Sex-specific Cut-off Values Research Articles

Quantification of muscle mass in the legs of patients with peripheral arterial occlusive disease: associations between volumetric and cross-sectional single-slice measurements for identification of atrophy and focal sarcopenia.

Sarcopenia, commonly determined by measuring skeletal muscle mass index (SMI) at the third lumbar level, has been identified as a predictor of clinical outcome in a variety of diseases. For patients with peripheral arterial occlusive disease (PAOD), we hypothesized that lower extremity SMI (LESMI) might be a more precise predictor of outcome and the extent of chronic ischemia than the systemic muscle mass at the L3 level. We investigated the association between complete muscle volume and muscle area derived with single-slice 2-dimensional measurements in the legs to identify at which level cross-sectional single-slice measurements are most representative of the muscle volume and investigated whether LESMI is associated with systemic sarcopenia and PAOD severity. Muscle volumes and areas were semiautomatically segmented from computed tomography (CT) scans of the affected and contralateral legs of 50 PAOD patients with Fontaine stage IIb and 50 PAOD patients with Fontaine stage IV. The muscle mass was determined for the complete volumes of the upper and lower legs and for cross-sectional slices at 40%, 50%, and 60% of the length of the femur and tibia. Patients were determined as sarcopenic based on sex-specific cut-off values at the L3 spinal segment. Two observers segmented 20 randomly selected patients to determine the interobserver reliability with the intraclass correlation coefficient. The correlation between the LESMI of the complete muscle volume and the three cross-sectional slices in all 200 upper and 200 lower legs was moderately strong to strong. Interobserver reliability of cross-sectional slice segmentation was excellent. The LESMI, both measured volumetrically and cross-sectionally, were significantly lower in patients with sarcopenia compared to patients without sarcopenia. The LESMI was lower in patients with Fontaine stage IV compared to patients with Fontaine stage IIb for both volumetric and cross-sectional measurements. Segmentation of skeletal muscle mass from cross-sectional single-slice CT in the upper and lower leg can accurately and precisely substitute complete volume segmentations. These findings warrant the use of measurements based on cross-sectional single-slice CT for assessing the LESMI. Patients with systemic sarcopenia are also at increased risk for muscle mass loss in the lower extremities. In the current study, LESMI was lower in patients with Fontaine class IV PAOD compared to patients with Fontaine class IIb PAOD. Future studies should assess the predictive value of the LESMI on clinical outcomes in PAOD patients.

ASSOCIATION OF AORTIC BIOPROSTHETIC CALCIFICATION MEASURED BY CT WITH HEMODYNAMIC AND CLINICAL OUTCOMES

The prognostic value of aortic valve calcification (AVC) measured by non-contrast multidetector computed tomography (MDCT) has been well validated in native aortic valve stenosis (AS) and a sex-specific cut-off value of AVC have been proposed to identify severe AS. There are however few data on the impact of MDCT quantitation of valve leaflet calcification following biological aortic valve replacement (AVR). The study aimed to analyze the association of bioprosthetic AVC with: i) valve hemodynamic deterioration measured by echocardiography and ii) clinical outcomes and to determine whether there is any sex-related difference in these associations. Methods: From 2008 to 2010, we prospectively enrolled 204 patients who had undergone AVR at an average of 7.6 ± 3.4 years ago. We performed echocardiography and MDCT at 2 visits separated by 3 years. AVC measured by agastaton method was indexed to the cross-sectional area of aortic annulus to calculate the AVC density (AVCd). Correlation between the hemodynamic valve deterioration evaluated by echocardiographic and AVCd from postoperative to recruitment was assessed. The primary endpoint was mortality or reintervention. Results: The cohort consisted of 142 (70%) men and 62 (30%) women. Women were older (69.4 ± 7.4 years vs. 66.4 ± 8.0 years, p=0.013) with higher postoperative mean gradient (13.2 ± 5.7 mmHg vs. 11.2 ± 5.0 mmHg, p=0.015) and more severe patient-prosthesis mismatch (25.8% vs. 9.9%, p=0.009). Accordingly, AVCd at baseline visit were significantly higher in women (14.2 AU/cm2 [IQR: 2.4 to 59.5 AU/cm2] vs. 7.5 AU/cm2 [IQR: 0 to 24.5 AU/cm2], p=0.035). AVCd correlated with mean gradient change both in men (r=0.37, p < 0.001) and in women (r=0.48, p < 0.001) (Figure). After adjusting for clinical factors, the correlation remained significant (p< 0.001). During a median follow-up of 5.7 [3.9, 8.0] years, there were 134 (65.7%) death or reintervention. Univariate analysis showed a strong association between AVCd and the composite endpoint (p < 0.001) with a linear pattern by spline curve (Figure). On multivariable analysis, AVCd independently predicted the composite endpoint (adjusted HR: 1.11; 95% CI: 1.06 to 1.2, p< 0.001) (Figure). The inclusion of AVCd in the model improved the prediction of the event with an integrated discrimination index (IDI) of 0.056 (p=0.032). Bioprosthesis calcification, as measured by MDCT shows no sex-related pattern as opposed to calcification of the native valves. AVCd provides independent and incremental prognostic value beyond clinical and echocardiographic assessment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Sex differences in reproductive hormones during mini-puberty in infants with normal and disordered sex development

