Cut-off Value For Diagnosis Research Articles

Preliminary characterizations of a serum biomarker for sarcoidosis by comparative proteomic approach with tandem-mass spectrometry in ethnic Han Chinese patients

BackgroundThe diagnosis of sarcoidosis is still a significant challenge in China because of the need to exclude other diseases including granulomatous infections and malignancies that may be clinically and radiographically similar. The specific aim of the study is to search for serum protein biomarkers of sarcoidosis and to validate their clinical usefulness in differential diagnosis.MethodsSerum samples were collected from patients with sarcoidosis (n = 37), and compared to those from patients with tuberculosis (n = 20), other pulmonary diseases (n = 20), and healthy volunteers (n = 20) for determination of sarcoidosis-specific or -associated protein expression profiles. The first part of this study focused on proteomic analysis of serum from patients with sarcoidosis to identify a pattern of peptides capable of differentiating the studied populations using the ClinProt profiling technology based on mass spectrometry. Enzyme Linked Immunosorbent Assay (ELISA) was then used to verify corresponding elevation of the serum protein concentration of the potential biomarkers in the same patients sets. Receiver operating characteristic curve (ROC) analyses was performed to determine the optimal cutoff value for diagnosis. Immunohistochemistry was carried out to further confirm the protein expression patterns of the biomarkers in lung tissue.ResultsAn unique protein peak of M/Z 3,210 Daltons (Da) was found to be differentially expressed between the sarcoidosis and control groups and was identified as the N-terminal peptide of 29 amino acids (94-122) of serum amyloid A (SAA). ELISA confirmed that the serum SAA level was significantly higher in the sarcoidosis group than that of the other 3 control groups (p < 0.05). The cutoff for serum SAA concentration determined by ROC analysis was 101.98 ng/ml, with the sensitivity and specificity of 96.3% and 52.5%, respectively. Immunohistochemical staining showed that the SAA depositions in lung tissue of the sarcoidosis patients were also significantly more intense than in non-sarcoid lung tissue (p < 0.05).ConclusionThis is the first study to investigate serum protein markers in Chinese subjects with sarcoidosis. This study shows that the serum SAA expression profiles were different between the sarcoidosis and non-sarcoidosis groups. SAA may be a potential serum biomarker for ruling-out the diagnosis of sarcoidosis in Chinese subjects.

Prevalence and risk factors for female sexual dysfunction among Egyptian women

To assess sexual function among married women and determine associated risk factors for sexual dysfunction. Cross-sectional hospital-based study involving 509 non-pregnant married females 20-59 years old who were enrolled into the study after approval of the ethics committee. The study population was recruited among women attending gynecology outpatient clinic or their relatives visiting inpatients of obstetrics and gynecology department at Suez Canal University Hospital. Female and male partner-related data were collected using an interview questionnaire. Sexual dysfunction was assessed using female sexual function index (FSFI). Mean female age was 39.5 years. About half of the participants were premenopausal (48.7 %). Most of the females were circumcised (71.7 %). Desire and Orgasm domains were the most affected with 52.8 % of the participants having sexual dysfunction. Total FSFI score of ≤26.55 was the cutoff value for diagnosis of FSD and female age, postmenopausal status, duration of marriage, circumcision, partner's age, and the presence of male sexual dysfunction were found to be significant associated factors with FSD. FSD is highly prevalent in Egypt and orgasm and desire scores were the most affected domains. Several personal (female age, postmenopausal status, duration of marriage and circumcision) and male partner (age, and the presence of sexual dysfunction) factors were significantly associated.

