Original Cut-off Values Research Articles

Accuracy of the third molar maturity index (I3M) for diagnosing the legal majority of young southern Brazilians.

The numerous techniques for identifying adulthood require research testing the accuracy of each method in different populations. This study verified the accuracy of the third molar maturity index (I3M) proposed by Cameriere et al. (2008) for diagnosing the age of majority in a southern Brazilian population sample. Panoramic radiographs of patients with dental element 38 treated at the School of Dentistry of the University of Passo Fundo (UPF), RS, Brazil, were analyzed. The patients were separated into age groups between 15.00 and 22.99 years. The Cameriere (2008) method was applied to each radiograph. The study sample comprised 671 individuals, with 385 women (mean age 19.67 ± 2.05) and 286 men (mean age 19.5 ± 2.11). The original cut-off value of I3M≤0.08 classified individuals younger and older than 18 years. ROC curve plotting resulted in an overall accuracy of 0.69 and 0.84 for women and men, respectively. The most favorable cut-off value for southern Brazilian men was 0.06, and women showed better results with an I3M adjusted to 0.13. The new cut-off values produced an accuracy of 0.78 for women and 0.84 for men. The original cut-off point to the I3M (0.08) was not the most appropriate for the studied sample. Thus, index adjustments to 0.13 for women and 0.06 for men may improve method performance among southern Brazilian individuals. Key words:Molar, third, radiography, panoramic, forensic dentistry, age groups, imputability.

Proposed New Cutoff Value for Troponin in the Diagnosis of Acute Myocardial Infarction (AMI) in Patients with Congestive Heart Failure (CHF) and/or End Stage Renal Disease (ESRD)

Abstract Introduction/Objective In a recent publication, we assessed the efficacy of two serum biomarkers for AMI, cardiac Troponin I (cTnI) and creatine kinase-MB (CK-MB), for patients presenting to our emergency department (ED) with acute chest pain. We found that two conditions, CHF and ESRD in 85 patients, caused a significant number of false positive results that resulted in lowering the specificity and positive predictive value of both tests, which were already reduced by the low prevalence of AMI in our patient population. Removal of these patients resulted in significant increases in the two latter parameters. In this study, we focus on cTnI to determine if changing the cutoff value can increase the sensitivity and specificity of diagnosing acute MI in patients with CHF and ESRD. Methods/Case Report A cohort of 380 patients who presented with acute chest pain in the ED and worked up for acute MI were included, 85 of whom had CHF and/or ESRD. A total of 47 patients (15.4% prevalence) were definitively diagnosed with AMI. An initial serum cTnI sample was collected for each patient. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) were then compared using the routine cutoff cTnI value (0.05 ng/mL) and the higher cutoff of 0.2 ng/mL. Results (if a Case Study enter NA) Using the original cutoff of 0.05 ng/mL for cTnI in the patients with CHF or ESRD, the sensitivity and NPV were both 100%, while the specificity and PPV were low at 40.3% and 23%, respectively. Interestingly, when the cutoff was raised from 0.05 to 0.2 ng/mL, the sensitivity decreased by about 8% to 92.3 (12 out of 13 patients with AMI), and the specificity increased almost two-fold to 76.4%. The PPV increased to 40.4% and NPV was 98.2%. These values are comparable with the sensitivity, specificity, PPV and NPV of the total population at 85.3%, 82.4%, 38.7% and 97.7%, respectively. Conclusion The original cutoff value for cTnI in patients with ESRD and CHF produces a very low specificity and PPV. The results of this study suggest that an acceptable cutoff for cTnI to rule-out AMI patients who have CHF and or ESRD is 0.2 ng/mL which is four times higher than the original, but has comparable specificity, sensitivity, PPV and PPV to the total patient population. We note that this study must be regarded as a pilot study since the numbers of patients are small. We recommend a larger study to determine the validity of these conclusions.

Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B patients.

Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65-0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61-0.68; untreated models: 0.51-0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.

Third molar maturity index (I3M) assessment according to different geographical zones: a large multi-ethnic study sample

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (> 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18years old which is the goal of the forensic methods used for justice.

