Cutoff Value For Patients Research Articles

Exploring the relationship between malnutrition and the systemic immune-inflammation index in older inpatients: a study based on comprehensive geriatric assessment

BackgroundMalnutrition is a prevalent and major challenge among senior citizens, possibly due to the continual low-grade inflammatory state of the body. A novel inflammatory parameter, the systemic immune-inflammation index (SII), is highly valuable in evaluating and predicting the prognosis of a wide range of diseases. This study aims to explore the significance of the SII in assessing malnutrition in older inpatients.MethodsThis retrospective study included 500 senior hospitalized patients who met the inclusion and exclusion criteria from the Comprehensive Geriatric Assessment database of the First Hospital of Jilin University. The Mini-Nutritional Assessment (MNA) questionnaire was used to evaluate the nutritional status of patients. The SII was calculated using complete blood counts, and we performed natural logarithm transformation of the SII [ln(SII)]. Multivariable logistic regression analysis was used to identify the association between ln(SII) and malnutrition. To ensure the stability of the findings, a sensitivity analysis was conducted.ResultsThe 500 patients had a mean age of 77.29 ± 9.85 years, and 68.6% were male. In accordance with the MNA, 30.4% of the patients were malnourished or at risk of malnutrition, and patients in this group had considerably greater levels of ln(SII) than patients with adequate nutrition (P < 0.001). The optimum ln(SII) cutoff value for patients with malnutrition or at risk of malnutrition was 6.46 (SII = 635.87) with 46.7% sensitivity and 80.2% specificity [95% CI: 0.613–0.721, AUC: 0.667, P < 0.001]. Multivariable logistic regression demonstrated that ln(SII) was an independent risk factor for the risk of malnutrition or malnutrition in older individuals (OR 3.984, 95% CI: 2.426–6.543, P < 0.001). Other metrics from the geriatric comprehensive assessment, including body mass index, calf circumference, fat ratio, activities of daily living and instrumental activities of daily living, and geriatric depression scale scores, were also independently correlated with nutritional status.ConclusionsAccording to our research, a high SII is an independent predictor of older inpatient malnutrition, and the SII aids in screening for malnutrition and may be a potential target for intervention. Comprehensive geriatric assessment parameters such as BMI, calf circumference, fat ratio, activities of daily living and depression were also linked to malnutrition.

Abstract 16671: Supraventricular Ectopic Activity Predicts Postoperative Atrial Fibrillation, New-Onset Atrial Fibrillation, and Worse Survival in Hypertrophic Cardiomyopathy

Introduction: Supraventricular ectopic activity (SEA), in the form of frequent premature atrial contractions (PACs) and runs of PACs, has been considered a marker of foci that are capable of firing rapidly to initiate atrial fibrillation (AF), but the cut-off value has not been determined. Therefore, we aimed to examine the association between SEA and postoperative AF (POAF) and clinical outcomes and to investigate the cut-off value in patients with hypertrophic cardiomyopathy. Methods: This cohort included 1491 consecutively recruited patients, of which 530 were excluded for various reasons, leaving 961 patients for final analysis. All patients received 24-hour Holter ECG monitoring 2-5 days before surgery. Results: The mean age of the study population was 48.4 (SD,12.3) years and 397 patients (41.3%) were female. The incidence of POAF was 20.7% and increased with PACs severity. Multivariable logistic regression analysis showed that supraventricular tachycardia (SVT) was independently associated with higher incidence of POAF and the model including SVT had the largest area under the curve (AUC) [AUC=0.710] among all the multivariable models. Furthermore, Kaplan-Meier survival curves demonstrated that patients in the tertile 3 (upper tertile of the total numbers of PACs), PACs&gt;100, PACs &gt;200, ESVEA (top decile of PACs plus top decile length of short atrial runs), and ESVEA3 (PACs&gt;100 plus top decile length of short atrial runs) group had significantly higher cumulative rates of new-onset AF and composite endpoints compared to their counterparts. On multivariable Cox regression analysis, PACs&gt; 100, PACs&gt;200, ESVEA, and ESVEA3 were independent indicators for higher incidence of new-onset AF and composite endpoints. Among those multivariate models, PACs &gt;200 had the higher effect size for predicting new-onset AF [Hazard ratio (HR) 3.13, 95% confidence interval (CI) 1.74-5.62] and composite endpoints [HR =2.00, 95%CI 1.30-3.06]. Conclusions: The incidence of POAF was 20.7% increasing with the severity of the PACs burden. Moreover, among supraventricular arrhythmias, SVT was the best indicator for predicting POAF. Likewise, PACs&gt;200 may consider as the best candidate for predicting a higher incidence of new-onset AF and composite endpoints.