Context The early activation of the hypothalamic-pituitary-gonadal axis during infancy can be used in the evaluation of infants suspected of disorders of sex development (DSD). However, few data exist on sex-specific reference ranges for these hormones during early life. Objective To evaluate sex differences in reproductive hormone concentrations in serum from healthy infants to define sex-specific cutoff values and to apply these in infants with DSD. Design A cross-sectional study. Setting A tertiary center for pediatric endocrinology at the University Hospital of Copenhagen. Patients or Other Participants Healthy infants (1840) and patients with DSD (27), aged 2 to 5 months. Main Outcome Measures Serum concentrations of LH, FSH, testosterone (T), estradiol, sex hormone-binding globulin (SHBG), inhibin B, anti-Mullerian hormone (AMH), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), 17-hydroxyprogesterone (17-OHP), androstenedione, and LH/FSH ratio. Results LH and FSH concentrations showed overlap between sexes, with LH being highest in boys and FSH being highest in girls. The LH/FSH ratio separated infant boys from girls with minimal overlap at a cutoff value of 0.32. Inhibin B and AMH concentrations were markedly higher in boys compared with girls, with minimal or no overlap. In infants with Klinefelter syndrome, 45,X/46,XY mosaicism and male phenotype, and Turner syndrome, the LH/FSH ratio matched the gender of rearing. However, infants with complete androgen insensitivity syndrome had LH/FSH ratios within the male range. Conclusions Reference ranges for reproductive hormones and LH/FSH ratio during mini-puberty were established in this study. The classifiers that best separated sex in mini-puberty were AMH, LH/FSH ratio, and T. Use of the LH/FSH ratio may add valuable information in the workup of infants suspected of DSD.

The combination of obesity and high salt intake are associated with blood pressure elevation among healthy Japanese adolescents.

We examined the associations of obesity and high salt intake with blood pressure (BP) in a cross-sectional sample of 1679 healthy Japanese adolescents (827 females and 852 males) aged 12-18 years (mean age: 14.9 years) who had no history of treatment for hypertension, diabetes mellitus, or renal disease. Brachial arterial BP of the subject was measured at the left arm using a digital BP monitor with an appropriate cuff size. The weight status was evaluated by body mass index (BMI), and obesity was determined according to the age- and sex-specific cut-off values for adolescents. All subjects were interviewed by dietitians using a food frequency questionnaire to obtain data on their average daily salt intake. In the study subjects, obesity and high salt intake were associated with a significantly increased BP except for diastolic BP in females. In multiple regression analyses, both BMI (z-score) and salt intake were found to be major determinants of systolic BP and diastolic BP after adjustment for potential confounders, including age, sex, and serum lipid and glucose parameters. The association between salt intake and BP values was more pronounced among individuals with obesity than among those with normal weight. These results suggest that high salt intake is associated with BP elevation in healthy adolescents, and the association may become stronger by the presence or severity of obesity.

