. For any kind of assay development, screening for the optimal antigen is essential. Here we describe the verification of a new protein microarray with different commercially available preparations significant antigens of SARS-CoV-2 that can be used for the evaluation of the performance of these antigens in serological assays and for antibody screening in serum samples. Antigens of other pathogens that are addressed by widely used vaccinations were also included. To evaluate the accuracy of 21 different antigens or antigen preparations on the microarray, receiver operating characteristics (ROC) curve analysis using ELISA results as reference were performed. Except for a single concentration, a diagnostic sensitivity of 1 was determined for all antigen preparations. A diagnostic specificity, as well as an area under the curve (AUC) of 1 was obtained for 16 of 21 antigen preparations. For the remaining five, the diagnostic specificity ranged from 0.942 to 0.981 and AUC from 0.974 to 0.999. The optimized assay was subsequently also applied to determine the immune status of previously tested individuals and/or to detect the immunization status after COVID-19 vaccination. Microarray evaluation of the antibody profiles of COVID-19 convalescent and post vaccination sera showed that the IgG response differed between these groups, and that the choice of the test antigen is crucial for the assay performance. Furthermore, the results showed that the immune response is highly individualized, depended on several factors (e.g., age or sex), and was not directly related to the severity of disease. The new protein microarray provides an ideal method for the parallel screening of many different antigens of vaccine-preventable diseases in a single sample and for reliable and meaningful diagnostic tests, as well as for the development of safe and specific vaccines.

Finding an Appropriate Cut-off Point for Neck Circumference to Determine Overweight and Obesity in a Large Sample of Iranian Adults

Objective: Obesity is a major public health concern and there are different ways to detect it in population. The aim of the present study is to evaluate the neck circumference (NC) in a simple and practical way.&#x0D; Materials and Methods: This cross-sectional survey utilized data from the Yazd Health Study (YaHS) which is a population-based cohort study. In brief, 9962 individuals aged 20-70 years with measurement of body weight, height, waist circumference (WC) and NC were available for analysis. To determine the relationship between NC and other anthropometric measurement, we utilized of Pearson's correlation coefficient. Receiver operator characteristic (ROC) curve analysis was used to find out an optimal cut off value for detecting general and central obesity as well as to determine the sensitivity and specificity of NC in predicting general and central obesity. The whole analysis was performed using SPSS version 22.&#x0D; Results: NC correlated positively with body mass index (BMI) (r= 0.608, P&lt; 0.001 in men and r= 0.541, P&lt; 0.001 in women) and WC (r= 0.662, P&lt; 0.001 in men and r= 0.542, P&lt; 0.001 in women). The best cut-off point for NC to determine people with general obesity was 40.25 cm for men and 35.75 cm for women.&#x0D; Conclusion: The NC has an acceptable correlation with BMI and WC. In addition, NC is a simple free measurement which may be utilized in various health-care settings. These properties make the NC as the best anthropometrics to determine overweight and obesity and it can be used as an appropriate predictor for overweight and obesity in population-based screening programs.

Monoexponential, biexponential and diffusion kurtosis MR imaging models: quantitative biomarkers in the diagnosis of placenta accreta spectrum disorders

BackgroundTo investigate the diagnostic value of monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in differentiating placenta accreta spectrum (PAS) disorders.MethodsA total of 65 patients with PAS disorders and 27 patients with normal placentas undergoing conventional DWI, IVIM, and DKI were retrospectively reviewed. The mean, minimum, and maximum parameters including the apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, diffusion kurtosis (MK), and mean diffusion coefficient (MD) from DKI and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured from the volumetric analysis and compared between patients with PAS disorders and patients with normal placentas. Univariate and multivariated logistic regression analyses were used to evaluate the value of the above parameters for differentiating PAS disorders. Receiver operating characteristics (ROC) curve analyses were used to evaluate the diagnostic efficiency of different diffusion parameters for predicting PAS disorders.ResultsMultivariate analysis demonstrated that only D mean and D max differed significantly among all the studied parameters for differentiating PAS disorders when comparisons between accreta lesions in patients with PAS (AP) and whole placentas in patients with normal placentas (WP-normal) were performed (all p < 0.05). For discriminating PAS disorders, a combined use of these two parameters yielded an AUC of 0.93 with sensitivity, specificity, and accuracy of 83.08, 88.89, and 83.70%, respectively.ConclusionThe diagnostic performance of the parameters from accreta lesions was better than that of the whole placenta. D mean and D max were associated with PAS disorders.

Estradiol (E 2) Reduction Adversely Affect the Embryo Quality and Clinical Outcomes of In Vitro Fertilization and Embryo transfer (IVF-ET).