Comparison of the effectiveness of delirium evaluation tools in intensive care patients: pre-deliric versions 1 and 2, E-pre-deliric and ICDSC.

This study's objective was to compare the effectiveness of the delirium prediction model (pre-deliric) and the early prediction model (E-pre-deliric) in delirium prediction in an intensive care unit (ICU) according to the Intensive Care Delirium Screening Checklist (ICDSC). Our aim was to determine these models' usability and cut-off values for ICU patients. We classified the studied patients based on their highest ICDSC scores (tested twice daily) during ICU hospitalization. ICDSC scores of 4 or higher indicated positive results for delirium, whereas a score of 0 represented a negative result. We recorded the patients' demographic and clinical details and characteristics and calculated their E-pre-deliric and pre-deliric version 1 and version 2 scores. To evaluate the effectiveness of the models, we used receiver operating characteristic (ROC) curve analysis. Two hundred fifty patients (55.6% males, mean age 60.6±18.7 years) participated in this study. Their mean Acute Physiology and Chronic Health Evaluation II (APACHE-II) score was 17.0±9.1. Delirium was more common in men, patients of older ages, those with high APACHE-II scores, those who had undergone urgent admissions, those with histories of trauma, those with high urea or creatinine values and those who had undergone sedation or mechanical ventilation. Compared to patients who did not develop delirium, those who did had longer ICU stays and hospital stays, as well as greater mortality risk. The cutoff values for the patients' pre-deliric version 1, pre-deliric version 2 and E-pre-deliric scores were 38% [area under ROC (AUROC)=1], 22% (AUROC=1) and 28% (AUROC=1), respectively. This study is the first to compare the pre-deliric and E-pre-deliric prediction models. These models' validity and reliability were acceptable. They were clinically useful, and we identified their cut-off values. These models provide options for early detection of delirium and are easily applicable in the ICU.

Determination of anti-HCV signal to cut-off value in patients with hepatitis C virus infection and the variety of antibody responses

Objectives: The diagnosis of hepatitis C virus (HCV) infection starts with the detection of antibodies against recombinant or synthetic HCV proteins by Enzyme Immunoassay (EIA). Although EIA tests are highly sensitive, false positivity rates are not low. Positive anti-HCV results are generally confirmed with complementary tests such as Nucleic Acid Amplification Tests (NAAT), or Western Blot modifications. Methods: The anti-HCV results of 199,516 individuals referred from various clinics between 2015 and 2019 were evaluated retrospectively at University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Medical Microbiology Laboratory. From the 2039 samples, of which EIA tests resulted borderline and reactive, 1419 samples having Line Immunoassay (LIA) confirmatory test results were included in the study. Results: LIA tests yielded positive, negative and indeterminate for 820 (57.8%), 519 (36.6%) and 80 (5.6%) of 1419 samples, respectively. The optimal threshold point for EIA anti-HCV signal to cut-off (S/Co) according to LIA was found to be 15.85 corresponded to diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 94.9%, 94.8%, 96.6%, 92.1%, 94.9%, respectively. The most common proteins detected in LIA positive samples were C1 96.3%, C2 90.4%, and NS3 93.2%. Conclusions: To prevent false positivities, confirmatory tests must be used for samples with low S/Co ratios. The use of S/Co value will make significant contribution to reducing both false-positive results and the LIA confirmatory test consumption. There was no correlation between the number of bands and EIA index values in LIA positive samples, while the relationship between the number of 3+ bands and index values was remarkable.

Can we predict the need for postnatal surgery in patients with prenatal fetal lung masses detected by CVR value?