P: 69 Sarcopenia Pre- and Post-liver Transplantation: Implication for Hepatic Encephalopathy

BACKGROUND: Muscle wasting (sarcopenia) and hepatic encephalopathy affect 30 to 70% of cirrhotic patients. The presence of sarcopenia may be associated with a worst prognosis and complications, including hepatic encephalopathy, in cirrhotic patients awaiting and after liver transplantation (LT). To this day, few studies have evaluated and followed muscle mass (in terms of quantity and quality) after LT. The goal of this study was to assess the association between the evolution of sarcopenia and the prognosis of cirrhotic patients, including hepatic encephalopathy and neurological complications, before and after LT. METHODS: In total, 94 cirrhotic patients who underwent LT at the Montreal University Hospital Center - Liver Unit were included. Sarcopenia was assessed at the third lumbar level vertebrae using a computed tomography scan (CT-scan). The diagnostic of sarcopenia was based on previously established sex-specific cut-off values of skeletal muscle index. Patients were classified into two groups: (1) persistent or newly developed sarcopenia after LT (Sarc+); (2) resolved sarcopenia or absence of sarcopenia before and after LT (Sarc-). Muscle quality (myosteatosis) was assessed by calculating intramuscular adipose tissue content. The prognostic factors were collected 6 months before and during 1 year after LT through medical records and included the number of complications, the presence of hepatic encephalopathy and the episodes of infections, the length of stay, and the frequency of readmissions. RESULTS: Sarcopenia persisted or was newly developed (Sarc+) in 62% of the patients (n = 58). It remained absent or was resolved after LT in 38% of the patients (n = 35). Muscle quality was significantly decreased post-LT (P = 0.034). The group Sarc+ experienced more complications pre-LT (P = 0.012) and post-LT (P &lt; 0.001), infections post-LT (P = 0.006) and readmissions (P = 0.048) compared to the group Sarc-. The length of stay was longer for the group Sarc+ as opposed to the group Sarc- (P &lt; 0.001). Hepatic encephalopathy was present in 83% of patients pre-LT whereas 17% experienced persistent neurological complications post-LT. CONCLUSIONS: Persistent and newly developed sarcopenia after LT appear to have negative outcomes on the prognosis of patients. Interventional strategies to optimize, increase or preserve muscle mass could help to improve post-operative recovery as well as the quality of life in patients who have undergone LT.

Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population.

Low muscularity (LM) is associated with high mortality in the Caucasian critically ill population. Muscularity can be accurately measured by the skeletal muscle index (SMI; cm2 /m2 ) generated by computed tomography (CT). This study aimed to establish the overall and sex-specific cutoff values that predict hospital mortality in an Asian critically ill population. This single-center, retrospective, observational study included patients aged ≥18 years with an abdominal CT conducted within 72 hours of admission to the intensive care unit. SMI generated from CT images at the level of the mid-third lumbar vertebra were extracted from the medical records. Area under the receiver operating characteristic curves (AUC) was generated to determine the SMI cutoff values for hospital mortality. Association between LM (defined by SMI cutoff value) and hospital mortality was further evaluated by multivariable logistic regression. In a sample of 228 patients, the overall SMI cutoff value (cm2 /m2 ) for hospital mortality was 42.0 (AUC: 0.637; sensitivity: 66.7%, specificity: 56.8%), whereas it was 46.5 in males and 35.3 in females. More males than females had LM (51.4% vs 37.5%), and >40% of overweight/obese patients had LM. Patients with LM were older and had a longer duration of mechanical ventilation and hospitalization. After adjusting for known confounders, LM independently predicted hospital mortality in the overall sample (adjusted odds ratio: 2.42; 95% CI 1.16-5.03; P = 0.003) and in both sexes. This study established a set of SMI cutoff values that predict hospital mortality. LM is independently associated with hospital mortality.