Accuracy of Non-ECG–gated Computed Tomography Angiography of the Chest in Assessment of Left-sided Cardiac Chamber Enlargement

To determine whether measurement of left ventricular (LV) and left atrial (LA) diameters on nongated computed tomography angiography (CTA) can detect left atrial and left ventricular enlargement (LAE and LVE) with high specificity. Ninety-nine patients who had undergone both nongated CTA of the chest and echocardiography within 1 week constituted the pilot group. On CTA, LA and LV diameters were measured in the axial plane and on a 3-chamber-view multiplanar reconstruction. These measurements were compared with echocardiography results. Receiver operating characteristic (ROC) curves were then generated to determine optimal cutoff values for diagnosis of LAE and LVE. These thresholds were applied to a validation group (n = 203), and sensitivities and specificities for cutoff values were determined. Simple κ-coefficients were calculated for interobserver agreement. In the pilot group, axial measurements of the LA and LV diameters were superior to multiplanar reconstruction measurements based on areas under the ROC (LV: 0.82 vs. 0.76, LA: 0.87 vs. 0.82). Using the ROC results, cutoff values of 5.5 and 4.5 cm were chosen for LVE and LAE, respectively. These thresholds were applied to the validation group, achieving an average sensitivity and specificity for LAE of 53% [confidence interval (CI): 37%-71% and 94% (89%-97%)], respectively. Average sensitivity and specificity for LVE were 41% (CI: 23%-59%) and 99% (CI: 96%-100%), respectively. Kappa coefficients for diagnosis of LAE and LVE were 0.70 and 0.81, respectively. Thresholds for LA and LV diameter on nongated CTA can be chosen to provide specific, but not sensitive, detection of LAE and LVE.

Effect of older age on diagnostic and prognostic performance of high-sensitivity troponin T in patients presenting to an emergency department

The effect of age on diagnostic and prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) has not been addressed adequately, so far. High-sensitivity cardiac troponin T was measured serially in patients with acute symptoms presenting to our emergency department. We tested the diagnostic and prognostic performance of baseline and serial hs-cTnT concentrations related to age in all consecutive patients with acute coronary syndrome (ACS) (n = 342) or hs-cTnT increases not due to ACS (n = 442). Prevalence of elevated hs-cTnT in the study population was higher among patients ≥75 years compared with younger patients (89.1 % vs 73.3 %, hazard ratio [HR] 1.2, P < .0001). Elevated hs-cTnT was more likely due to ACS in the younger patients (HR 1.4, P = .001) and conversely more frequently due to non-ACS conditions in the elderly patients (HR 1.3, P = .0001). Diagnostic performance of hs-cTnT using the 99th percentile was significantly superior in younger than in elderly patients (P < .0001). For receiver operating characteristic-optimized cutoffs, a trend to significance was found between younger and older patients (area under the curve 0.87 vs 0.79, P = .074), with higher sensitivities (98.2 % vs 72.6%) and negative predictive values (97.3% vs. 78.5%) for patients <75 years. Moreover, receiver operating characteristic-optimized cutoff values for diagnosis of non-ST-segment elevation myocardial infarction were significantly higher in elderly patients (32.9 ng/L) compared with younger patients (12.9 ng/L). The prognostic information of single and serial hs-cTnT measurements was comparably poor in both age groups, showing no better prognostic information to hs-cTnT measurement on presentation. Elevated hs-cTnT is more common in the elderly due to higher prevalence of non-ACS conditions and significantly impairs diagnostic performance in discriminating non-ST-segment elevation myocardial infarction.

Direct and quantitative analysis of underivatized acylcarnitines in serum and whole blood using paper spray mass spectrometry.

A simple protocol for rapid quantitation of acylcarnitines in serum and whole blood has been developed using paper spray mass spectrometry. Dried serum and whole blood containing a mixture of ten acylcarnitines at various concentrations were analyzed as spots from paper directly without any sample pretreatment, separation, or derivatization. The composition of the spray solvent was found to be a critical factor: for serum samples, spray solvent of methanol/water/formic acid (80:20:0.1) gave the best signal intensity while for blood samples which contain more matrix components, acetonitrile/water (90:10) was a much more suitable spray solvent. For the paper type and size used, 0.5 μL of sample provided an optimal signal for both serum and whole blood samples. For quantitative profiling, the limits of quantitation obtained from both serum and blood were much lower than the clinically validated cutoff values for diagnosis of fatty acid oxidation disorders in newborn screening. Linearity (R(2) > 0.95) and reproducibility (RSD ~10 %) were achieved in the concentration ranges from 100 nM to 5 μM for the C2 acylcarnitine, and for other acylcarnitines, these values were from 10 to 500 nM. Acylcarnitine profiles offer an effective demonstration of the fact that paper spray mass spectrometry is an appropriate, simple, rapid method with high sensitivity and high reproducibility applicable to newborn screening tests.