Objective The purpose of this study was to explore the influence of decreased serum estradiol (E2) levels during controlled ovarian hyperstimulation (COH) on in vitro fertilization and embryo transfer (IVF). Methods The clinical data of 300 IVF-ET cycles with patients were analyzed retrospectively. According to the presence of falling E2 level during the COH, we divided all subjects into two groups: the E2 levels fall group (n = 120, group A) and the control group (n = 180, group B). In group A, there were 57 patients with falling E2 with drug dosage reduction. The other 63 patients experienced the decreased E2 level spontaneously. The clinical and laboratory variables in the groups were compared. Receiver operator characteristic (ROC) curve analyses were carried out in order to evaluate the predict value of E2 level on the day of human chorionic gonadotropin (hCG) administration on IVF outcomes. Results Duration and total dosage of gonadotropin (Gn) used were statistically more in group A than in group B (P < 0.001). The high-quality embryo rate was significantly lower in group A (P = 0.048). Women in group A had lower clinical pregnancy rate (P = 0.029), live birth rate (P < 0.001), ongoing pregnancy rate (P = 0.001), and higher early abortion rates (P = 0.008) than group B. Women with spontaneously falling E2 group had a higher BMI index than those in the drug dosage reduction group (P = 0.001). More dosage and longer duration of Gn in spontaneously falling E2 group than in the drug dosage reduction group (P < 0.01). There were no differences in clinical outcomes between the two types of E2 decreased groups. Results from ROC showed an E2 level <1987.5 pg/ml on the hCG day might predict early abortion in this study. The sensitivity was 58.4% and the specificity was 78.9%. In addition, an E2 level >2020 pg/ml on the hCG day might be an index to predict live birth. The sensitivity was 57.0% and the specificity was 61.7%. Conclusions Reduction of E2 during COH might adversely affect the clinical pregnancy, early abortion, and ongoing pregnancy of IVF-ET.

Prediction of gestational diabetes mellitus by different obesity indices

BackgroundThe incidence rates of obesity and gestational diabetes mellitus (GDM) are increasing in parallel. This study aimed to evaluate the relationship between different obesity indices, including prepregnancy body mass index (preBMI), the first-trimester abdominal circumference (AC), and first-trimester abdominal circumference/height ratio (ACHtR), and GDM, and the efficacy of these three indices in predicting GDM was assessed.MethodsA total of 15,472 pregnant women gave birth to a singleton at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Prepregnancy weight was self-reported by study participants, body height and AC were measured by nurses at the first prenatal visit during weeks 11 to 13+6 of pregnancy. GDM was diagnosed through a 75-g oral glucose tolerance test at 24–28 gestational weeks. Using receiver operator characteristic (ROC) curve analysis, we evaluated the association between obesity indices and GDM.ResultsA total of 1912 women (12.4%) were diagnosed with GDM. Logistic regression analysis showed that AC, ACHtR, and preBMI (P < 0.001) were all independent risk factors for the development of GDM. In the normal BMI population, the higher the AC or ACHtR was, the more likely the pregnant woman was to develop GDM. The area under the ROC curve (AUC) was 0.63 (95% CI: 0.62–0.64) for the AC, 0.64 (95% CI: 0.62–0.65) for the ACHtR and 0.63 (95% CI: 0.62–0.64) for the preBMI. An AC ≥ 80.3 cm (sensitivity: 61.6%; specificity: 57.9%), an ACHtR of ≥ 0.49 (sensitivity: 67.3%; specificity: 54.0%), and a preBMI ≥ 22.7 (sensitivity: 48.4%; specificity: 71.8%) were determined to be the best cut-off levels for identifying subjects with GDM.ConclusionsAn increase in ACHtR may be an independent risk factor for GDM in the first trimester of pregnancy. Even in the normal BMI population, the higher the AC and ACHtR are, the more likely a pregnant woman is to develop GDM. AC, ACHtR in the first trimester and preBMI might be anthropometric indices for predicting GDM, but a single obesity index had limited predictive value for GDM.

Diagnostic value of platelet indices in infected nonunion: a retrospective study

BackgroundThe diagnostic value of platelet indices has been evaluated in various infectious diseases but not in infected nonunion. The purpose of this study was to assess the usefulness of platelet indices for diagnosis of infected nonunion after open reduction and internal fixation.MethodsThis retrospective study was performed in patients who underwent primary fracture nonunion revision surgeries from January 2016 to December 2021. A total of 297 patients were included in the study: 96 with infected nonunion (group A) and 201 with aseptic nonunion (group B). Receiver operator characteristic (ROC) curve analysis was performed to evaluate diagnostic value of each index. Area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated and compared.ResultsDemographic characteristics were comparable between the two groups. White blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen, plasma D-dimer, platelet count (PC), plateletcrit, and ratio of platelet count to mean platelet volume (PC/MPV) were significantly higher, and MPV and platelet distribution width (PDW) significantly lower, in group A than in group B (P < 0.05). ROC analysis showed PC/MPV and plasma fibrinogen to have better diagnostic value than the other coagulation indicators (AUC of 0.801 and 0.807, respectively). The combination of ESR, plasma fibrinogen, and PC/MPV had good sensitivity and specificity for diagnosis of infected nonunion. PC/MPV had better diagnostic value than ESR and plasma fibrinogen in the subgroup of patients with coagulation-related comorbidities.ConclusionsPlasma fibrinogen and PC/MPV ratio might be useful parameters for early diagnosis of infected nonunion.