The purpose of this study is to evaluate whether CPAM-volume ratio (CVR) can predict postnatal management (follow up for resolution and surgical treatment) in fetuses with fetal lung masses in the prenatal period. 44 patients who presented at our center with prenatally diagnosed CPAM (Congenital Pulmonary Airway Malformation) and BPS (Bronchopulmonary Sequestration) were analyzed. Obstetric history and outcomes, karyotype results, CVR, additional sonographic findings, characteristics of masses were recorded. CVR was calculated for all cases. İn the study we sought to identify a CVR threshold and did not use the thresholds classically used in the literature. 20 fetal BPS and 24 CPAM cases were analyzed. After excluding 5 patients, 46% of the patients were diagnosed with BPS and 54% with CPAM. İn this study the cut off < 0,53 for CVR is taken, it predicts the no need for postnatal surgery with a sensitivity of 85% and a specificity of 88%. When we take the > 0,76 cut-off value for patients who will require emergency surgery within the first 10 days, it predicts the need for surgery with 90% sensitivity and 89% specificity. In addition, it was determined that all patients with mediastinal shift were operated. We believe that the CVR value and the presence of mediastinal shift should be evaluated in all cases of CPAM and BPS for prediction of the surgery. Proper counseling about the prognosis could be given to the family in cases with mediastinal shift and CVR value above 0,76.

Association between Inflammatory Markers and the Outcome of Critically Ill COVID-19 Patients

Background: Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). It had emerged from Wuhan, China and has rapidly spread around the world. In critically ill patients, the mortality rates are significantly high. This study analyzed the various inflammatory markers and their association with patient mortality, thus helping to identify critically ill patients with a high possibility of worsening prognosis. Materials and Methods: In this multicenter, prospective study, 85 patients were included and were followed until either of two outcomes was achieved: patients were successfully discharged or patients expired at the ICU. Correlation between the patient outcome and inflammatory markers were analyzed. Cut-off values for patients with worse prognosis were speculated through ROC curve. Results: Significantly, mortality was associated with CRP (P&lt;0.001), d-dimer (P&lt;0.001)., LDH (P=0.001), IL-6(P&lt;0.001), serum ferritin(P=0.001), procalcitonin (P&lt;0.001)along with neutropenia (P&lt;0.001) and lymphocytosis (P&lt;0.001). Conclusion: With the following inflammatory markers such as CRP, d-dimer, LDH, IL-6, procalcitonin and serum ferritin, patients who have a worse prognosis can be identified among the critically ill patients at the ICU. Hence, close monitoring and early management of such patients can help improve their prognosis.

Presepsin cut-off value for diagnosis of sepsis in patients with renal dysfunction.

Presepsin is used as a marker for diagnosing sepsis, but its serum concentration is affected by renal function. We investigated the effect of the estimated glomerular filtration rate (eGFR) determined by creatinine on the diagnostic accuracy of presepsin to identify the optimal cut-off value in patients with renal dysfunction. A total of 834 patients aged ≥18 years with serum presepsin and creatinine measured on the same day over a period of 1 year were included. Sepsis was diagnosed in three ways: sepsis-1, sepsis-3, and clinical diagnosis (Sep-C). Presepsin showed a significant negative correlation with eGFR (r = -0.55, p<0.01), with median and interquartile ranges of presepsin values for patients in each eGFR category as follows: ≥90, 263 (169-460); ≥60-<90, 309 (205-578); ≥45-<60, 406 (279-683); ≥30-<45, 605 (379-1109); ≥15-<30, 1027 (675-1953); <15, 1977 (1199-3477); and on hemodialysis, 3964 (2343-6967). In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for sepsis-1 was the lowest (0.64 ± 0.02), while Sep-C (0.80± 0.03) and sepsis-3 (0.75 ± 0.03) were moderately accurate. Comparing AUCs after dividing patients into eGFR ≥60 and <60 showed that the AUC of Sep-C was lower in the eGFR ≥60 group, while the AUC of sepsis-3 was ≥ 0.7 in both groups. The following cut-offs were obtained by ROC analysis for sepsis-3: 466 pg/mL in the ≥60 group and 960 pg/mLin the < 60 group. Presepsin facilitated diagnosis sepsis based on sepsis-3 criteria regardless of renal function. We found that the optimal cut-offs for patients in this study were 500 pg/mL for eGFR ≥ 60 and 1000 pg/mL for < 60. However, future prospective diagnostic studies on sepsis-3 are needed to determine the cut-offs for patients with renal dysfunction.

Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study.

Background: This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient’s condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival. Results: Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 μg/dL; values were different for patients with ROSC (96.5 μg/dL) and those without ROSC (156 μg/dL) at hospital arrival. Conclusions: Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.

Sensitivity and specificity of four screening sleep-disordered breathing tests in patients with and without cardiovascular disease.

