Diagnostic Value Of Serum Research Articles

58-Year-Old Woman With Melena

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (T.G.C., B.A.-B.); Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (C.G.L.). A 58-year-old woman presented to the emergency department with a 3-day history of passing dark, tarry stools. Her medical history was notable for symptomatic hemophilia A carrier state, gastroesophageal reflux disease, internal hemorrhoids, papillary thyroid cancer treated with thyroidectomy and radioactive iodine for nodal metastasis with secondary hypothyroidism, and obesity with a recent intentional 22.5-kg weight loss. She reported a 3-day history of passing black, tarry stools, averaging 3 stools per day. She did not have light-headedness on standing, any previous episodes, abdominal pain, vomiting, hematochezia, hematemesis, or history of liver or renal disease or alcohol abuse. She was not taking nonsteroidal anti-inflammatory drugs, iron, bismuth subsalicylate, or antiplatelet or anticoagulant medications. Her family history was notable for adenomatous colonic polyposis (at age 17 years, her son was diagnosed as having adenomatous colonic polyps that necessitated a subtotal colectomy). The patient’s last colonoscopy was 4 years before the current presentation and was negative for masses or polyps. On presentation, she had sinus tachycardia at 110 beats/min with a blood pressure of 111/ 51 mmHg. Examination findings were remarkable for conjunctival pallor and positive results on a fecal occult blood test with melenic stool noted on rectal examination. Examination revealed no abdominal tenderness or stigmata of chronic liver disease. Laboratory testing revealed the following notable results (reference ranges provided parenthetically): hemoglobin, 5.5 g/dL (12.015.5 g/dL); platelets, 179 10/L (150450 10/L); international normalized ratio, 1.0 (0.8-1.2); activated partial thromboplastin time, 27 seconds (28-38 seconds); factor VIII activity, 86% (55%-200%); sodium, 139 mmol/L (135-145 mmol/L); potassium, 4.2 mmol/L (3.6-5.2 mmol/L); serum urea nitrogen, 28 mg/dL (6-21 mg/dL); and creatinine, 0.7 mg/dL (0.6-1.1 mg/dL).

Diagnostic Value of Serum YKL-40 Level for Coronary Artery Disease: A Meta-Analysis.

This meta-analysis aimed to identify the value of serum YKL-40 level for the diagnosis of coronary artery disease (CAD). Through searching the following electronic databases: the Cochrane Library Database (Issue 12, 2013), Web of Science (1945 ∼ 2013), PubMed (1966 ∼ 2013), CINAHL (1982 ∼ 2013), EMBASE (1980 ∼ 2013), and the Chinese Biomedical Database (CBM; 1982 ∼ 2013), related articles were determined without any language restrictions. STATA statistical software (Version 12.0, Stata Corporation, College Station, TX) was chosen to deal with statistical data. Standard mean difference (SMD) and its corresponding 95% confidence interval (95% CI) were calculated. Eleven clinical case-control studies that recruited 1,175 CAD patients and 1,261 healthy controls were selected for statistical analysis. The main findings of our meta-analysis showed that serum YKL-40 level in CAD patients was significantly higher than that in control subjects (SMD = 2.79, 95% CI = 1.73 ∼ 3.85, P < 0.001). Ethnicity-stratified analysis indicated a higher serum YKL-40 level in CAD patients than control subjects among China, Korea, and Denmark populations (China: SMD = 2.97, 95% CI = 1.21 ∼ 4.74, P = 0.001; Korea: SMD = 0.66, 95% CI = 0.17 ∼ 1.15, P = 0.008; Denmark: SMD = 1.85, 95% CI = 1.42 ∼ 2.29, P < 0.001; respectively), but not in Turkey (SMD = 4.52, 95% CI = -2.87 ∼ 11.91, P = 0.231). The present meta-analysis suggests that an elevated serum YKL-40 level may be used as a promising diagnostic tool for early identification of CAD.

Diagnostic value of serum basic Fibroblast Growth Factor in gastric ulcers patients for assessment of wound severity

Diagnostic value of serum basic Fibroblast Growth Factor in gastric ulcers patients for assessment of wound severity

Diagnostic value of serum and joint fluid anti-CCP (citrulline-containing peptide) antibody for rheumatoid arthritis and its relationship with other inflammatory indicators

