Cutoff Value Of Concentration Research Articles

Pancreas-specific lipase concentrations and amylase and lipase activities in the peritoneal fluid of dogs with suspected pancreatitis

Diagnosing acute pancreatitis in the dog can be challenging. The aim of this study was to determine the concentrations of pancreas-specific lipase immunoreactivity (cPLI), and the activities of amylase and lipase, in the peritoneal fluid from a population of dogs diagnosed with acute pancreatitis based on clinical signs, ultrasonographic findings and serum cPLI concentrations. In a prospective study, cPLI concentrations, and amylase and lipase activities, were measured in the peritoneal fluid of 14 dogs with pancreatitis and 19 dogs with non-pancreatic disease.The sensitivity and specificity of peritoneal fluid cPLI concentration (cut-off value 500 µg/L) were 100.0% (95% confidence interval, CI, 80.7–100.0%) and 94.7% (95% CI 76.7–99.7%), respectively. The sensitivity and specificity of peritoneal fluid amylase (cut-off value 1050 U/L) and lipase activities (cut-off value 500 U/L) were 71.4% (95% CI 44.5–90.2%) and 84.2% (95% CI 62.8–95.8%) for amylase activity, and 92.9% (95% CI 69.5–99.6%) and 94.7% (95% CI 76.7–99.7%) for lipase activity, respectively. In conclusion, peritoneal fluid cPLI concentration was highly sensitive as a complementary diagnostic tool in a group of dogs with suspected acute pancreatitis. Peritoneal fluid lipase activity was not as sensitive as cPLI concentration, but may also support a diagnosis of acute pancreatitis in dogs.

MP8-14 FACTORS PREDICTING SEPTIC SHOCK AFTER PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT FOR EMERGENCY DRAINAGE OF UPPER URINARY TRACT OBSTRUCTION

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2014MP8-14 FACTORS PREDICTING SEPTIC SHOCK AFTER PERCUTANEOUS NEPHROSTOMY TUBE PLACEMENT FOR EMERGENCY DRAINAGE OF UPPER URINARY TRACT OBSTRUCTION Ahmed Harraz, Mohamed Zahran, Hossam Nabeeh, Kirolos N. Meilika, Hesham Orban, and Ahmed Shokeir Ahmed HarrazAhmed Harraz More articles by this author , Mohamed ZahranMohamed Zahran More articles by this author , Hossam NabeehHossam Nabeeh More articles by this author , Kirolos N. MeilikaKirolos N. Meilika More articles by this author , Hesham OrbanHesham Orban More articles by this author , and Ahmed ShokeirAhmed Shokeir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.357AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infectious complications, notably septic shock (SS), are potential sequelae after percutaneous nephrostomy tube (PCN) drainage for upper urinary tract obstruction (UUTO). We examined the incidence and predictors of SS development in a large contemporary series of patients with UUTO drained by PCN. METHODS We retrospectively reviewed our electronic database for patients underwent PCN placement for emergency drainage of UUTO between January 2011 and June 2013. Septic shock was defined as the presence of systemic inflammatory response syndrome (SIRS) plus sepsis plus a sign of end-organ damage e.g. renal failure plus refractory hypotension necessitating treatment in the ICU. Factors predicting SS were examined using univariate and multivariate analyses. RESULTS A total of 236 patients were included during the specified period. Septic shock and mortality developed in 28 (11.9%) and 6 (2.5%) patients, respectively. Patients developed SS had significantly leukocytosis (p = 0.018) and lower albumin (p = 0.015), platelets (p = 0.021) and prothrombin concentration (p = 0.002) levels. On the other hand, the cause of obstruction (benign vs malignant disease), laterality (one or both sides) or the duration of obstruction did not show significant association. On multivariate analysis, thrombocytopenia (OR: 0.994; 95%CI: 0.99-0.998; p = 0.007), hypoprothrombinemia (OR: 0.968; 95%CI: 0.942-0.994; p = 0.018) were independent predictors while higher leukocytic count showed marginal significance (OR: 1.049; 95%CI: 1-1.1; p = 0.05). Using Receiver Operating Characteristic (ROC) curve, we determined a platelet cut-off value < 147 x 103 (AUC: 0.7; p = 0.001; Sensitivity: 46.4%; Specificity: 90.6%) and a prothrombin concentration cut-off value of < 76% (AUC: 0.7; p = 0.0003; Sensitivity: 67.9%; Specificity: 63.6%) to be predictors for SS. CONCLUSIONS Patients with relative thrombocytopenia and hypoprothrombinemia at time of PCN placement for temporal relief of UUTO should receive the maximum care to avoid the development of SS. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e79 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ahmed Harraz More articles by this author Mohamed Zahran More articles by this author Hossam Nabeeh More articles by this author Kirolos N. Meilika More articles by this author Hesham Orban More articles by this author Ahmed Shokeir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Characterization of phosphatidylethanol blood concentrations for screening alcohol consumption in early pregnancy