ObjectivesPolysomnogram is the gold standard for the diagnosis of sleep-disordered breathing (SDB); a sensitive and specific alternative strategy would be ideal, due to its low availability, and screening patients at high risk of OSA is very important. This study aimed to determine the operating characteristics of screening tests in patients with and without cardiovascular disease (CVD).Material and MethodsEpworth sleepiness scale (ESS), Berlin, STOP-bang and Pittsburgh sleep quality index (PSQI) were applied in adults with and without cardiovascular disease in three Colombian cities, as well as anthropometric measurements and a polysomnogram. Operating characteristics were calculated for each test and the best cut-off values in patients with and without CVD were obtained.Results964 patients (median age: 58), 662 with and 302 without CVD were included. The prevalence for SDB (AHI =5) were 43.4 % (OSA), 16.2% (central apnea), and 12.4 % (other). In patients without CVD, the highest sensitivity for OSA and central apnea was for PSQI (80-85%). The highest specificity was for STOP-bang (68%) and Berlin (78.6%). In CVD the best sensitivity was for PSQI (81.9%) followed by Berlin (71.9%) and the best specificity for STOP-bang (82.1%). No isolated questionnaire showed good diagnostic performance (AUC=0.6) and the cut-off values had no variations except for ESS.ConclusionScreening tests showed low operating characteristics for the diagnosis to SDB, but better performance in patients with CVD. They are not recommended as the only diagnostic test, but they can be useful to guide the initial diagnostic process.

Application of Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping Score for Efficacy of Clopidogrel: Secondary Analysis of the CHANCE Trial.

The age, body mass index, chronic kidney disease, diabetes, and genotyping (ABCD-GENE) score is a validated risk score integrating CYP2C19 genotypes with clinical risk factors influencing clopidogrel response that would allow the more precise identification of subjects at risk for high platelet reactivity and adverse clinical outcomes. Our objective was to further verify application of the ABCD-GENE score and investigate appropriate cutoff value in patients with minor stroke or transient ischemic attack. In this post-analysis of the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events), the ABCD-GENE score was calculated for all patients enrolled in this study. By using the proposed cutoff of 10, patients were stratified as being at high risk for high platelet reactivity or not. We further categorized the ABCD-GENE score to 0 to 5, 6 to 24, and >24 to investigate the cutoff value of this scale in clinical application. Stroke recurrence at 3 months was considered as the primary outcome. Among a total of 2923 patients with minor stroke/transient ischemic attack, there were 2273 (77.76%) with ABCD-GENE score <10 and 650 (22.24%) patients with ABCD-GENE score ≥10. Compared with the aspirin alone, hazard ratios (95% CIs) of the clopidogrel-aspirin therapy for stroke recurrence were 0.70 (0.54-0.91) and 0.76 (0.46-1.24), among patients of ABCD-GENE scores <10 and ABCD-GENE scores ≥10, respectively. Stratified analyses by ABCD-GENE score 0 to 5, 6 to 24, and >24, hazard ratios of the clopidogrel-aspirin therapy for stroke recurrence were 0.57 (95% CI, 0.38-0.85), 0.78 (0.58-1.06), and 1.20 (0.44-3.28) (P value for trend=0.0052). Among Chinese minor stroke/transient ischemic attack population, the efficacy of clopidogrel-aspirin therapy was decreased in patients with higher ABCD-GENE score. Our study suggests that CYP2C19 genotypes and clinical risk factors can be integrated by ABCD-GENE score to estimate the efficacy of clopidogrel-aspirin therapy.

A single-center prospective study: assessment of coronary arteries during routine echocardiography; feasibility and prognostic value