Elevated Serum Regulator of Calcineurin 2 is Associated With an Increased Risk of Non-Alcoholic Fatty Liver Disease.

Background: The promoting effect of the regulator of calcineurin 2 (RCAN2) in hepatic steatosis has been observed in animal studies. However, the association of RCAN2 with non-alcoholic fatty liver disease (NAFLD) in humans remains unclear. This study aimed to evaluate the expression of RCAN2 in the liver of mice with hepatic steatosis and in the serum of NAFLD patients and to explore the relationship between serum RCAN2 levels and NAFLD. Methods: The mRNA and protein expression of RCAN2 were detected by quantitative real-time PCR (qRT-PCR) and Western blot. NAFLD was diagnosed by abdominal ultrasonography. Circulating RCAN2 levels were measured by ELISA kits. The relationship between serum RCAN2 levels and NAFLD was assessed. Results: qRT-PCR and Western blot analysis showed that compared with the corresponding controls, the mRNA and protein expression of RCAN2 were significantly increased in the liver tissues of db/db and mice on a high-fat diet. Serum RCAN2 levels were markedly elevated in NAFLD patients compared with non-NAFLD subjects. Binary logistic regression analysis showed that serum RCAN2 levels were significantly associated with NAFLD. Receiver operation characteristic (ROC) curve analysis showed that serum RCAN2 might act as a predictive biomarker for NAFLD [area under the curve (AUC) = 0.663, 95% CI = 0.623–0.702], and the serum RCAN2/(AST/ALT) ratio displayed improved predictive accuracy (AUC = 0.816, 95% CI = 0.785–0.846). Conclusion: Elevated serum RCAN2 levels were associated with an increased risk of NAFLD. Serum RCAN2, especially the serum RCAN2/(AST/ALT) ratio, might be a candidate diagnostic marker for NAFLD.

A27 COMPARATIVE EVALUATION OF THE ABC SCORE TO OTHER RISK STRATIFICATION SCALES IN MANAGING HIGH-RISK PATIENTS PRESENTING WITH ACUTE UPPER GASTROINTESTINAL BLEEDING

BackgroundThe ABC risk score identifies patients at high-risk of mortality in acute lower and upper gastro-intestinal bleeding (UGIB).AimsWe aimed to externally validate the ABC score, while comparing it to other prognostication scales when assessing UGIB patients at high-risk of negative outcomes prior to endoscopy.MethodsUGIB patients from a national Canadian registry (REASON) were studied, with mortality prediction as primary outcome. Secondary endpoints included prognostication of rebleeding, intensive care unit (ICU) admission, ICU and hospitalization lengths of stay (LOS), and a previously proposed composite outcome measure. Univariable and areas under the Receiver Operating Characteristic Curve (AUROC) analyses compared discriminatory abilities of the ABC score to the AIMS65, Glasgow Blatchford (GBS) and clinical Rockall Scores.ResultsThe REASON registry included 2020 patients (89.4% nonvariceal; mean age [± SD] 66.3±16.4 years; 38.4% female). Overall mortality, rebleeding, ICU admission, transfusion and composite score rates were 9.9%, 11.4%, 21.1%, 69.0%, and 67.3% respectively. ICU and hospitalization LOS were 5.4 ± 9.3 days and 9.1 ± 11.5 days, respectively. The ABC score displayed superior 30-day mortality prediction (0.78 (0.73; 0.83)) compared to GBS (0.69 (0.63; 0.75) or clinical Rockall (0.64 (0.58; 0.70) but not AIMS65 (0.73 (0.67; 0.79)). Although most scales significantly prognosticated secondary outcomes in univariable analysis except for ICU LOS, discriminatory abilities on AUROC analyses were poor.ConclusionsABC and AIMS65 display similar good prediction of mortality. Clinical usefulness in prognosticating secondary outcomes was modest for all scales, limiting their adoptions when informing early management of high-risk UGIB patients.Funding AgenciesInternational Scientific Partnership Program ISPP at King Saud University for funding this research work through ISPP-21–156

Abstract WP104: Radiographic Predictors Of Aneurysmal Etiology In Patients With Aneurysmal Pattern Subarachnoid Hemorrhage