Diagnostic accuracy of the third molar maturity index (I3M) to assess the age of legal majority in Northern Brazil-population-specific cut-off values.

International guidelines for dental age assessment have recommended the use of methods based on available population-specific data. The Third Molar Maturity Index (I3M) was previously validated in several populations worldwide. This was the first study to evaluate the I3M in a northern Brazilian population and to test the diagnostic accuracy of the method to distinguish between minors and adults. The sample consisted of 1.070 panoramic radiographs retrospectively collected from females (n = 595) and males (n = 475) with ages between 16 and 22years. I3M's original cut-off value of 0.08 was used to classify individuals below and above the age of 18. Receiver operating characteristic (ROC) curves were plotted to assess the accuracy (ACC) of the method. In females and males separately, the overall ACC was 73.1% and 80%, respectively. The overall ACC for the combined sample was 76.1%. For northern Brazilian males, the best cut-off value remained 0.08, while for females, an adjustment to 0.12 showed optimal outcomes. The new cut-off value led to an ACC of 98.5% for females, which reflected an increase of 25.5% compared to the original cut-off value. The original cut-off value proposed by I3M was applicable to the present sample of northern Brazilian individuals. Adjustments to 0.12, however, may be encouraged to enhance the performance of the method among females.

The CCAS-scale in hereditary ataxias: helpful on the group level, particularly in SCA3, but limited in individual patients

BackgroundA brief bedside test has recently been introduced by Hoche et al. (Brain, 2018) to screen for the Cerebellar Cognitive Affective Syndrome (CCAS) in patients with cerebellar disease.ObjectiveThis multicenter study tested the ability of the CCAS-Scale to diagnose CCAS in individual patients with common forms of hereditary ataxia.MethodsA German version of the CCAS-Scale was applied in 30 SCA3, 14 SCA6 and 20 FRDA patients, and 64 healthy participants matched for age, sex, and level of education. Based on original cut-off values, the number of failed test items was assessed, and CCAS was considered possible (one failed item), probable (two failed items) or definite (three failed items). In addition a total sum raw score was calculated.ResultsOn a group level, failed items were significantly higher and total sum scores were significantly lower in SCA3 patients compared to matched controls. SCA6 and FRDA patients performed numerically below controls, but respective group differences failed to reach significance. The ability of the CCAS-Scale to diagnose CCAS in individual patients was limited to severe cases failing three or more items. Milder cases failing one or two items showed a great overlap with the performance of controls exhibiting a substantial number of false-positive test results. The word fluency test items differentiated best between patients and controls.ConclusionsAs a group, SCA3 patients performed below the level of SCA6 and FRDA patients, possibly reflecting additional cerebral involvement. Moreover, the application of the CCAS-Scale in its present form results in a high number of false-positive test results, that is identifying controls as patients, reducing its usefulness as a screening tool for CCAS in individual patients.

Comparative Investigation of Daylight Glare Probability (DGP) Comfort Classes in Clear Sky Condition

Glare is considered one of the most important variables to reach visual comfort and visual quality. It represents one of the fundamental barriers for an effective use of daylighting in buildings. One of the best performing and robust glare prediction models, relative to other available metrics, is a Daylight Glare Probability (DGP). Based on a validated and precise methodology (RADIANCE) the aim of this work is to compare the DGP model (original cut-off values) with new cut-off values that differ according to the time of day (morning, noon and afternoon). Both cut-off values were compared at more than 300 simulated conditions of daylighting in an interior space. This work offers the originality of studying recently proposed cut-off values in climate luminous with predominant clear sky conditions. Currently, the application of these new cutoff values is reduced to the field of science or simulation professionals. The results showed important differences (64.86%) between the categories proposed by both cut-off values. Nevertheless, these differences do not have a significant impact in glare prediction (< 2.7%), in terms of glare absence (DGP <0.38) and presence (DGP >0.38). This analysis made it possible: (i) to regionally apply the main current corpus criteria regarding glare issues as well as emergent proposals and (ii) to present new experimental data aimed at helping the field and, together with other works, improving the tools used by professionals on a daily basis.