Abstract Background Previous pilot studies have shown a significant diagnostic value of coronary artery (CA) velocity parameter assessment acquired during echocardiography examinations [1]. The main limitations for the assessment of CA are considered low feasibilities and unknown cut-off values for patients' prognosis. Aims of the study were the evaluation of the feasibility of left-sided coronary artery assessment during echocardiography and its prognostic value analysis in non-selected patients' population. Methods This is a single-center prospective study. All consecutive patients who were referred to echocardiography were included in the study by having additional scans of left-sided CA. One thousand four hundred and fifty-one (1,451) consecutive patients were prospectively included in the study during two years (769 women, 59±14 years old). Death from any cause and nonfatal myocardial infarction (MI) were defined as primary end-points; revascularization cases were analyzed separately. Results It was feasible to assess velocities in left-sided CA in 1,231 patients (85%; 95% CI 83–87%). The feasibility was 82% during the first year and 90% during the second year. Over a median follow-up of 36 months, there were 42 deaths and 17 nonfatal MI and 198 patients underwent revascularization. Maximal proximal velocity (OR 1.01, CI 1.01–1.02, p&amp;lt;0.0006) and age (OR 1.07, CI 1.04–1.10, p&amp;lt;0.0001) were proven to be independent prognostic predictors of mortality. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p&amp;lt;0.0001), ejection fraction (OR 0.98, CI 0.95–0.99, p&amp;lt;0.04), and age (OR 1.05, CI 1.03–1.08, p&amp;lt;0.0003) were independent prognostic predictors for death/MI. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p&amp;lt;0.0001), smoking (OR 1.6, CI 1.1–2.4, p&amp;lt;0.02), and diabetes mellitus (OR 1.75, CI 1.2–2.4, p&amp;lt;0.003) were independent prognostic predictors for revascularization. The cut-off value for maximal proximal for predicting death within 36 months was 67 cm/s. Sensitivity was 67% and specificity was 75%, with an area under the ROC curve of 0.77, p&amp;lt;0.0001. Maximal velocity of 66 cm/s predicted death/MI with sensitivity 74%, specificity 75% (area under the ROC curve of 0.79, p&amp;lt;0.0001) were cut-off values. Conclusion Assessment of left-sided CA during echocardiography is a feasible and prognostically valuable method. Accelerated velocity in proximal part of CA is associated with a poor prognosis. Funding Acknowledgement Type of funding sources: None.

Which skin prick test wheal size detects true allergy to Salsola kali?

Background. Sensitization to Salsola kali (Sk) weed pollen allergen is the most common cause of seasonal allergic rhinitis (SAR) in Middle East countries. Aim. To identify Salsola kali skin prick test (SkSPT) wheal size cut-off, able to determine true allergy among adult patients with moderate to severe SAR, who are in need of Salsola kali allergen specific immunotherapy (SkAIT). Methods. In 151 adults with moderate to severe SAR, mean age 32.79 ± 10.79 years, of both gender (females: 43.05%), with a positive SkSPT, (i.e., cut off wheal longest diameter of 3 mm) and one or more other local weed pollens, Salsola kali nasal provocation test (SkNPT) was carried out. Response was assessed both subjectively, with scores, and objectively, by measuring peak nasal inspiratory flow (PNIF). Safety profile of SkNPT was assessed using peak expiratory flow rate (PEF) measurements. Results. SkNPT positive response was found in 125 patients (82.78%). Mean skin prick test (SPT) wheal size to Sk was bigger in the nasal provocatin test (NPT) positive group (9 mm) compared to the NPT negative patients (5 mm), p less than 0.0001. ROC analysis showed that a SPT wheal size to Sk at the threshold of > 7.5 mm enabled identification of SkNPT positivity with a sensitivity of 73.6% and specificity of 100.0% (area under the curve 0.9498, standard error 0.01808; 95% confidence interval (CI): 0.9144 to 0.9853; p less than 0.0001). Conclusions. SPT wheal size of 3 mm might overestimate the presence of real allergy to Sk in a desert environment. A SPT wheal size > 7.5 mm for Sk appears to distinguish individuals who develop disease from those who does not. Physicians should select the proper SPT wheal size value as an appropriate criterion according to the allergen than using a uniform cut off value in patients eligible for SkAIT.

Coagulation and Fibrinolysis Biomarkers as Potential Indicators for the Diagnosis and Classification of Ovarian Hyperstimulation Syndrome