Prognostic Impact of Low Skeletal Muscle Mass on Major Adverse Cardiovascular Events in Coronary Artery Disease: A Propensity Score-Matched Analysis of a Single Center All-Comer Cohort.

The impact of sarcopenia on atherosclerotic cardiovascular disease remains unclear. We aimed to investigate the prognostic impact of sarcopenia on coronary artery disease (CAD). A total of 475 patients with CAD who underwent successful percutaneous coronary intervention (PCI) and computed tomography (CT) were enrolled. The cross-sectional area of skeletal muscle at the first lumbar (L1) vertebral level was measured, and sex-specific cut-off values of L1 skeletal muscle index (L1 SMI; male <31.00 cm2/m2, female <25.00 cm2/m2) were obtained. The primary outcome was 3-year all-cause mortality and the secondary outcome was 3-year major adverse cardiovascular events (MACEs). Low L1 SMI was present in 141 (29.7%) of 475 patients. The incidence of all-cause mortality (23.7% vs. 5.9%, p < 0.001) and MACEs (39.6% vs. 11.8%, p < 0.001) was significantly higher in patients with low L1 SMI than in those with high L1 SMI. In multivariate analysis, low L1 SMI was an independent predictor of higher risk of all-cause mortality (hazard ratio (HR): 4.07; 95% confidence interval (CI): 1.95–8.45; p < 0.001) and MACEs (HR: 3.76; 95% CI: 2.27–6.23; p < 0.001). These findings remained consistent after propensity score-matched analysis with 91 patient pairs (C-statistic = 0.848). CT-diagnosed low skeletal muscle mass is a powerful predictor of adverse outcomes in patients with CAD undergoing PCI.

Measurement of Complement C2 using the binding site SPAPLUS® turbidimetric analyzer and Complement C2 assay

The aim of the present analysis was to evaluate sex-specific cut-off values of a high-sensitivity cardiac troponin T (hs-cTnT) assay and a high-sensitivity cardiac troponin I (hs-cTnI) assay in an emergency department setting.We retrospectively studied 1945 male and 1643 female emergency department patients in whom we had measured both Roche hs-cTnT and Abbott hs-cTnI routinely upon every troponin measurement request. We performed reclassification analyses of sex-specific thresholds versus sex-neutral thresholds of both assays. In addition, we performed sensitivity analyses to find those sex-specific cut-off values for the Roche hs-cTnT and the Abbott hs-cTnI assays with the lowest possible rate of discordant classifications by both assays.Compared with the classification by the sex-neutral thresholds (i.e., 14 ng/L for hs-cTnT and 26 ng/L for hs-cTnI), using sex-specific thresholds (i.e., 16 ng/L in males and 9 ng/L in females for hs-cTnT; and in 34 ng/L males and 16 ng/L in females for hs-cTnI) resulted in a total reclassification rate of 4% for hs-cTnT and 3% for hs-cTnI in male individuals, and of 11% and 6%, respectively, in female individuals. In our cohort, the sex-specific hs-cTnT cut-off values currently in use (i.e., 16 ng/L in males and 9 ng/L in females) were best matched to a hs-cTnI cut-off value of 11 ng/L in male and 5 ng/L in female individuals. Conversely, the sex-specific hs-cTnI cut-off values currently in use (i.e., 34 ng/L in males and 16 ng/L in females) were best matched to a hs-cTnT cut-off value of 49 ng/L in male and 24 ng/L in female individuals. These “harmonised” cut-off values reduced discordant classifications between both assays by 43–68% compared to using cut-off values currently in use.Especially in women, reclassification rates were high, when using sex specific versus sex-neutral thresholds. Best matching cut-off values for hs-cTnT and hs-cTnI were markedly different to those currently in use. These “harmonised” cut-off values minimised discordant classifications between both assays.