To investigate the diagnostic sensitivity and specificity of serum and joint fluid citrulline-containing peptide (CCP), variant antibody (anti-CCP antibody) for active rheumatoid arthritis (RA) and to explore their relationship with other clinical inflammatory indicators, the levels of serum and joint fluid anti-CCP antibodies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factors (RF) were detected in 104 active RA patients including 68 with knee joint effusion. The sensitivity of serum anti-CCP antibody to RA was 92.3% (96/104) and that of joint fluid anti-CCP antibody was 82.4% (56/68) (P>0.05). The specificity of serum and joint fluid anti-CCP antibody was 100%. There was no significant correlation between anti-CCP antibody and ESR, CRP, score of DAS28, and RF in RA patients positive for serum anti-CCP antibody (P>0.05). After treatment for half month with integrated traditional Chinese and Western medicine, all indicators were improved. The levels of ESR, CRP, RF, score of DAS28 and serum anti-CCP antibody were decreased significantly after treatment when compared with those before treatment (P<0.05). In our study, two patients with early RA (course<2 months) were negative for serum anti-CCP antibody but positive for joint fluid anti-CCP antibody, and seroconversion was noted with the prolongation of disease duration. Combination of serum anti-CCP antibody and joint fluid anti-CCP antibody is helpful for the “early diagnosis” of RA and evaluation of the severity of RA, thus providing basis for the early treatment. The negativity and positivity of anti-CCP antibody are interchangeable under certain conditions. Key words: Anti-CCP antibody, rheumatoid arthritis, early diagnosis.

Diagnostic value of serum (1-3)-β-D-glucan for invasive fungal infection in neonates

Objective To evaluate the diagnostic value of serum (1-3)-β-D-glucan detection for invasive fungal infection (IFI) in neonates. Methods Eighty-seven neonates who were suspected to be IFI cases in neonatal intensive care unit from May 2008 to January 2010 were enrolled into this study. All subjects had infection symptoms, while did no react to the antibiotics treatment. The diagnosis of IFI was made according to Invasive pulmonary fungal infection diagnostic criteria of children set by Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association and Invasive fungal infection diagnostic criteria for critical patients set by the Society of Critical Care Medicine, Chinese Medical Association. Circulating (1-3)-β-D-glucan levels were determined with GKT-5M set kinetic fungus detection kit. Levels of (1-3)-Β-D-glucan in IFI group and that in the control group were compared; optimal cut-off value was established with receiver operating characteristic (ROC) curve; and the sensitivity and specificity at the cut-off value of 20.0 pg/ml and optimal cut-off value were calculated and compared. Results Among the 87 suspected cases, 59 cases were not diagnosed as IFI and 28 cases were diagnosed as IFI finally. Five patients were confirmed to be IFI; seven cases were clinically diagnosed and 16 cases were still suspected IFI. Among the five confirmed cases, four cases were blood culture positive for Candida parapsilosis, one case Candida albicans positive and two cases both cerebrospinal fluid culture and blood culture positive for Candida albicans. The median levels of (1-3)-β-D-glucan of patients diagnosed as IFI (n=28) was 131.6 pg/ml(18.6-9999.0 pg/ml), which was higher than that of the patients without IFI (8.5 pg/ml, 5.0-34.6 pg/ml)(Z=-5.064, P<0.05). Area under ROC curve was 0.806 (95% CI: 0.725-0.886, P<0.05). The sensitivity (96.43% vs 69.49%) and specificity (72.22% vs 84.21%) for (1-3)-β-D-glucan were different as 20.0 pg/ml and 53.7 pg/ml were used as the cut-off values for diagnosing IFI. Conclusions (1-3)-β-D-glucan level could be used to diagnose IFI of neonates, but further studies are needed to evaluate false-positive rates and its cut-off value in IFI diagnosis. Key words: Mycoses; Infant, newborn; beta-Glucan

Diagnostic Value of Serum and Serum and Cerebrospinal Fluid Procalcitonin in Differentiation Bacterial from Aseptic Meningitis

Problem statement: Acute bacterial meningitis is one of the most important causes of medical emergency diseases, which can cause high mortality and morbidity rates. Early antibiotic therapy is life saving in bacterial meningitis. One of the most common etiologies of acute meningitis is viral. Differentiation between bacterial and Aseptic meningitis is mandatory, which leads to avoid useless administration of antibiotics. Various diagnostic tests are available for diagnosis of acute bacterial meningitis; one of these tests is serum procalcitonin. Approach: This survey is a descriptive cross- sectional study. During a 2 year period 50 patients over 13 years old who were admitted to Sina and Emam Reza hospitals of Tabriz University of Medical Sciences with presumptive diagnosis of acute meningitis were selected. Serum and Cerebrospinal Fluid (CSF) procalcitonin of the patients were measured by semiquantative chromatographic PCT-Q Assay. Statistical data's of the patients were analyzed by SPSS 15. Results: 38% of the patients had acute bacterial and 62% aseptic meningitis, on the basis of positive clinical and lab tests. 0.5ng mL −1 of serum pricalcitonin was cut off point, which correlated to sensitivity of 100%, positive predictive value of 82.6%, specificity of 87.09% and negative predictive value of 100%. CSF procalcitonin cut off of 0.5ng mL −1 had sensitivity of 100% specificity of 84.21%, positive predictive value of 88.88% and negative predictive value of 90.62%. Conclusion: Serum procalcitonin cut off of 0.5 ng mL −1 has sensitivity and negative predictive value of 100%. This test can be a valuable measure in screening and differentiation of bacterial from aseptic meningitis.