Background: Accurate diagnosis and classification of ovarian hyperstimulation syndrome (OHSS) is important for its management. We employed a new high-sensitivity chemiluminescence immunoassay to detect the thrombin-antithrombin complex (TAT), plasmin alpha2-plasmin inhibitor complex (PIC), soluble thrombomodulin (sTM), and tissue plasminogen activator-inhibitor complex (TPAI-C), and evaluated their diagnostic and classification performance for OHSS.Methods: A total of 106 women were enrolled, including 51 patients with OHSS (25 mild or moderate OHSS, 26 severe OHSS), and 55 without OHSS (control group). TAT, PIC, sTM, and TPAI-C levels were measured using the Sysmex HISCL5000 automated analyzer.Results: Compared to the control group, TAT, PIC, and TPAI-C levels were significantly higher (P < 0.001, P < 0.001, P < 0.001, respectively), whereas the sTM level was significantly lower (P < 0.001) in the patients with OHSS. The receiver operating characteristic was used to evaluate the diagnostic efficiency. For the diagnosis of OHSS, the area under the curves (AUCs) for TAT, PIC, sTM, and TPAI-C were 0.991, 0.973, 0.809, and 0.722, respectively. In particular, the sensitivity, specificity, positive predictive value, and negative predictive value for TAT and PIC were all above 90%. For the differential diagnosis of mild–moderate and severe OHSS, the AUCs for TAT, PIC, and TPAI-C were 0.736, 0.735, and 0.818, respectively. The cutoff values of TAT, PIC, and TPAI-C for the differential diagnosis of mild–moderate and severe OHSS were 11.5 ng/mL, 2.4 μg/mL, and 5.8 ng/mL, respectively. Based on these cutoff values, eight cases of mild–moderate OHSS exceeded the cutoff values, two of which developed to severe OHSS in the following days. However, of the remaining 17 cases of mild–moderate OHSS patients with negative biomarkers, none subsequently developed severe OHSS.Conclusions: TAT, PIC, sTM, and TPAI-C can be used as sensitive biomarkers in the diagnosis of OHSS. Meanwhile, TAT, PIC, and TPAI-C also displayed remarkable potential in the classification of OHSS. In addition, the levels of TAT, PIC, and TPAI-C above the cutoff values in patients with mild–moderate OHSS might predict a high risk of developing severe OHSS.

MO175TROPONIN CUT-OFFS FOR ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH IMPAIRED RENAL FUNCTION - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and Aims Background Identifying acute myocardial infarction in patients with renal disease is notoriously difficult due to atypical presentation and chronically elevated troponin. Aim To generate an optimized troponin cut-off value for patients with impaired renal function and acute myocardial infarction via meta-analysis. Method Two investigators screened 2,580 publications from Medline, Embase, Pubmed, Web of Science and Cochrane library. Only studies that investigated alternative cut-offs according to renal impairment were included. 15 articles fulfilled the inclusion criteria and results were included in a meta-analysis. Study characteristics and cut-off values were extracted. Study quality and risk of bias were assessed by using QUADAS-2 score. Six studies were included in the meta-analysis. To calculate the optimal cut off value in accordance to AUC for troponin T and troponin I in patients with renal impairment a bivariat mixed effect model on the sensitivity and specificity transformed by way of the inverse probit function similar to the model implemented in the R-package diagmeta was employed. Results Review: There was a considerable diversity in study design, study population and endpoint definition. The cut-off value for patients on peritoneal dialyses was twice as high (144 ng/L) when compared to patients on hemodialysis (75 ng/l). Asian studies suggested a substantially higher troponin cut-off when compared to European and American studies. The risk of bias was low in the analyzed studies, yet several studies were considered to have a low applicability. Meta-analysis Cut-off value for troponin T in patients not in dialysis with eGFR &amp;lt;60 ml/min/1.73m2, a troponin T value of 47.89 ng (23.95; 71.83) was found. In patients on dialysis a troponin T value of 239.75 ng/l ( 69.27 ; 410.23) was demonstrated. The 99th percentile of the upper reference limit for troponin T was 14 ng/l. Cut-off value for troponin I: In patients not in dialysis with eGFR &amp;lt; 60 ml/min/1.73m² a troponin I value of 42.45 ng/l ( 33.83 ; 51.08 ) was demonstrated. The 99th percentile of the upper reference limit for troponin I ranged from 9-42 ng/l depending on the assays used. Troponin I cut-off for patients in dialysis could not be calculated due to limited data. Conclusion The new cut-off values could help to identify patients whose troponin suggests acute myocardial infarction rather than renal function related troponin elevation. The meta-analysis is based on only six studies in total. Further subdivision according to eGFR would be desirable in order to optimize troponin cut-off values especially for dialysis patients. A differentiation on troponin cut-offs for HD and PD patients may yield further benefits. Asian studies suggested a substantially higher troponin cut-off when compared to European and American studies. The factors behind these findings may be worth investigating.