Objective. Phosphatidylethanol (PEth) is formed endogenously by the direct action of ethanol, and has a half-life long enough to make it a reliable biomarker of alcohol exposure in early pregnancy. In this study, we aimed to characterize PEth blood concentrations to differentiate different levels of alcohol exposure in pregnant women. Methods. The study consisted of 305 consecutive pregnant women who had been referred to our hospital for antenatal care. Of them, 117 self-reported alcohol ingestion in the first trimester of pregnancy and 188 were abstainers. Total PEth concentration in whole blood was quantified by liquid chromatography-mass spectrometry (LC-MS/MS). Alcohol ingestion was classified according to the United States National Institute on Alcohol Abuse and Alcoholism into light drinkers: ≤ 3 drinks/week, moderate drinkers: 3–7 drinks/week, and heavier drinkers: > 7 drinks/week (a standard drink = 14 g of ethanol). Results. Participants had quantifiable PEth blood levels 3–4 weeks after the last drink. There were 4.8% abstainers who had positive PEth concentrations; all of them reported a positive history of alcohol consumption before conception. PEth blood concentrations were significantly correlated to drinks per occasion (r = 0.44; P < 0.001) and days drinking per week (r = 0.34; P < 0.001). However, almost 74% of participants with ≤ 3 drinks/week of alcohol, and 46% with 3–7 drinks/week, had PEth blood concentrations below the lower limit of quantification (LLOQ). The area under the curve (AUC) generated by a receiver operation characteristic curve (ROC) analysis increased as the cutoff value of PEth blood concentration increased. However, the cutoff values were below or close to the LLOQ. Conclusions: Our study presents a formal characterization of PEth blood concentrations for screening alcohol ingestion in first-trimester pregnant women. However, caution is recommended for overrepresenting either negative or positive results.

The Influence of Serum Sodium Concentration on Prognosis in Resected Non-Small Cell Lung Cancer

Hyponatremia is the most common electrolyte disorder and is a negative prognostic factor in several kinds of cancer. However, few reports have referred to hyponatremia in non-small cell lung cancer (NSCLC). In the present study, the authors examined the influence of preoperative serum sodium concentration on survival in completely resected NSCLC. A total of 386 completely resected NSCLC patients were retrospectively analyzed. Kaplan-Meier survival curves showed that serum sodium concentration was a significant prognostic factor, and the log-rank statistical value was maximum (9.173, p = 0.002) when the cutoff value of serum sodium concentration was 139 mEq/L. The overall 5-year survival rate of the high-serum sodium concentration group (> 139 mEq/L) was 74.8% and that of the low-serum sodium concentration group (≤ 139 mEq/L) was 59.7%. Clinicopathological factors showed significant differences between the two groups for leukocyte count, neutrophil count, C-reactive protein, tumor size, and pleural invasion. Low-serum sodium concentration, which was associated with tumor status and inflammation, had negative prognostic influence in completely resected NSCLC.

Clinical relevance of Y-linked CNV screening in male infertility: new insights based on the 8-year experience of a diagnostic genetic laboratory