Evaluation of serum percent trisialotransferrin as potential predictive biomarker of hepatocellular dedifferentiation in chronic liver disease

Background and aim Chronic hepatitis induced liver fibrogenesis is characterized by epithelial-to-mesenchymal transition of liver parenchymal cells (hepatocytes) to fibroblast (-like cells), i.e. increasing hepatocellular dedifferentiation, ultimatively leading to the development of hepatocellular carcinoma (HCC). Up to now the spectrum of valid serum biomarkers for this process of hepatocellular dedifferentiation is very limited. We therefore investigated the dynamics of alterations in the serum transferrin isoform pattern in the pathogenetic sequence from liver fibrosis to hepatocellular carcinoma, to evaluate the suitability of one of the isoforms as potential biomarker for hepatocellular dedifferentiation in chronic liver disease. Results Our data on 252 patients with hepatitis C virus (HCV) induced fibrogenic liver disease and on 43 patients with HCV induced HCC demonstrate a dynamic alteration of serum % trisialotransferrin levels in the pathogenetic sequence from early stage hepatic fibrosis to fully developed hepatocellular carcinoma, whereas serum % di- and pentasialotransferrin values seem not to be affected. We show that patients with early stage fibrosis (METAVIR stage F1) and weak fibrogenic activitiy (METAVIR grade A1) display significantly lower values of serum % trisialotransferrin compared to healthy controls, and that serum % trisialotransferrin values increased steadily parallel to an increase of fibrotic stage and grade, respectively, while finally exceeding normal values in those patients with hepatocellular carcinoma. Conclusion These findings propose a possible diagnostic value of serum % trisialotransferrin concentrations in the pathogenesis of hepatocellular dedifferentiation and the use of this parameter as possible predictive tumor marker in patients with chronic liver disease. Monitoring the pattern of transferrin bound sialic acid residues may thus be a helpful tool in assessing the risk of malignant degeneration in patients with chronic fibrogenic liver disease.

The diagnostic value of serum and urinary NT-proBNP for heart failure

Serum B-type natriuretic peptide (BNP) and the amino-terminal cleavage product of the prohormone (NT-proBNP) have been shown to be valuable parameters for the diagnosis of heart failure (HF) in the general population. Urinary BNP and NT-proBNP have also been suggested for diagnosis of HF. The present study investigated the diagnostic value of both serum and urinary NT-proBNP in selected groups of controls and patients diagnosed with HF. Creatinine clearance and serum and urinary NT-proBNP were measured in 76 controls and in 47 patients diagnosed with HF (NYHA III and IV). Echocardiography was used to exclude cardiac dysfunction in the control population by the combined normality of left ventricular ejection fraction (LVEF), E/A ratio (echocardiographic early [E] and late, or atrial [A] phases of ventricular filling), deceleration time and LV mass index. All patients diagnosed with HF had LVEF <40%. NT-proBNP measurements in urine samples are subject to high variability. Receiver-operating characteristic area under the curve (AUC) for serum, urinary NT-proBNP and their products were 0.94, 0.72 and 0.93, respectively. Correction of urinary NT-proBNP for urinary creatinine content improved the AUC from 0.72 to 0.80. Negative predictive values for ruling out HF were 0.94, 0.67 and 0.89, respectively. Linear regression analysis revealed that creatinine clearance was more important in determining serum NT-proBNP concentrations than age. Serum NT-proBNP is the best parameter to rule out HF. The product of the serum and urinary concentrations has equal value. Urinary NT-proBNP alone performs rather poorly. Renal function influences NT-proBNP concentrations more than age in this selected population.

Study on the value of tumor markers ProGRP, CYFRA21-1, NSE and CEA in the differential diagnosis of pleural effusion