Quelles indications pour le prasugrel et le ticagrelor dans les syndromes coronariens aigus ?

The effect of age on diagnostic and prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) has not been addressed adequately, so far.High-sensitivity cardiac troponin T was measured serially in patients with acute symptoms presenting to our emergency department. We tested the diagnostic and prognostic performance of baseline and serial hs-cTnT concentrations related to age in all consecutive patients with acute coronary syndrome (ACS) (n = 342) or hs-cTnT increases not due to ACS (n = 442).Prevalence of elevated hs-cTnT in the study population was higher among patients ≥75 years compared with younger patients (89.1 % vs 73.3 %, hazard ratio [HR] 1.2, P < .0001). Elevated hs-cTnT was more likely due to ACS in the younger patients (HR 1.4, P = .001) and conversely more frequently due to non-ACS conditions in the elderly patients (HR 1.3, P = .0001). Diagnostic performance of hs-cTnT using the 99th percentile was significantly superior in younger than in elderly patients (P < .0001). For receiver operating characteristic–optimized cutoffs, a trend to significance was found between younger and older patients (area under the curve 0.87 vs 0.79, P = .074), with higher sensitivities (98.2 % vs 72.6%) and negative predictive values (97.3% vs. 78.5%) for patients <75 years. Moreover, receiver operating characteristic–optimized cutoff values for diagnosis of non–ST-segment elevation myocardial infarction were significantly higher in elderly patients (32.9 ng/L) compared with younger patients (12.9 ng/L). The prognostic information of single and serial hs-cTnT measurements was comparably poor in both age groups, showing no better prognostic information to hs-cTnT measurement on presentation.Elevated hs-cTnT is more common in the elderly due to higher prevalence of non-ACS conditions and significantly impairs diagnostic performance in discriminating non–ST-segment elevation myocardial infarction.

Appropriateness of Adenosine Deaminase-Guided Management for Patients with Pericardial Effusion

Background/Aims: The prognostic impact of empirical anti-tuberculous management according to adenosine deaminase (ADA) levels in patients exhibiting pericardial effusion (PE) has not been established. We evaluated the appropriateness of ADA-guided anti-tuberculous medication for patients with PE. Methods: From 2001 to 2010, 47 patients with PE and who were diagnosed with either tuberculous pericarditis (TbP) or idiopathic pericarditis (IP) were enrolled. The diagnosis of definite TbP was made by the presence of Tb bacilli or caseous granuloma in pericardial tissue or effusion. The diagnosis of probable TbP was made by the presence of one or more of the following: (1) elevated ADA (≥ 40 IU/L) in pericardial fluid, (2) positive Tb interferon test, or (3) extracardiac presence of Tb. All clinical information was collected by medical record review and telephone contact. Results: Among the 47 patients with PE, 12 were diagnosed with definite TbP; 17, with probable TbP; and 18, with IP. The mean ADA level was significantly higher in patients with definite TbP than in patients with IP (74.97 ± 36.79 vs. 20.14 ± 7.39 IU/L; p < 0.001). The optimal ADA cutoff value for diagnosis of definite TbP was 64 IU/L. The median follow-up time was 12.1 months (range, 0.17-100 months). In patients with low levels of ADA (< 40 IU/L), the incidence of death or recurrence did not different between patients who were prescribed anti-tuberculous medication and those who were not. Conclusions: The ADA level in pericardial fluid was useful for making a rapid diagnosis of tuberculous pericarditis. Even in tuberculosis-endemic areas, patients with ADA < 40 IU/L may have a good prognosis without empirical anti-tuberculous treatment. (Korean J Med 2012;82:441-448)