Sex-specific differences in pulmonary embolism

IntroductionSex-specific differences regarding risk factors, symptoms and prognosis have been reported for several cardiovascular diseases. For patients with pulmonary embolism (PE), sex-specific data are limited and inconsistent. We aimed to investigate sex-specific differences in PE. Materials and methodsOver a 10-year period (01/2003–09/2013), patients with confirmed PE were enrolled in a prospective single-centre cohort study. ResultsWe prospectively examined 569 PE patients (55.9% women). Men more often had cancer (20.7% vs. 13.5%, p = 0.024) and unprovoked PE (61.0% vs. 47.5%, p = 0.001) while women more frequently presented with risk factors for venous thromboembolism such as older age (median, 71 [IQR, 55–79] vs. 67 [53–75] years, p = 0.008), surgery/trauma/immobilisation (38.4% vs. 29.5%, p = 0.026) and sex-hormone therapy (14.8% vs. 0.8%, p < 0.001).Overall, 84 patients (14.8%) had an adverse 30-day outcome and 43 (7.6%) died within 30 days; outcomes did not differ between males and females and were not influenced by the patients' sex. Risk stratification markers and models such as right ventricular dysfunction on TTE/CT, cardiac troponin, sPESI, Bova score and 2014 ESC guidelines algorithm predicted adverse outcome in normotensive female patients only, while tachycardia, hypoxia, NT-proBNP and modified FAST score were able to predict an adverse outcome in both sexes. Using sex-specific biomarker cut-off values, the 2014 ESC guidelines algorithm was able to predict adverse outcome in both sexes. ConclusionsThe 30-day adverse outcomes did not differ between male and female PE patients and were not influenced by the patients' sex despite sex-specific differences in the prognostic performance of risk stratification markers/models.

Sex-Specific Cut-Offs for High-Sensitivity Cardiac Troponin: Is Less More?

Management of patients presenting to the Emergency Department with chest pain is continuously evolving. In the setting of acute coronary syndrome, the availability of high-sensitivity cardiac troponin assays (hs-cTn) has allowed for the development of algorithms aimed at rapidly assessing the risk of an ongoing myocardial infarction. However, concerns were raised about the massive application of such a simplified approach to heterogeneous real-world populations. As a result, there is a potential risk of underdiagnosis in several clusters of patients, including women, for whom a lower threshold for hs-cTn was suggested to be more appropriate. Implementation in clinical practice of sex-tailored cut-off values for hs-cTn represents a hot topic due to the need to reduce inequality and improve diagnostic performance in females. The aim of this review is to summarize current evidence on sex-specific cut-off values of hs-cTn and their application and usefulness in clinical practice. We also offer an extensive overview of thresholds reported in literature and of the mechanisms underlying such differences among sexes, suggesting possible explanations about debated issues.

Using single sex-specific high-sensitivity cardiac troponin cut-off values for ruling out myocardial infarction - Are we there yet?

Using single sex-specific high-sensitivity cardiac troponin cut-off values for ruling out myocardial infarction - Are we there yet?

Low Body Mass Index Is an Independent Prognostic Factor in Patients With Non-Small Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor.