Malignant pleural effusion is usually caused by lung cancer, and tumor markers may be helpful to its differential diagnosis. The aim of this study is to explore the clinical value of serum and pleural effusion pro-gastrin-releasing peptide (ProGRP), neuron specific enolase (NSE), cyto- keratin fragment 19 (CYFRA21-1) and carcinoembryonic antigen (CEA) in differential diagnosis and histological typing of malignant pleural effusion caused by lung cancer. According to histological type of primary tumor, 99 patients with malignant pleural effusion caused by lung cancer were divided into small cell lung cancer (SCLC) group, adenocarcinoma group and squamous cell carcinoma group, with 37 patients with benign pleural effusion and 35 healthy persons as controls. Diagnostic value of serum and pleural effusion ProGRP , NSE, CYFRA21-1 and CEA was evaluated for each group. The levels of ProGRP, NSE, CYFRA21-1 and CEA in serum and pleural effusion of all the malignant groups were significantly higher than those in the control groups (P < 0.01). In the SCLC group, detection of pleural effusion ProGRP showed the highest Youden index and accuracy. In the adenocarcinoma group and squamous cell carcinoma group, combined detection of pleural effusion CEA+CYFRA21-1 (on parallel test) showed the highest Youden index and accuracy. Detection of pleural effusion tumor markers ProGRP, CYFRA21-1, NSE and CEA is of great clinical value in differential diagnosis and histological typing of malignant pleural effusion. Pleural effusion ProGRP is the optimal tumor marker for malignant pleural effusion caused by SCLC. Pleural effusion CEA+CYFRA21-1 (on parallel test) is a good auxiliary diagnosis index for malignant pleural effusion caused by adenocarcinoma and squamous cell carcinoma of the lung.

The heterogeneity of neuropsychiatric systemic lupus erythematosus is reflected in lack of association with cerebrospinal fluid cytokine profiles.

The objective was to study the occurrence of autoantibodies and cytokines in serum and cerebrospinal fluid (CSF) in neuropsychiatric systemic lupus erythematosus (NPSLE). In total, 28 consecutive patients with NPSLE and 16 systemic lupus erythematosus (SLE) patients without neuropsychiatric involvement (non-NPSLE) were studied. IFN-alpha, IL-6, IL-10, soluble terminal complement complex (TCC), anti-ribosomal P protein antibodies (anti-P) and anti-cardiolipin antibodies (aCL) were measured in serum and CSF by immunoassays. Analyses of white blood cell differential count, CSF-albumin/serum-albumin ratio, IgG-index in CSF and isoelectric focusing in serum and CSF were also performed. CSF specimens from 23 healthy individuals were used as controls. IFN-alpha was elevated in the CSF of 5 of 28 NPSLE patients compared to three of 14 among the non-NPSLE patients. IL-6 was elevated in CSF in three of 26 NPSLE patients. Normal concentration of IL-10 was found in CSF in all 27 NPSLE-patients analysed. IFN-alpha in serum was elevated in 18 of 28 NPSLE patients. No distinct clinical phenotype was related to elevated cytokine concentration in serum or CSF. One patient with cerebral involvement complicated by progressive multifocal leukoencephalopathy displayed a very high IFN-alpha concentration in serum. High concentration of TCC was present in CSF from only one patient with systemic vasculitis and focal cerebral symptoms. In conclusion, the results of this study suggest that the diagnostic value of serum and CSF concentrations of IFN-alpha, IL-10, IL-6 and TCC is limited in unselected neuropsychiatric SLE, probably due to the heterogeneity of NPSLE pathogenesis.

The diagnostic value of serum copper/zinc ratio in gynecological tumors.

Serum copper levels (SCu) and serum zinc levels (SZn) were determined on admission in 73 women hospitalized for suspected gynecological tumor. Twenty-five of the women were subsequently found to have malignant tumor, while 48 had benign growths. The serum Cu/Zn ratio of the malignant group (2.13 +/- 0.53) was significantly (p less than 0.001) higher than that of the benign group (1.45 +/- 0.25). A good correlation was established between the Cu/Zn ratio and the stage of the malignant tumor. Serum copper level showed a linear correlation (R = 0.878) with serum ceruloplasmin values. These results indicate that the serum Cu/Zn ratio may be used as a valuable predictor of the presence of malignant gynecological tumor and its stage.

Normal Ranges and Diagnostic Value of Serum 5'Nucleotidase and Alkaline Phosphatase Activities in Infancy

Determinations of serum alkaline phosphatase (APase) and 5′nucleotidase (5Nase) activities have been carried out in 159 children investigated for possible disease of liver or bones, and in 147 children in whom these possibilities never arose. The latter group, which served as a control population, showed 5Nase levels very much lower than those encountered in a normal adult population. APase values in this group rose after birth, fell after the first year, and remained stable until puberty when the range increased slightly. APase was raised in 73% of children with hepatobiliary disease, 65% of children with bone disease, and 28% of children in whom there was no evidence of disease of either type. The corresponding figures for 5Nase activity were 87%, 6%, and 3%, and the degree of increase encountered in hepatobiliary disease was proportionately higher than the increase of APase seen in the same subjects. It is concluded that 5Nase is superior to APase in the diagnosis of hepatobiliary disease in infancy.

The diagnostic value ofserum enzyme measurements

The diagnostic value ofserum enzyme measurements