Exhaled Nitric Oxide Cutoff Values for Asthma Diagnosis According to Rhinitis and Smoking Status in Japanese Subjects

Measurement of the exhaled nitric oxide fraction (FE(NO)) has been proposed as a useful diagnostic test for asthma. However, most of the data concerning the FE(NO) cutoff values for the diagnosis of asthma have not yet examined using standard procedures. Furthermore, there is no detailed study that investigated the cutoff values that takes into account patient factors that influence the FE(NO) levels. FE(NO) was measured in 142 steroid-naive asthmatics and 224 control subjects using an online electrochemical nitric oxide analyzer in accordance with the current guidelines. Subjects without respiratory symptoms and normal spirometric parameters were included in the control group. Asthma was diagnosed on the basis of the presence of significant airway reversibility and/or airway hyperresponsiveness during clinical follow up 6 months after FE(NO) measurements. FE(NO) was significantly higher in asthmatic patients compared with control subjects (p < 0.01). Based on all study subjects, the receiver operating characteristic curves indicated that the cutoff value of FE(NO) 22 parts per billion (ppb) was associated with the highest combination of sensitivity (90.8%) and specificity (83.9%). Multivariate analysis showed allergic rhinitis, current smoking, and asthma were significant factors influencing the FE(NO) levels. The cutoff values of FE(NO) to discriminate asthma from non-asthma ranged from 18 to 28 ppb depending on rhinitis and smoking status. The cutoff values presented may be useful for the interpretation of FE(NO) values in the clinical practice.

Diagnosis of stress urinary incontinence using poster urethrovesical angel measured by ultrasonography

To evaluate the clinical value of ultrasonography detecting the poster urethrovesical angle (PUVA) in diagnosis of stress urinary incontinence (SUI). From Jan. 2006 to Dec. 2008, the PUVA in resting phase (PUVA-r) and stress phase (PUVA-s) between 84 patients with SUI and 100 healthy women were measured by color Doppler ultrasound, including 57 cases in SUI degree I, 22 cases in SUI degree II, 5 cases in SUI degree III. (1) The PUVA-r and PUVA-s were (130+/-29) degrees and (158+/-36) degrees in SUI patients, which were significantly higher (113+/-19) degrees and (115+/-23) degrees in control group (P<0.01). (2) Correlation analysis showed that PUVA-s was positively correlated with the severity of SUI (P<0.01). (3) The area under the receiver operating characteristic curves (ROC) of PUVA-s was 0.82 (95% CI: 0.76-0.89) between SUI patients and healthy women. When PUVA-s>or=140 degrees was chosed as the cut-off value, the specificity, accuracy rate and positive predictive value in diagnosis of SUI were 84%, 79%, 81%, which were significantly higher than those when cut-off value of PUVA-s>or=120 degrees (54%, 68%, 62%; P<0.05). The PUVA-s in SUI patients are significantly increased and is positively correlated with the severity of SUI, which are indicated that PUVA-s>or=140 degrees should be used as cut-off value in diagnosis of SUI by ultrasonography.

Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study

Although serologic analysis is used in diagnosis of celiac disease, histopathology is considered most reliable. We performed a prospective study to determine the clinical, pathologic, and serologic spectrum of celiac disease in a general population (Kalixanda study). A random sample of an adult general population (n = 1000) was analyzed by upper endoscopy, duodenal biopsy, and serologic analysis of tissue transglutaminase (tTg) levels; endomysial antibody (EMA) levels were analyzed in samples that were tTg+. The cut off values for diagnosis of celiac disease were villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs). Samples from 33 subjects were tTg+, and 16 were EMA+. Histologic analysis identified 7 of 1000 subjects (0.7%) with celiac disease; all were tTg+, and 6 of 7 were EMA+. Another 26 subjects were tTg+ (7/26 EMA+). This was addressed by a second quantitative pathology study (nested case control design) using a threshold of 25 IELS/100 ECs. In this analysis, all 13 samples that were tTg+ and EMA+ had > or =25 IELs/100 ECs. In total, 16 subjects (1.6%) had serologic and histologic evidence of gluten-sensitive enteropathy. IELs were quantified in duodenal biopsy samples from seronegative individuals (n = 500); 19 (3.8%) had >25 IELs and lymphocytic duodenosis. Measurement of > or =25 IELs/100 ECs correlated with serologic indicators of celiac disease; a higher IEL threshold could miss 50% of cases. Quantification of tTg is a sensitive test for celiac disease; diagnosis can be confirmed by observation of > or =25 IELs/100ECs in duodenal biopsy specimens. Lymphocytic enteropathy (celiac disease and lymphocytic duodenosis) is common in the population (5.4%).