AZF microdeletion screening is routinely performed in the diagnostic work-up for male infertility; however, some issues remain debated. In this study, we provide insights into the sperm concentration cutoff value for routine testing, the predictive value of AZFc deletion for testicular sperm retrieval and the Y-background contribution to the interpopulation variability of deletion frequencies. In the Spanish population, partial AZFc rearrangements have been poorly explored and no data exist on partial duplications. In our study, 27/806 (3.3%) patients carried complete AZF deletions. All were azoo/cryptozoospermic, except for one whose sperm concentration was 2 × 10(6)/ml. In AZFc-deleted men, we observed a lower sperm recovery rate upon conventional TESE (9.1%) compared with the literature (60-80% with microTESE). Haplogroup E was the most represented among non-Spanish and hgr P among Spanish AZF deletion carriers. The analysis of AZFc partial rearrangements included 330 idiopathic infertile patients and 385 controls of Spanish origin. Gr/gr deletion, but not AZFc partial duplications, was significantly associated with spermatogenic impairment. Our data integrated with the literature suggest that: (1) routine AZF microdeletion testing could eventually include only men with ≤2 × 10(6)/ml; (2) classical TESE is associated with low sperm recovery rate in azoospermic AZFc-deleted men, and therefore microTESE should be preferred; (3) Y background could partially explain the differences in deletion frequencies among populations. Finally, our data on gr/gr deletion further support the inclusion of this genetic test in the work-up of infertile men, whereas partial AZFc duplications do not represent a risk for spermatogenic failure in the Spanish population.

Population Pharmacokinetics of Lumefantrine in Pregnant and Nonpregnant Women With Uncomplicated Plasmodium falciparum Malaria in Uganda.

Pregnancy alters the pharmacokinetic properties of many antimalarial compounds. The objective of this study was to evaluate the pharmacokinetic properties of lumefantrine in pregnant and nonpregnant women with uncomplicated Plasmodium falciparum malaria in Uganda after a standard fixed oral artemether–lumefantrine treatment. Dense venous (n = 26) and sparse capillary (n = 90) lumefantrine samples were drawn from pregnant patients. A total of 17 nonpregnant women contributed with dense venous lumefantrine samples. Lumefantrine pharmacokinetics was best described by a flexible absorption model with multiphasic disposition. Pregnancy and body temperature had a significant impact on the pharmacokinetic properties of lumefantrine. Simulations from the final model indicated 27% lower day 7 concentrations in pregnant women compared with nonpregnant women and a decreased median time of 0.92 and 0.42 days above previously defined critical concentration cutoff values (280 and 175 ng/ml, respectively). The standard artemether–lumefantrine dose regimen in P. falciparum malaria may need reevaluation in nonimmune pregnant women.

Cutoff Value of Choline Concentration Reliably Reveals High-Grade Brain Tumors among Other Contrast-Enhancing Brain Lesions

To evaluate whether there is a cutoff value for a metabolite concentration measured by 1 H MR spectroscopy (MRS), which can be used to differentiate malignant brain tumors (high-grade gliomas, primary CNS lymphomas [PCNSL] and metastases) from other contrast-enhancing lesions like low-grade gliomas and non-neoplastic lesions. 1 H MRS was performed in 252 consecutive patients with space-occupying brain lesions which were enhanced with application of a contrast agent. Concentrations of N-acetyl-aspartate, total creatine, choline containing metabolites (total choline, tCho), lipids, and lactate were evaluated from the contrast-enhancing part of the lesions and from the normal appearing brain tissue. Linear discriminant analysis was used to find the best predictor for malignant brain tumors. In addition, receiver operating characteristic analysis (ROC) was performed to determine a cutoff value for the best predictor in detecting malignant brain tumors with a specificity of >95%. All brain tumors and 20 out of 47 nonneoplastic lesions were examined histopathologically. The remaining 27 diagnoses were based on MR imaging, clinical findings, and follow-up. The final diagnosis was 134 high-grade gliomas (WHO grade III/IV), 36 metastases, 9 PCNSL, 8 low-grade gliomas (WHO grade I/II), 34 infections, 9 infarctions, 2 hematomas, and 2 vasculitides. 18 patients were excluded due to insufficient spectral quality. The tCho concentration was the best predictor to differentiate malignant brain tumors from enhancing low-grade gliomas or non-neoplastic lesions (F=26.6 [df: 25.833], p<0.0005). The ROC revealed that a cutoff tCho value, based on an increase of ≥40% compared to normal, yielded a specificity of 100% and a sensitivity of 89.4% to correctly diagnose a malignant brain tumor. 1 H MRS reliably differentiates malignant brain tumors from other contrast-enhancing brain lesions. At least a 40% increase of tCho compared to normal brain tissue indicates a malignant tumor (WHO grade III/IV gliomas, PCNSL, metastases) with >90% specificity and sensitivity.