BackgroundSarcopenia and obesity have been suspected as factors associated with efficacy of treatment and prognosis in various malignancies. This study aimed to investigate the association of pretreatment sarcopenia and visceral obesity with efficacy and prognosis of first- and second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for patients with non-small cell lung cancer (NSCLC) and positive EGFR mutation.MethodsWe retrospectively collected 167 NSCLC patients with mutant EGFR who had started EGFR-TKI monotherapy between October 2007 and August 2018 at our hospital. We classified 167 patients into two groups, according to the definition of underweight based on the World Health Organization (WHO) body mass index (BMI) classification and the Japanese sex-specific cut-off values of the following computed tomography (CT) images-assessed markers of pretreatment sarcopenia or visceral obesity, such as psoas muscle index (PMI), intramuscular adipose tissue content (IMAC) and visceral-to-subcutaneous fat ratio (VSR) at lumbar vertebra L3 level. We compared overall survival (OS) and progression-free survival (PFS) of two groups by Kaplan-Meier curves and log-rank tests. Using multivariate Cox proportional hazard analyses adjusted by age, neutrophil-to-lymphocyte ratio, performance status, EGFR mutation types and EGFR-TKI lines, and extra-pulmonary metastases or three or more than 3 metastatic sites, we searched independent prognostic factors of OS and PFS of EGFR-TKI therapy.ResultsThe OS (median 26.0 vs. 32.3 months, P = 0.02) and PFS (9.1 vs. 14.8 months, P = 0.03) of patients with BMI < 18.5 were significantly shorter than those of patients with BMI ≥ 18.5. However, there was no significant difference in OS and PFS according to PMI, IMAC and VSR. The multivariate analyses detected only BMI < 18.5 as an unfavorable prognostic factor of shorter OS (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.03 - 2.81, P = 0.04) and PFS (HR 1.72, 95% CI 1.11 - 2.67, P = 0.02).ConclusionsPretreatment underweight was a significant prognostic factor of poor PFS and OS of EGFR-TKI therapy. However, neither pretreatment sarcopenia nor visceral obesity was associated with prognosis of EGFR-TKI. Underweight may be a surrogate for advanced disease burden.

Effect of BMI and Its Optimal Cut-Off Value in Identifying Hypertension in Uyghur and Han Chinese: A Biethnic Study from the China National Health Survey (CNHS).

Objective The effect of adiposity on hypertension among Uyghur Chinese is not clear. This study aimed to compare the effect of BMI and its optimal cut-off value in identifying hypertension in Uyghur and Han adults in China. Methods By using a multistage stratified sampling method, 3072 Uyghur and 3195 Han adults underwent questionnaire interview, physical examination, and biochemical tests. Age- and sex-standardized prevalence of hypertension was calculated. Adjusted odds ratios for adiposity associated with hypertension were estimated. ROC analyses were used for assessing the ethnic and sex specific optimal BMI cut-off values in identifying hypertension. Results Both in Uyghur and Han, increased BMI was consistent with the elevated systolic and diastolic blood pressure. Although more Uyghur were overweight/obese, their standardized prevalence of hypertension (17.87%) was lower than that of Han (20.28%). Han adults had 1.42 times odds than Uyghur of hypertension. The adjusted ORs of overweight and obesity were 2.67 and 6.04 in Uyghur and 2.74 and 7.58 in Han. In male, the optimal cut-off values of BMI identifying hypertension in Uyghur and Han were 24.6 kg/m2 and 24.9 kg/m2 , respectively, but the correspond values in Uyghur and Han females were 27.2 kg/m2 and 25.0 kg/m2. Conclusions Adiposity had strong effect on hypertension, but this effect was less strong in Uyghur female than in Han female.

Waist Circumference and Waist-to-Height Ratio as Indicators for Excess Adiposity in Adolescents

The aimed of study was to evaluate the accuracy of Waist Circumference (WC) and Waist-to-Height Ratio (WHtR) for identification of excess adiposity in adolescents. The study design was diagnostic study. The subjects consisted of 620 adolescents (283 boys and 337 girls) aged 14-18 years. The classification of excess adiposity termed as overfat and obese was based on age-and sex-specific percent body fat cut-off values of body fat reference curves for children from the Growth Foundation. Receiver-operating characteristic (ROC) curve analyses was used to assess the accuracy of WC and WHtR as diagnostic tests of excess adiposity in adolescent. Area under curve (AUC) of WC and WHtR for the diagnostic of overfat were over 0.8 for boys and over 0.9 for girls. Whereas for obese, the AUC of WC and WHtR were over 0.9 for both sexes. The thresholds for defining overfat were 75.25 cm for WC and 0.45 for WHtR (Sensitivity (Se) and Specificity (Sp) >0.8) for boys, and 73.85 cm for WC and 0.49 for WHtR (Se dan Sp >0.8) for girls. The thresholds for defining obese were 86.45 cm for WC and 0.51 for WHtR (Se=1; Sp>0.9) for boys, and 75.60 cm for WC (Se and Sp >0.8) and 0.55 for WHtR (Se>0.8; Sp >0.9) for girls. WC and WHtR are accurate for screening of excess adiposity in adolescents.