Evaluation of left ventricular dyssynchrony using combined pulsed wave and tissue Doppler imaging.

IntroductionThe combination of pulsed wave (PW) and tissue Doppler imaging (TDI) has been proposed as a new method to assess left ventricular (LV) mechanical dyssynchrony (LVMD), but results have not been validated. We investigated the correlation of a combination of PW and TDI with a positive response to cardiac resynchronization therapy (CRT).Material and methodsWe studied 108 consecutive patients who received CRT. Patients with atrial fibrillation were excluded. The time difference (TPW-TDI) between onset of QRS to the end of LV ejection by PW (TPW) and onset of QRS to the end of the systolic wave in LV basal segments with greatest delay by TDI (TTDI) was measured before CRT and during short-term and long-term follow-up.ResultsThe TPW-TDI interval before CRT was 74 ±48 ms. Intra-observer variabilities for TPW and TTDI were 1.5 ±0.24% and 1 ±0.17%. Inter-observer variabilities for TPW and TTDI were 1 ±0.36% and 1 ±0.64%, respectively. TPW-TDI > 50 ms was defined as the cutoff value for diagnosis of LVMD by receiver operating curve (ROC) analysis. During follow-up of 15 ±11 months, the sensitivity and specificity of TPPW-TDI to predict a positive response to CRT were 98% and 82%, respectively. The area under the ROC curve was 0.92. There was a significant agreement between LVMD determined by TPW-TDI and the positive response to CRT (κ=0.80).ConclusionsLeft vertricular dyssynchrony detected by the method combining PW and TDI demonstrated a high reproducibility, sensitivity, specificity and agreement with a positive response to CRT.

Hepatic Arterial Diameter Measured with US: Adjunct for US Diagnosis of Biliary Atresia

To prospectively evaluate the accuracy of hepatic artery diameter and hepatic artery diameter-to-portal vein diameter ratio for ultrasonographic (US) diagnosis of biliary atresia, with cholangiographic or clinical information as reference standard. Institutional review board approval and informed consent were obtained. US was performed in 68 neonates and infants with cholestatic jaundice (mean age, 61 days; male-to-female ratio, 38:30). Biliary atresia (n = 38) was confirmed with cholangiography, and hepatitis (n = 30) was diagnosed with clinical (n = 24) or cholangiographic (n = 6) findings. Diameter of the right hepatic artery was measured with US. Right hepatic artery diameter-to-right portal vein diameter ratio was measured to determine relative enlargement of the hepatic artery. As a control group, 17 neonates and infants (mean age, 67 days; male-to-female ratio, 12:5) without jaundice underwent US of the porta hepatis. Statistical analysis was performed to compare US parameters among three groups with one-way analysis of variance. Optimal cutoff values of the hepatic artery diameter and hepatic artery diameter-to-portal vein diameter ratio for biliary atresia diagnosis were obtained with receiver operating characteristic analysis. The diameter of the right hepatic artery in biliary atresia group (1.9 mm +/- 0.4 [standard deviation]) was significantly larger than that in the hepatitis (1.4 mm +/- 0.3) and control (1.2 mm +/- 0.2) groups (P < .001). Hepatic artery diameter-to-portal vein diameter ratio in the biliary atresia group (0.52 +/- 0.12) was larger than that in hepatitis (0.40 +/- 0.07) and in control (0.40 +/- 0.10) groups (P < .001). Optimum cutoff values for diagnosis of biliary atresia were 1.5 mm (sensitivity, 92%; specificity, 87%; accuracy, 89%) for hepatic artery diameter and 0.45 for hepatic artery diameter-to-portal vein diameter ratio (sensitivity, 76%; specificity, 79%; accuracy, 78%). Measurement of hepatic artery diameter can be helpful in the US diagnosis of biliary atresia.