Introduction: Spontaneous angiogram-negative subarachnoid hemorrhage (anSAH) can represent a diagnostic dilemma as there is no vascular etiology identified and patients may require further imaging, including multiple angiograms, and have prolonged hospital stays. We sought to determine radiographic predictors of aneurysmal cause based on admission non-contrast head CT. Methods: We performed a retrospective case control study of patients who were admitted for spontaneous subarachnoid hemorrhage (SAH) with suspected aneurysmal etiology to an academic center from 2016 to 2021. Patients with pure convexity SAH were excluded. We compared blood thickness (continuous variable) in the basal cisterns and Sylvian fissures and modified GRAEB scores on admission head CT between the two groups. We subsequently developed a predictive model to identify aneurysmal etiology. Results: Of 148 included patients (mean age 56 years [SD 12.7]; 55% female, 70% white), 61 were aneurysmal SAH (aSAH) and 87 were anSAH with no vascular etiology. Median modified GRAEB score was higher in aSAH than anSAH (6 [IQR2-10] vs 0 [IQR0-4], p&lt;0.001). Mean blood thickness was greater in the Sylvian fissure (8mm [SD 5.8]vs 3mm [SD 5.2]; p&lt;0.001), interpeduncular (9mm [SD 5.3]vs 6mm [SD 4.2]; p=0.005), quadrigeminal (3mm [SD 3.7] vs 1mm [SD 2]; p=0.003), crural (6mm [SD 3.7] vs 3mm [SD 2.2]; p=0.014), and ambient cisterns (6mm [SD 7.1] vs 3mm [SD 2.6], p=0.0015) in aSAH compared to anSAH, but less in prepontine cistern (3mm [SD 3.8] vs 5mm [5.2], p=0.006). Our 8-point scoring model is based on differences in radiographic features. Receiver operating characteristics (ROC) curve analysis showed high accuracy in predicting aneurysmal etiology (area under the curve [AUC] 0.79, 95% CI 0.70-0.88; odds ratio 1.45 per point increase, 95% CI 1.24-1.70; p&lt;0.001). Conclusion: The proposed scoring tool can aid clinicians in predicting aneurysmal etiology in patients with aneurysmal pattern SAH using measurements from admission head CTs. Eliminating an aneurysmal etiology of anSAH earlier may reduce the need for further extensive work up, hospital length of stay and associated complications, thereby reducing health care related costs. This model needs to be validated in a larger multi-center study.

Abstract WP109: Association Of Cisternal Blood Clot Burden And Ventriculoperitoneal Shunt Requirement In Subarachnoid Hemorrhage

Background: Aneurysmal Subarachnoid hemorrhage (aSAH) can be complicated by refractory hydrocephalus requiring a ventriculoperitoneal shunt (VPS). In an effort to optimize external ventricular drain (EVD) management, we sought to identify early radiographic predictors for refractory hydrocephalus requiring VPS placement. Methods: We conducted a retrospective case-control study of patients admitted for aSAH to a referral academic center from 2016 to 2021. We included those who survived their hospital course and compared radiographic features on admission non-contrast head CTs of patients who required a VPS and those who did not. We calculated modified GRAEB scores and measured total blood clot thickness (blood clot cisternal score) in the basal cisterns including interpeduncular, ambient, crural, prepontine, suprasellar, and interhemispheric cisterns plus bilateral Sylvian fissures (in mm). Binary logistic regression was used to test the association of VPS requirement with radiographic features. Receiver operating characteristics (ROC) curve analysis was performed to compare predictive accuracy of cisternal score to other predictors. Results: Our inclusion criteria yielded 176 patients (mean age of 54.9 years [SD 12.8]; 57% female, 70% white) of which 29 (16.5%) required a VPS. Cisternal score was greater in patients who required a VPS than those who did not (median 61.6 mm, IQR 49.8-74.3 mm vs 26.8mm, IQR 12.4-46.7; p&lt;0.001). Binary logistic regression showed higher blood clot cisternal score on admission head CT scan was associated with higher odds of developing refractory hydrocephalus with VPS requirement (odds ratio 1.06 per each millimeter increase, 95% CI 1.03-1.09; p&lt;0.001), independent of age, Hunt and Hess grades and modified GRAEB scores. Blood clot cisternal score has higher accuracy in predicting VPS requirement than modified GRAEB score (AUC 0.83, 95% CI 0.74-0.93 vs AUC 0.72, 95% CI 0.63-0.82) and other clinical or radiographic predictors on admission. Conclusions: While further validation is needed, our model suggests that blood clot cisternal score on admission head CT scan has high accuracy in predicting VPS requirement. This may allow for more efficacious and cost-effective treatment of hydrocephalus in aSAH patients.