Determination of the optimal cutoff values and validity of the Purdue Pegboard Test

Introduction The Purdue Pegboard Test (PPT) is crucial for assessing fine dexterity of patients with hand injury. Determining the PPT cutoff value is needed to distinguish patients with impaired hand dexterity from those with unimpaired hand dexterity. The aim of this article is to examine the construct validity of PPT and to determine its cutoff values for patients with hand injuries. Method The PPT and Disabilities of Arm Shoulder and Hand Questionnaire Turkish version (DASH-T) were used to measure hand dexterity. To examine construct validity, we measured the correlation between PPT and DASH-T. The cutoff values were determined using the receiver operating characteristic (ROC) curve generated with sensitivity and 1-specificity. We recruited 101 patients with hand injury and 162 healthy participants. Results Correlation between all subtests of PPT and DASH-T were weak ( r = −0.282; −0.473: p&lt;0.05). The cutoff value for the assembly subtest of PPT was 24.5. The range of area under the curve (AUC) values for PPT subtests was good to excellent (AUC: 0.82–0.92). Conclusion The current study demonstrates that PPT is a valid instrument for measuring hand dexterity in patients with hand injury. Results also suggest that PPT distinguished the patients with impaired hand function from those with unimpaired hand dexterity.

Diagnostic performance of 2D shear wave elastography in predicting liver fibrosis in patients with chronic hepatitis B and C: a histopathologicalcorrelationstudy.

In this study, we investigated the diagnostic efficacy of 2D-Shear Wave Elastography (2D-SWE) in detecting stages of liver fibrosis and determining the disease-specific cut-off values in patients with chronic hepatitis B and C infection, using histopathological analysis as the reference method. Our study included 103 consecutive adult patients with chronic hepatitis B and C infection (CHB and CHC) who had liver biopsy within three months of elastography examination. A real-time 2D-SWE was performed using the LOGIQ E9 system (GE Medical Systems, Wisconsin, USA). The correlation between the liver stiffness measurements and the METAVIR scores was evaluated. The diagnostic performance of 2D-SWE was assessed, and cut-off values were set. We found a statistically significant positive correlation between elastography values and the degree of liver fibrosis (Spearman's correlation coefficient = 0.76 and 0.83 for CHB and CHC; respectively) (p = 0.0001). The stiffness cut-off values were F ≥ 1: 5.92kPa, F ≥ 2: 7.69kPa, F ≥ 3: 8.97kPa, F ≥ 4: 12.15kPa in CHB; and F ≥ 1: 6.09kPa, F ≥ 2: 7.81kPa, F ≥ 3: 9.0kPa, F ≥ 4: 12.47kPa in CHC patients. 2D-SWE is reliable and accurate for the diagnosis of liver fibrosis. In selected patients, 2D-SWE may be useful in reducing the need for liver biopsy when staging fibrosis. Further studies in larger prospective series are needed to confirm these results and determine the most appropriate cut-off values for each stage of liver fibrosis.

The Return-to-Work Self-efficacy Questionnaire (RTW-SE): A Validation Study of Predictive Abilities and Cut-off Values for Patients on Sick Leave Due to Anxiety or Depression

Purpose This study aimed to evaluate the validity of the Return-to-Work Self-efficacy Questionnaire (RTW-SE) in a Norwegian sample of patients with common mental disorders. The secondary aim was to provide validated cut-off scores for the RTW-SE. Methods Among patients receiving work-focused therapy (N = 626), the RTW-SE was measured pre-and post-treatment, and work status was assessed up to one-year post-treatment. The factor structure, internal consistency and construct validity were assessed. Furthermore, post-treatment cut-off scores were calculated using receiver operating characteristic (ROC) analysis for patients on sick leave at baseline (n = 314) and at the end of treatment (n = 145). The predictive ability of the suggested RTW-SE cut-off scores were investigated longitudinally. Results Exploratory principal component analysis identified a one-factor solution with high internal consistency (0.91). RTW-SE exhibited small to moderate negative correlations with measures of depression and anxiety, and was significantly different between subgroups of patients with different work status, supporting construct validity. Pre- and post-treatment RTW-SE scores significantly predicted full return to work at 3, 6 and 12 months post-treatment. ROC analysis suggested an upper cut-off score of 4.6, associated with full RTW, and lower cut-off score of 3.7, associated with partial RTW. These cut-offs showed acceptable discriminative ability and significant longitudinal predictive ability. Conclusion The RTW-SE possesses good psychometric properties and the suggested cut-off scores have significant predictive ability in a clinical setting.

Clinical Usefulness of Serum (1,3)-β-D-glucan to predict invasive candidiasis in patients with severe burn trauma.