Cortisol levels in cerebrospinal fluid correlate with severity and bacterial origin of meningitis

IntroductionOutcomes following bacterial meningitis are significantly improved by adjunctive treatment with corticosteroids. However, little is known about the levels and significance of intrathecal endogenous cortisol. The aim of this study was to assess cortisol as a biological and diagnostic marker in patients with bacterial meningitis.MethodsForty-seven consecutive patients with bacterial meningitis and no prior treatment were evaluated. For comparison, a group of 37 patients with aseptic meningitis and a group of 13 healthy control individuals were included.ResultsThe mean age of the bacterial meningitis patients was 42 years, and the mean Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores on admission were 12, 13 and 4, respectively. Altogether, 40 patients (85%) were admitted to the intensive care unit, with a median (interquartile range) length of stay of 8 (4 to 15) days. A bacterial etiology was confirmed in 35 patients (74%). The median (interquartile range) cortisol concentration in cerebrospinal fluid (CSF) was 133 (59 to 278) nmol/l. CSF cortisol concentrations were positively correlated with serum cortisol levels (r = 0.587, P < 0.001). Furthermore, CSF cortisol levels correlated with Acute Physiology and Chronic Health Evaluation II score (r = 0.763, P < 0.001), Sequential Organ Failure Assessment score (r = 0.650, P < 0.001), Glasgow Coma Scale score (r = -0.547, P < 0.001) and CSF lactate levels (r = 0.734, P < 0.001). CSF cortisol was only weakly associated with intrathecal levels of IL-6 (r = 0.331, P = 0.02) and IL-8 (r = 0.296, P < 0.05). CSF cortisol levels in bacterial and aseptic meningitis significantly differed (P < 0.001). The CSF cortisol concentration of 46.1 nmol/l was found to be the optimal cutoff value for diagnosis of bacterial meningitis.ConclusionCSF cortisol levels in patients with bacterial meningitis are highly elevated and correlate with disease severity. Moreover, our findings also suggest that intrathecal cortisol may serve as a valuable marker in discriminating between bacterial and aseptic meningitis.

Prognostic factors in patients with minor troponin-I elevation but without acute myocardial infarction

Although cardiac troponin I is widely used as a marker for myocardial infarction, its minor elevations are also observed in other clinical situations, and the prognostic factors in such clinical settings have not been well established. The aim of this study was to identify predictors of mortality in patients with minor troponin elevations without an acute myocardial infarction. We consecutively enrolled 134 patients from the emergency department with a peak troponin I level greater than the lower limit of detectability (0.04 ng/ml) but less than the 10% coefficient of variation cutoff value for diagnosis of myocardial infarction (0.26 ng/ml). These patients had chest pain or nonspecific symptoms of a circulatory abnormality but lacked the traditional features of an acute myocardial infarction. End point was defined as death from all causes. Cox regression analysis was used to test relations between clinical and biochemical variables and the outcome. During the follow-up of 7.6+/-7.4 months, 12 patients died. Age, log creatine kinase myocardial isoform, and log C-reactive protein were found to be significantly correlated with death. After adjusting for possible confounders in the multivariate model, age (hazard ratio 1.09, confidence interval 1.02-1.16, P=0.012), log creatine kinase myocardial isoform (hazard ratio 13.11, confidence interval 2.01-85.52, P=0.007), and log C-reactive protein (hazard ratio 1.64, confidence interval 1.02-2.56, P=0.041) were identified as independent predictors of mortality. Creatine kinase myocardial isoform and C-reactive protein levels and age can be integrated to risk-stratify patients with minor troponin I elevation for reasons other than acute myocardial infarction.