Cutoff Value of Choline Concentration Reliably Reveals High-Grade Brain Tumors among Other Contrast-Enhancing Brain Lesions

Cutoff Value of Choline Concentration Reliably Reveals High-Grade Brain Tumors among Other Contrast-Enhancing Brain Lesions

Clinical Significance of Plasma Ammonia in Patients With Traumatic Hemorrhage

Hemorrhagic shock has been reported to elevate the concentration of ammonia in the blood of animals. However, only one clinical study, of a few surgical patients, found a similar effect. This investigation sought to determine whether ammonia is elevated in the plasma of trauma patients with hemorrhage and whether it could be used to predict serious hemorrhage. Subjects were consecutive trauma patients admitted to our Level I trauma center between November 2006 and April 2008 who met the inclusion criteria to determine plasma ammonia. Their blood was sampled at admission. Patients who required blood transfusion > or = 2 U or intervention for bleeding within 24 hours were classified into a bleeding group. Patients who did not require a transfusion or interventions were classified as controls. In addition to routine hemodynamic measurements, we recorded the hourly infused volume of Ringer's lactate solution (infusion volume) during emergency room treatment and total transfused blood volume within the first 24 hours. The subjects were 282 trauma patients. Their mean age was 44.0 +/- 20.4 years old, and their mean injury severity score was 15.8 +/- 13.1. Ammonia was significantly correlated with systolic blood pressure, shock index at admission, infusion volume, base deficit, and injury severity score. Forty-one patients required blood transfusion and 31 needed intervention for arterial bleeding. Because some patients required both therapies, the bleeding group consisted of 46 patients. The control group consisted of 236 patients who needed neither blood transfusion nor intervention. The plasma ammonia concentration in the bleeding group (113 +/- 52.2 microg/dL) was significantly higher than in the control group (55.4 +/- 20.8 microg/dL). In the bleeding group, the ammonia concentration of patients who died from bleeding (170 +/- 68.7 microg/dL) was significantly higher than in survivors (102 +/- 40.7 microg/dL). The best ammonia concentration cutoff value that maximized sensitivity and specificity to select for the bleeding group was > or = 77 microg/dL (sensitivity, 82%; specificity, 89%). Elevated plasma ammonia concentration at admission can be a clinically significant indicator for traumatic hemorrhage that requires treatment.

Plasma B-type natriuretic peptide in diagnosing inferior myocardial infarction with right ventricular involvement

B-type natriuretic peptide (BNP) is secreted from the ventricles in response to volume expansion and pressure overload. We aimed to investigate plasma BNP levels in inferior myocardial infarction (MI) with and without right ventricular MI (RVMI). We enrolled 49 patients (mean age: 60+/-10 years, 45 males) who were admitted with first acute inferior MI. Sixteen patients (mean age: 58+/-10 years, 15 males) had also RVMI. The BNP levels were measured at admission. All patients underwent echocardiographic examination in the first day of hospitalization. Receiver-operating characteristic curve was obtained for prediction of inferior MI with RVMI. Inferior MI with RVMI had lower RV fractional area change (36+/-14% vs. 48+/-15%, P=0.03) and right ventricle lateral annulus S velocity (10.6+/-1.9 m/s, 12.2+/-2.6 m/s, P=0.02). The BNP levels were higher in inferior MI with RVMI than isolated inferior MI (75+/-44 pg/ml vs. 32+/-24 pg/ml, P=0.001). On the basis of the receiver-operating characteristic analysis, the cutoff value of BNP concentration >46 pg/ml provided the best discrimination of patients with and without RVMI (sensitivity 76%, specificity 88%) with positive and negative predictive values of 92 and 63%, respectively. Plasma BNP levels are higher in inferior MI with RVMI than isolated inferior MI. RV involvement may be suspected when BNP levels are higher than 46 pg/ml in inferior MI.

Discriminative procalcitonin values for diagnosis of systemic inflammatory response syndrome and sepsis in the ICU

No study has found a procalcitonin level that distinguishes between systemic inflammatory response syndrome (SIRS) and sepsis [1]. The goal of our study was to determine a cutoff value of serum procalcitonin concentration for diagnosis of SIRS and sepsis.