(1,3)-β-D-glucan (BD) assays were developed as a method to rapidly diagnose invasive candidiasis (IC). The incidence of fungal infections and the demands for BD assay are gradually increasing in patients with severe trauma and under intensive care. However, the ideal BD cut-off value to predict IC has not been clarified. In this study, we evaluate the predictability of the BD assay and investigate the optimal cut-off value in patients with severe burn injuries. From July to December 2018, 134 samples from 86 patients with severe burns were analyzed. Serum BD levels were measured utilizing a Fungitell (Cape Cod Inc.) assay. A receiver operator characteristic (ROC) curve was generated, and the cumulative progression of IC was studied using a Cox proportional hazards model. Partial dependence plots (PDP) was applied to predict the risk of IC. Eleven patients were diagnosed with IC. BD over 120pg/mL (HR=8.68; P=0.001) was found to be independent predictor of the occurrence of IC, when the multivariable Cox model was adjusted for age, total body surface area, inhalation injury, and antifungal agents. The area under the ROC curve was 0.658 (95% CI, 0.513-0.803), at an optimal cut-off value of 124.7pg/mL. PDP analysis showed the higher predicted IC occurrence at a BD level of 120-150pg/mL and TBSA over 60%. Our findings suggest that BD is an independent predictor for IC, and that a BD level between 120 and 150pg/mL could be utilized for IC prediction.

Follow-up investigation of antibody titers and diagnostic antibody cutoff values in patients with scrub typhus in South Korea

BackgroundScrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Few follow-up studies have assessed antibody titers using serologic tests from various commercial laboratories and the Korea Centers for Disease Control and Prevention (KCDC).MethodsA prospective study to assess the antibody titers in patients with scrub typhus and seroprevalence in individuals undergoing health checkups was conducted using results of immunofluorescence antibody assays (IFAs) and serologic tests, used by the KCDC and commercial laboratories, respectively. The following tests were performed simultaneously: (i) indirect IFA used by the KCDC to detect immunoglobulin (Ig) M and IgG, (ii) IFA used by a commercial laboratory to detect total Ig, and (iii) antibody tests using two commercially available kits.ResultsWhen the IgM and IgG cutoff values (≥1:16 and ≥1:256, respectively) used in the IFA and the total IgG cutoff values (≥1:40) were used in prospective follow-up investigations, the antibody positivity rates of 102 patients with scrub typhus were 44.1, 35.3, and 57.6%, respectively, within 5 days of symptom onset. Among 91 individuals who recovered from scrub typhus, the follow-up IgM, IgG, and total Ig positivity rates for 13 years were 37.4% (34/91), 22.0% (20/91), and 76.9% (70/91), respectively. Among 216 individuals undergoing health checkups, the seroprevalence of IgM was 4.2% (9/216); no seroprevalence of IgG was observed.ConclusionsIFAs used by the KCDC and the commercial laboratory and rapid commercial kits could not distinguish between patients who had recovered from scrub typhus and those who are currently infected with O. tsutsugamushi. In South Korea and other countries, where low antibody cutoff values are used, upward adjustments of cutoff values may be necessary.

Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis.

Background:Pulmonary embolism (PE), depending on the severity, carries a high mortality and morbidity. Proper evaluation, especially in patients with low probability for PE, is important to avoid unnecessary diagnostic testing.Objective:To review the diagnostic utility of conventional versus age-adjusted D-dimer cutoff values in patients 50 years and older with suspected pulmonary embolism.Methods:Systematic review with univariant and bivariant meta-analysis.Data sources:We searched PubMed, MEDLINE, and EBSCO for studies published before September 20th, 2020. We cross checked the reference list of relevant studies that compares conventional versus age-adjusted D-dimer cutoff values in patients with suspected pulmonary embolism.Study selection:We included primary published studies that compared both conventional (500 µg/L) and age-adjusted (age × 10 µg/L) cutoff values in patients with non-high clinical probability for pulmonary embolism.Results:Nine cohorts that included 47 720 patients with non-high clinical probability were included in the meta-analysis. Both Age-adjusted D-dimer and conventional D-dimer have high sensitivity. However, conventional D-dimer has higher false positive rate than age-adjusted D-dimer.Conclusion:Age-adjusted D-dimer cutoffs combined with low risk clinical probability assessment ruled out PE diagnosis in suspected patients with a decreased rate of false positive tests.