Evaluation of haemostatic molecular markers for diagnosis of disseminated intravascular coagulation in patients with infections

Early treatment of disseminated intravascular coagulation (DIC) is recommended but global coagulation tests used in authorized DIC criteria are not sensitive for diagnosis of early-phase DIC. We examined the plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC) and D-dimer in patients with suspected DIC to determine the cutoff values for diagnosis of DIC. Plasma levels of D-dimer, TAT and PPIC were significantly elevated in patients with DIC and correlated with DIC score. The cutoff values were determined using the receiver operative curve analysis. The cutoff value represented the point at which the sensitivity curve crossed the specificity curve. The cutoff values of D-dimer, TAT and PPIC for DIC were 12.0 mug/ml, 11.0 ng/ml and 1.8 mug/ml, respectively. These values were moderately to highly sensitive for the diagnosis of DIC but not for poor outcome. The combination of D-dimer, TAT and PPIC showed high sensitivity and low specificity when one or more tests were positive, but showed low sensitivity and high specificity when all three tests were positive. We conclude that hemostatic molecular markers might be useful for the diagnosis of DIC and should be confirmed by several trials.

Comparative Diagnostic Test Characteristics of Oscillometric and Doppler Ultrasonographic Methods in the Detection of Systolic Hypertension in Dogs

Comparison of test characteristics allows a clinician to choose the optimal diagnostic test method for an individual patient. This study assessed the comparative test characteristics of noninvasive (NI) blood pressure measurement methods (oscillometric and Doppler) and used this information to develop optimal cutoff values for diagnosis of systolic hypertension in dogs by these NI methods. Simultaneous NI (oscillometric or Doppler methods) and invasive (arterial puncture [AP]) systolic blood pressure (SBP) measurements were obtained prospectively from normal dogs and dogs suspected of having systemic hypertension based on clinical signs. Oscillometric SBP readings were obtained from the distal hind limb (Osc‐L, n = 54) or the proximal tail (T, n = 27). Doppler BP measurements were obtained using a forelimb cuff (n = 57). AP‐SBP was categorized as hypertensive if a 160 mmHg, and sensitivity (Se), specificity (Sp), and likelihood ratios (LR) were calculated for diagnostic cutoff values ranging from 130 to 220 mmHg. Receiver operator characteristic (ROC) curves were analyzed to determine optimal cutoff values for diagnosis of AP‐SBP a 160 mmHg. Optimal NI SBP cutoff values considered to reflect AP values a 160 mmHg were: Osc‐L = 160 mmHg (Se: 65%, Sp: 85%, LR = 4.33:1), Osc‐T = 150 mmHg (Se: 84%, Sp: 75%, LR = 3.36:1), and Doppler = 160 mmHg (Se: 71%, Sp: 86%, LR: 5:1).

European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: How to use existing assays clinically and for clinical trials

Background The European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction suggest that the cutoff value for diagnosis of acute myocardial infarction (AMI) be the 99th percentile of the reference population at a level measured with imprecision (coefficient of variation) ≥10%. No current commercially available troponin assay meets this requirement. Accordingly, questions have been raised about how to implement cutoff values from the guidelines. The Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial asked for recommendations concerning the use of troponin assays for the trial. Methods Cutoff values for the various assays were obtained from package inserts or from direct communication with manufacturers. Results The cutoff value with ≥10% imprecision was above the 99th percentile of the reference range for all assays. For the present, we suggest that this value be used for clinical and clinical trial purposes. It will account for analytic variability and individual biological changes. We provide recommendations for clinical practice and clinical trials concerning how to make the diagnosis of AMI in patients with ischemic symptoms and patients who undergo percutaneous coronary intervention and coronary artery bypass surgery. Conclusions This is a first attempt to define cutoff values on the basis of the European Society of Cardiology and American College of Cardiology guidelines. These criteria will provide increased consistency until assays improve to allow full implementation of the guidelines. (Am Heart J 2002;144981-6.)