Glasgow prognostic score can be a prognostic indicator after percutaneous coronary intervention: a two-center study in Japan.

Glasgow prognostic score (GPS) has been used to evaluate inflammatory response and nutritional status. This study aimed to investigate the impact of nutritional status on cardiac prognosis by using GPS in patients after undergoing percutaneous coronary intervention (PCI). We included 862 patients who underwent PCI for stable angina pectoris between 2015 and 2018. We used the original cutoff values, which were an albumin (Alb) level of 3.5g/dl and a C-reactive protein (CRP) level of 0.3mg/dl. We categorized them into the three groups: originally defined GPS (od-GPS) 0 (high Alb and low CRP), 1 (low Alb or high CRP), and 2 (low Alb and high CRP). Major adverse clinical events (MACEs) included all-cause death, nonfatal myocardial infarction, revascularization, and hospitalization for heart failure. The median follow-up period was 398.5days. During the follow-up, MACEs occurred in 136 patients. Od-GPS 2 had higher prevalence rates in terms of chronic kidney disease (CKD; 31.7% [229/722] vs. 44.9% [53/118] vs. 63.6% [14/22], p < 0.001), hemodialysis (6.4% [46/722] vs. 14.4% [17/118] vs. 31.8% [7/22], p < 0.001), and heart failure cases (HF; 9.1% [66/722] vs. 14.4% [17/118] vs. 27.3% [6/22], p = 0.007), with higher creatinine (1.17 ± 1.37mg/dl vs. 1.89 ± 2.60mg/dl vs. 3.49 ± 4.01mg/dl, p < 0.001) and brain natriuretic peptide levels (104.1 ± 304.6pg/ml vs. 242.4 ± 565.9pg/ml vs. 668.1 ± 872.2pg/ml, p < 0.001) and lower low-density lipoprotein cholesterol (101.5 ± 32.9mg/dl vs. 98.2 ± 28.8mg/dl vs. 77.1 ± 24.3mg/dl, p = 0.002) than od-GPS 0 and 1.Od-GPS 2 (HR 2.42; 95% CI 1.16-5.02; p = 0.018), od-GPS 1 (HR 2.09; 95% CI 1.40-3.13; p < 0.001), diabetes (HR 1.41; 95% CI 1.00-1.99; p = 0.048), CKD (HR 2.10; 95% CI 1.49-2.96; p < 0.001), and HF (HR 1.64; 95% CI 1.05-2.56; p = 0.029) were independent predictors of MACEs. A scoring system using CRP and Alb levels with a milder definition than GPS suitably predicted the risk of MACEs in the patients who underwent PCI.

407 Requesting, Treatment and Outcomes Following Oncotype DX Testing in Breast Cancer

Abstract Aim Oncotype DX (ODX) is a 21-gene assay for invasive breast cancer that yields a recurrence score (RS) value which indicates the risk of distant recurrence and the benefit from chemotherapy. NICE has laid down guidance regarding the criteria for test requesting which include having early breast cancer at an intermediate risk of distant recurrence that is ER-positive, HER2-negative and LN-negative. The aim of this study was to determine whether ODX was appropriately requested and followed. Treatment and outcomes were also observed. Method The study included all patients from The Countess of Chester Hospital who had undertaken ODX testing in the years 2015-2017. Patients were identified and clinicopathological data was obtained from clinic notes and pathology reports. NPI and PREDICT scores were calculated. The ODX original cut-off values were used. Results All 65 patients included in the study were ER-positive, 1 was HER2-positive and 1 was LN-positive. 9 patients had ODX requested inappropriately, all of which were low risk on both NPI and PREDICT. Chemotherapy was received by 1/32 low risk patients (RS 0-17), 6/24 intermediate risk patients (RS 18-30) and 5/5 high risk patients (RS 31-100). 57 patients had no recurrence, 2 patients had local recurrence (intermediate RS), 1 patient had distant recurrence (low RS) and 1 patient had metastasis (low RS). Chemotherapy was not received by any of the patients who experienced recurrence. Conclusions Adherence to NICE guidance regarding ODX requesting needs further emphasising. This would help reduce unnecessary patient investigation, costs, and pathology-lab workload.