Peak C-Reactive Protein Concentration Correlates With Left Ventricular Thrombus Formation Diagnosed by Contrast Echocardiographic Left Ventricular Opacification in Patients With a First Anterior Acute Myocardial Infarction

Wall motion abnormality in the apical legion of the left ventricle (LV) with stagnant flow alone is not sufficient to identify patients at high risk for LV thrombus formation among those with first anterior acute myocardial infarction (AMI). The aim of this study was to identify the determinants of LV thrombus formation using contrast echocardiography. In 75 patients with first anterior AMI, standard and contrast echocardiography was performed to detect LV thrombus. Although LV thrombus was found in 10 patients (13%) using standard echocardiography, it was found in 15 patients (20%) using contrast echocardiography. Apical stagnant flow was observed in 14 patients (93%) with LV thrombus. In addition, patients with LV thrombus had a higher peak C-reactive protein (CRP) concentration (18.2+/-4.3 vs 7.9+/-5.5 mg/dl, p<0.0001). In multivariate analysis, only peak CRP concentration was identified as an independent predictor of LV thrombus (p=0.02, odds ratio: 1.400, confidence interval: 1.040-1.884). The receiver-operating characteristics (ROC) analysis revealed the best cutoff value of a peak CRP concentration >10.7 mg/dl to identify patients with LV thrombus (sensivity 0.93, specificity 0.75, area under ROC curve 0.91). The peak CRP concentration is a useful marker of patients with first anterior AMI who are at high risk for LV thrombus.

Lamellar body concentrations and the prediction of fetal pulmonary maturity

OBJECTIVE: Amniotic fluid lamellar body concentration was quantified in pregnancy and compared with the lecithin/sphingomyelin ratio and phosphatidylglyceryl to predict fetal lung maturity. STUDY DESIGN: Amniotic fluid was obtained from 56 patients at various gestational ages (16 to 42 weeks) and quantified on a Coulter counter set for particle size used for platelets (2 to 20 fl). The lamellar body concentration best agreeing with a mature lecithin/sphingomyelin ratio of 2 and with phosphatidylglycerol was determined. The lamellar body concentration cutoff was compared with the lecithin/sphingomyelin ratio and phosphatidylglycerol as a predicator of fetal lung maturity. RESULTS: Lamellar body concentration increased exponentially with gestation (r = 0.70, p < 0.001), as did the lecithin/sphingomyelin ratio (r = 0.78, p < 0.001). The two tests correlated with each other linearly (r = 0.67, p < 0.001). The lamellar body concentration cutoff value that best agreed with both mature lecithin/sphingomyelin ratio and phosphatidylglycerol was 30,000/μl (κ-test 0.66 and 0.73, respectively). In 28 patients delivered within 72 hours the lamellar body concentration correctly predicted four cases of respiratory distress syndrome (100% sensitivity and specificity). CONCLUSION: This study confirms that lamellar body concentration is a reliable and practical assay and should be evaluated further, especially for use in a community hospital setting. (AM J OBSTET GYNECOL 1994;170:72-6.)

What is a normal stimulated growth hormone concentration?

In a retrospective analysis, we have compared the response of serum GH concentration to insulin-induced hypoglycaemia in 148 short prepubertal children (114 males, 34 females) aged between 3.9 and 11.9 years with the growth rate of the individual to determine 'cut-off' values for the diagnosis of GH insufficiency. Sixty-three children grew with a height velocity standard deviation score (SDS) greater than -0.8 (group 1), which represents the growth velocity of children progressing along or closely parallel to the third height centile. Eighty-five children had a height velocity SDS of less than -0.8 (group 2). Median peak serum GH concentration responses to insulin-induced hypoglycaemia were 19.9 mU/l (range 1.5-54.4) in group 1 and 9.9 mU/l (range 0.7-46.2) in group 2 (Mann-Whitney; P less than 0.001). Using growth rate as the determinant of normality, the efficiency, sensitivity and specificity of the insulin-induced hypoglycaemia test were calculated using different serum GH concentration cut-off values to diagnose GH insufficiency. In our (Hybritech) assay, a cut-off value of 13.5 mU/l provided optimal performance in terms of efficiency (66%), sensitivity (64%) and specificity (70%). The response of serum GH concentration to insulin-induced hypoglycaemia in short children growing at different growth rates was continuous. Each laboratory measuring serum GH concentrations needs to construct its own 'normal' cut-off value.