Intrapartum screen for diabetes in patients without prenatal care: Use of labor admission serum glucose

Objective For patients presenting in labor with no prenatal care, a rapid screening test for gestational diabetes would potentially aid in decisions for tocolysis (e.g., preterm patients) and mode of delivery (e.g., large for gestational age). We sought to determine whether a labor admission serum glucose is of predictive value in the diagnosis of gestational diabetes. Methods We obtained labor admission glucose values for laboring patients and compared these with 1-h (50-g) postglucola (1° PG) screens obtained at 24 to 32 weeks' gestation. Diabetics being treated with insulin were excluded from the study. Labor admission serum glucose values were compared to 1° PG values by linear regression. Sensitivity and specificity of admission glucose for identification of a positive 1° PG (140 mg/dl) were evaluated by a receiver operator curve (ROC). Results A total of 98 patients with both 1° PG screens and labor admission glucose were identified. Linear regression showed no significant correlation of labor admission glucose and 1° PG values (r = 0.13; P = 0.9). The ROC failed to demonstrate an optimal admission random glucose cutoff value for diagnosis of diabetes. Conclusions In laboring patients without insulin-requiring diabetes, labor admission glucose does not predict an abnormal 1° PG and thus does not aid in labor management of patients with suboptimal prenatal care. J. Matern.-Fetal Med. 9:216–218, 2000. © 2000 Wiley-Liss, Inc.

Intrapartum screen for diabetes in patients without prenatal care: use of labor admission serum glucose.

For patients presenting in labor with no prenatal care, a rapid screening test for gestational diabetes would potentially aid in decisions for tocolysis (e.g., preterm patients) and mode of delivery (e.g., large for gestational age). We sought to determine whether a labor admission serum glucose is of predictive value in the diagnosis of gestational diabetes. We obtained labor admission glucose values for laboring patients and compared these with 1-h (50-g) postglucola (1 degree PG) screens obtained at 24 to 32 weeks' gestation. Diabetics being treated with insulin were excluded from the study. Labor admission serum glucose values were compared to 1 degrees PG values by linear regression. Sensitivity and specificity of admission glucose for identification of a positive 1 degree PG (140 mg/dl) were evaluated by a receiver operator curve (ROC). A total of 98 patients with both 1 degree PG screens and labor admission glucose were identified. Linear regression showed no significant correlation of labor admission glucose and 1 degree PG values (r = 0.13; P = 0.9). The ROC failed to demonstrate an optimal admission random glucose cutoff value for diagnosis of diabetes. In laboring patients without insulin-requiring diabetes, labor admission glucose does not predict an abnormal 1 degree PG and thus does not aid in labor management of patients with suboptimal prenatal care.

Intrapartum screen for diabetes in patients without prenatal care: Use of labor admission serum glucose

Objective: For patients presenting in labor with no prenatal care, a rapid screening test for gestational diabetes would potentially aid in decisions for tocolysis (e.g., preterm patients) and mode of delivery (e.g., large for gestational age). We sought to determine whether a labor admission serum glucose is of predictive value in the diagnosis of gestational diabetes.Methods: We obtained labor admission glucose values for laboring patients and compared these with 1-h (50-g) postglucola (1° PG) screens obtained at 24 to 32 weeks' gestation. Diabetics being treated with insulin were excluded from the study. Labor admission serum glucose values were compared to 1° PG values by linear regression. Sensitivity and specificity of admission glucose for identification of a positive 1° PG (140 mg/dl) were evaluated by a receiver operator curve (ROC).Results: A total of 98 patients with both 1° PG screens and labor admission glucose were identified. Linear regression showed no significant correlation of labor admission glucose and 1° PG values (r = 0.13; P = 0.9). The ROC failed to demonstrate an optimal admission random glucose cutoff value for diagnosis of diabetes.Conclusions: In laboring patients without insulin-requiring diabetes, labor admission glucose does not predict an abnormal 1° PG and thus does not aid in labor management of patients with suboptimal prenatal care.