The accuracy of the Ishii score chart in predicting sarcopenia in the elderly community in Chengdu

BackgroundSarcopenia is a disorder associated with age that reduces the mass of skeletal muscles, the strength of muscles, and/or physical activity. It increases the risk of fall incidence which can result in fractures, hospitalizations, limited movement, and considerably decreased quality of life. Hence, it is needed to explore candidate screening tools to evaluate sarcopenia in the initial phases. The reported studies have been revealed that the sensitivity and specificity of the Ishii score chart are higher. However, the Ishii score chart is principally based on the European Working Group on Sarcopenia in Older People (EWGSOP) consensus. Recently, the Asian Working Group for Sarcopenia (AWGS) 2019 consensus has updated its diagnostic criteria for sarcopenia,which was previously similar to the EWGSOP. Hence, it is necessary to determine whether the Ishii score chart is appropriate for use among the elderly population in China. The current study aimed to validate the precision of the Ishii score chart, within the Chinese old aged community to establish an effective model for the evaluation of sarcopenia.MethodsThe AWGS2019 sarcopenia diagnostic criteria were used as a standard, and among the elderly community, the accuracy of the Ishii score chart was determined by using indicators, including specificity, sensitivity, negative and positive predictive values, negative and positive likelihood ratios, Youden index, and receiver operating characteristic (ROC) curve.ResultsIn the elderly Chengdu community, the prevalence rate of sarcopenia was 18.38 %, 19.91 % for males and 16.91 % for females. The Ishii score chart predicts sarcopenia at an AUC value of 0.84 with 95 % confidence interval (CI), ranging between 0.80 and 0.89 for females, and at an AUC value of 0.81 with 95 % CI, ranging between 0.75 and 0.86 for males.According to the original cut-off, which was set at 120 points for females, the corresponding sensitivity was 46.91 % and the specificity was 93.22 %. The 105 cut-off points (original) set for males revealed a corresponding sensitivity of 64.94 % and the specificity of 85.46 %. However, the original cut-off value exhibited low sensitivity, hence, we selected a new cut-off value. With the new cut-off value, the sensitivity, specificity, positive and negative predictive values for sarcopenia were 75.31 %, 79.9 %, 43 %, and 94 % for females, and 70.65 %, 81.35 %, 49 %, and 92 % for males, respectively.ConclusionsThe Ishii score chart was used for the prediction of sarcopenia in the old-age people of the Chengdu community and the obtained results showed a high value of predictability. Hence, more than 95 and 102 points were suggested for males and females, accordingly which can set to be the diagnostic cut-off values for the prediction of sarcopenia.

The performance of osteoporosis self-assessment tool for Asians (OSTA) in identifying the risk of osteoporosis among Malaysian population aged 40years and above.

Osteoporosis self-assessment tool for Asians (OSTA) is a convenient screening algorithm used widely to identify patients at risk of osteoporosis. Currently, the number of studies validating OSTA in Malaysian population is limited. This study aimed to validate the performance of OSTA in identifying subjects with osteoporosis determined with DXA. This cross-sectional study recruited 786 Malaysians in Klang Valley, Malaysia. Their bone health status was assessed by DXA and OSTA. The association and agreement between OSTA and bone mineral density assessment by DXA were determined by Pearson's correlation and Cohen's kappa, respectively. Receiver operating characteristics (ROC) curves were used to determine the sensitivity, specificity, and area under the curve (AUC) for OSTA. OSTA and DXA showed a fair association in the study (r = 0.382, κ = 0.159, p < 0.001). OSTA (cutoff < - 1) revealed a sensitivity of 32.3%, specificity of 92.3%, and AUC of 0.618 in identifying subjects with suboptimal bone health. The sensitivity of OSTA (cutoff < - 4) in determining subjects at risk of osteoporosis was better among women (sensitivity = 20%) than men (sensitivity = 0%). Modified OSTA cutoff values improved the sensitivity of OSTA in identifying subjects with suboptimal bone health (men = 81.0% at cutoff 3.4, women = 82.8% at cutoff 2.0) and osteoporosis (men = 81.8% at cutoff 1.8, women = 81.3% at cutoff 0.8). OSTA with its original cutoff values is ineffective in identifying individuals at risk for osteoporosis. Adjusting the cutoff values significantly increases the sensitivity of OSTA, thus highlighting the need to validate this instrument among the local population before using it for osteoporosis screening clinically.

Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study

BackgroundFew prospective studies have evaluated the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) criteria in emergency department (ED)settings. The aim of this study was to determine the prognostic accuracy of...

New criteria for multiple chemical sensitivity based on the Quick Environmental Exposure and Sensitivity Inventory developed in response to rapid changes in ongoing chemical exposures among Japanese.

Background & objectivesThe Quick Environmental Exposure and Sensitivity Inventory (QEESI) developed by Miller and Prihoda in the USA is used as a questionnaire for patients with multiple chemical sensitivity (MCS) in >10 countries. We developed a Japanese version of QEESI, assessed its reliability and validity, and defined original cut-off values for screening Japanese patients with MCS in 2003. Our recent study revealed that opportunities for exposure to various chemicals had increased for people in Japan, while subjective symptoms of MCS in patients had increased in severity. In this study, we considered new cut-off values that combined QEESI subscale scores based on the current situation in Japan.MethodsThe questionnaire used was a Japanese version of QEESI. The survey was conducted from 2012 to 2015. Participants were 111 patients with MCS (mean age: 46 ± 20, 81% female) initially diagnosed by physicians, and 444 age- and gender-matched controls not diagnosed with MCS by doctors. The discriminatory validity of QEESI scores of patients and controls were evaluated by logistic regression and receiver operating characteristic analyses when considering interactions of the Masking Index (ongoing chemical exposure). New combined cut-off values were then set.ResultsNew combined cut-off values (meeting conditions of Chemical Intolerances ≥ 30, Symptom Severity ≥ 13, and Life Impacts ≥ 17) showed high sensitivity (82.0%) and specificity (94.4%). Using new criteria when considering ongoing chemical exposure, study participants were categorized as: Very suggestive, Somewhat suggestive, Problematic, and Not suggestive. Participants classified as Very suggestive included 25 (5.6%) controls.ConclusionsWe have set new criteria with combined cut-off values based on current Japanese conditions. Such new criteria can be used for screening and as a diagnostic aid for Japanese patients with MCS and suggest approximately 6% of the Japanese general population may be classified as “Very suggestive people with MCS”.

Is the motor skills checklist appropriate for assessing children in Japan?

PurposeMotor skill screening tools are essential for the early detection of developmental coordination disorder (DCD). The present study aimed to examine any cultural and rater effects on these tools. This then enabled us to judge the validity of the original cut-off values for identifying diagnosable children. MethodsA community sample survey was performed in Japan; 3852 children aged 6–9 years were recruited. Both parents and teachers evaluated the motor skills of their children using the Movement Assessment Battery for Children – Second Edition Checklist. The psychometric properties were evaluated and the scoring characteristics examined based on the type of rater and country of origin, as compared to data originally sampled in the UK. ResultsHigh reliability and validity of the Japanese samples were confirmed. The Japanese adults evaluated their children’s motor skills more rigorously than the Europeans. Additionally, there was a large disagreement between parent and teacher rating scores; the degree of agreement varied depending on the severity of motor deficits in the child. ConclusionThe first findings from a Japanese sample suggest that the assessment of motor skills in children is significantly affected by culture and rater. These cultural characteristics and rater biases strongly suggest that new cut-off values, reflecting country and rater type, be introduced for identifying children at risk of DCD.

Rethinking neck circumference in STOP-BANG for Asian OSA

Introduction: The STOP-BANG questionnaire is a simple screening tool for obstructive sleep apnoea (OSA) which has been validated for use in Asian populations. The original cut-off values for neck circumference were defined based on Caucasian populations. This study aims to validate the neck circumference component of the STOP-BANG score in Asians. Methods: A retrospective analysis of all patients suspected of having OSA who underwent a diagnostic polysomnography at a tertiary sleep centre in Singapore over the course of 1 year was conducted. Neck circumference was measured and correlated to the presence of OSA. A receiver operating curve was performed to obtain the optimal cut-off value for screening OSA in Asian patients. Results: 591 Asian subjects with OSA were analysed. The optimal neck circumference predictive for OSA was found to be 39 cm in males and 35 cm in females, with a sensitivity of 83.4% and 84.6% respectively. The existing STOP-BANG cut-off of 40 cm had 71% and 32% sensitivity in Asian males and females, respectively. Conclusion: The STOP-BANG cut-off value for neck circumference for screening for sleep apnoea in Asian males can be maintained at 40 cm, but the neck circumference value used for screening Asian females should be lowered to 35 cm.

The prognostic value of the systemic inflammatory score in patients with unresectable metastatic colorectal cancer.

Inflammation has been widely recognized as a contributor to cancer progression and several inflammatory markers have been reported as associated with the clinical outcomes in patients with various types of cancer. Recently, a novel inflammatory marker, the systemic inflammatory score (SIS), which is based on a combination of the lymphocyte-to-monocyte ratio (LMR) and the serum albumin concentration has been reported as a useful prognostic marker. The aim of the present study was to assess the prognostic value of the SIS in patients with unresectable metastatic colorectal cancer (mCRC). The retrospective cohort study included 160 patients who underwent combination chemotherapy for unresectable mCRC between January 2008 and December 2016. The SIS was used to classify the patients into three groups based on their LMR and the serum albumin concentration. Patients with high-LMR and high serum albumin level were given a score of 0; patients with low-LMR or low serum albumin level were given a score of 1; patients with low-LMR and low serum albumin level were given a score of 2. There were significant differences in the overall survival among the three SIS groups and the SIS was an independent prognostic factor for the overall survival. Although the SIS was significantly associated with the overall survival rate even when using the original cut-off values, the SIS according to the new cut-off values had a more accurate prognostic value. The present study determined that the SIS was a useful biomarker for predicting the survival outcomes in patients with unresectable mCRC, although the optimum cut-off value of the SIS according to the patients' background needs to be examined in further studies.

External validation of the NUn score for predicting anastomotic leakage after oesophageal resection

Early detection of anastomotic leakage (AL) after oesophageal resection for malignancy is crucial. This retrospective study validates a risk score, predicting AL, which includes C-reactive protein, albumin and white cell count in patients undergoing oesophageal resection between 2003 and 2014. For validation of the NUn score a receiver operating characteristic (ROC) curve is estimated. Area under the ROC curve (AUC) is reported with 95% confidence interval (CI). Among 258 patients (79.5% male) 32 patients showed signs of anastomotic leakage (12.4%). NUn score in our data has a median of 9.3 (range 6.2–17.6). The odds ratio for AL was 1.31 (CI 1.03–1.67; p = 0.028). AUC for AL was 0.59 (CI 0.47–0.72). Using the original cutoff value of 10, the sensitivity was 45.2% an the specificity was 73.8%. This results in a positive predictive value of 19.4% and a negative predictive value of 90.6%. The proportion of variation in AL occurrence, which is explained by the NUn score, was 2.5% (PEV = 0.025). This study provides evidence for an external validation of a simple risk score for AL after oesophageal resection. In this cohort, the NUn score is not useful due to its poor discrimination.

New Bioinformatics-Based Discrimination Formulas for Differentiation of Thalassemia Traits From Iron Deficiency Anemia.

Thalassemia traits (TTs) and iron deficiency anemia (IDA) are the most common disorders of hypochromic microcytic anemia (HMA). The present study aimed to differentiate TTs from IDA by analyzing discrimination formulas and provides comprehensive data of hemoglobin disorders prevalent in Pakistan. Among 12 published discrimination formulas, 6 formulas-MI, EF, G&K, RDWI, R, and HHI-were the most reliable to discriminate TTs from IDA. The failure cutoff values were improved by the random forest (RF) decision-tree approach. Moreover, the Shine and Lal (S&L) formula, which completely failed to discriminate IDA from TTs with original cutoff value (<1530), improved with the use of new proposed cutoff value (<1016) and was found to successfully discriminate all cases of TTs from those with IDA. In addition, 2 newly proposed formulas discriminated TTs from IDA more reliably than the original 12 formulas assessed. The proposed formulas could play a crucial role for clinicians to discriminate between TTs and IDA.

Development of the Japanese Version of the Leeds Assessment of the Neuropathic Symptoms and Signs Pain Scale: Diagnostic Utility in a Clinical Setting.

We aimed to assess the diagnostic utility of the linguistically validated Japanese version of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS-J) as a screening tool for neuropathic pain in the clinical setting. Patients with neuropathic pain or nociceptive pain who were 20 to 85 years of age were included. Sensitivity and specificity using the original cutoff value of 12 were assessed to evaluate the diagnostic utility of the LANSS-J. Sensitivity and specificity with possible cutoff values were calculated, along with area under the receiver operating characteristic curve. We then evaluated agreement regarding assessment of the LANSS-J by two investigators. We used the intraclass correlation coefficient (ICC) for the total score and Cohen's kappa coefficient for each item. Data for patients with neuropathic pain (n = 30) and those with nociceptive pain (n = 29) were analyzed. With a cutoff of 12, the sensitivity was 63.3% (19/30) and the specificity 93.1% (27/29). Sensitivity improved substantially with a cutoff of ≤ 11 (≥ 83.3%, 25/30). High specificity (93.1%, 27/29) was sustained with a cutoff of 9 to 12. The ICC for the total score was 0.85, indicating sufficient agreement. Kappa coefficients ranged from 0.68 to 0.84. The LANSS-J is a valid screening tool for detecting neuropathic pain. Our results suggest that employing the original cutoff value provides high specificity, although a lower cutoff value of 10 or 11 (with its high specificity maintained) may be more beneficial when pain attributed to neuropathic mechanisms is suspected in Japanese patients.

External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome.

BackgroundA recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as ‘APPS’) was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (ARDS). After thorough temporal external validation of the APPS, we tested the spatial external validity in a cohort of ARDS patients recruited during 3 years in two hospitals in the Netherlands.MethodsConsecutive patients with moderate or severe ARDS according to the Berlin definition were included in this observational multicenter cohort study from the mixed medical-surgical ICUs of two university hospitals. The APPS was calculated per patient with the maximal airway pressure instead of the plateau pressure as all patients were ventilated in pressure-controlled mode. The predictive accuracy for hospital mortality was evaluated by calculating the area under the receiver operating characteristics curve (AUC-ROC). Additionally, the score was recalibrated and reassessed.ResultsIn total, 439 patients with moderate or severe ARDS were analyzed. All-cause hospital mortality was 43 %. The APPS predicted all-cause hospital mortality with moderate accuracy, with an AUC-ROC of 0.62 [95 % confidence interval (CI) 0.56–0.67]. Calibration was moderate using the original cutoff values (Hosmer–Lemeshow goodness of fit P < 0.001), and recalibration was performed for the cutoff value for age and plateau pressure. This resulted in good calibration (P = 1.0), but predictive accuracy did not improve (AUC-ROC 0.63, 95 % CI 0.58–0.68).ConclusionsThe predictive accuracy for all-cause hospital mortality of the APPS was moderate, also after recalibration of the score, and thus the APPS does not seem to be fitted for that purpose. The APPS might serve as simple tool for stratification of mortality in patients with moderate or severe ARDS. Without recalibrations, the performance of the APPS was moderate and we should therefore hesitate to blindly apply the score to other cohorts of ARDS patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0190-0) contains supplementary material, which is available to authorized users.