Evaluation of sex-specific cut-off values of high-sensitivity cardiac troponin I and T assays in an emergency department setting – Results from the Linz Troponin (LITROP) study

BackgroundThe aim of the present analysis was to evaluate sex-specific cut-off values of a high-sensitivity cardiac troponin T (hs-cTnT) assay and a high-sensitivity cardiac troponin I (hs-cTnI) assay in an emergency department setting. MethodsWe retrospectively studied 1945 male and 1643 female emergency department patients in whom we had measured both Roche hs-cTnT and Abbott hs-cTnI routinely upon every troponin measurement request. We performed reclassification analyses of sex-specific thresholds versus sex-neutral thresholds of both assays. In addition, we performed sensitivity analyses to find those sex-specific cut-off values for the Roche hs-cTnT and the Abbott hs-cTnI assays with the lowest possible rate of discordant classifications by both assays. ResultsCompared with the classification by the sex-neutral thresholds (i.e., 14 ng/L for hs-cTnT and 26 ng/L for hs-cTnI), using sex-specific thresholds (i.e., 16 ng/L in males and 9 ng/L in females for hs-cTnT; and in 34 ng/L males and 16 ng/L in females for hs-cTnI) resulted in a total reclassification rate of 4% for hs-cTnT and 3% for hs-cTnI in male individuals, and of 11% and 6%, respectively, in female individuals. In our cohort, the sex-specific hs-cTnT cut-off values currently in use (i.e., 16 ng/L in males and 9 ng/L in females) were best matched to a hs-cTnI cut-off value of 11 ng/L in male and 5 ng/L in female individuals. Conversely, the sex-specific hs-cTnI cut-off values currently in use (i.e., 34 ng/L in males and 16 ng/L in females) were best matched to a hs-cTnT cut-off value of 49 ng/L in male and 24 ng/L in female individuals. These “harmonised” cut-off values reduced discordant classifications between both assays by 43–68% compared to using cut-off values currently in use. ConclusionEspecially in women, reclassification rates were high, when using sex specific versus sex-neutral thresholds. Best matching cut-off values for hs-cTnT and hs-cTnI were markedly different to those currently in use. These “harmonised” cut-off values minimised discordant classifications between both assays.

Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5-12 years, using receiver operating characteristic (ROC) analysis.

Background Different anthropometric parameters have been proposed for assessing central obesity in children, but the ability of these anthropometric parameters to correctly measure central obesity in Pakistani children is questionable and needs to be assessed. The aims of this investigation were to examine the diagnostic performance of anthropometric parameters as indicators of central obesity in Pakistani children as measured by waist circumference (WC) and to determine the sex-specific best cut-off values for these parameters that would identify obese children. Methods Anthropometric measurements - height, weight, WC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI) and neck circumference (NC) - from a cross-sectional sample of 5964 Pakistani children aged 5-12 years were analyzed. Receiver operating characteristics (ROC) analysis was used to examine the diagnostic performance and to determine the optimal cut-off point of each anthropometric parameter for identifying centrally obese children. Results It was found that WC had a significantly positive correlation with all studied anthropometric parameters. The ROC curve analysis indicated that all the parameters analyzed had good performance but WHtR had the highest value of the area under the curve (AUC). Optimal cut-off points associated with central obesity for boys and girls were, respectively, 0.47 and 0.48 for WHtR, 1.20 and 1.23 for CI, 0.96 and 0.96 for WHR and 26.36 and 26.54 cm for NC. Conclusions The sex-specific cut-off points for WHtR, CI, WHR and NC can be used to detect central obesity in Pakistani children.

P5595Clinical effect of sex-specific cutoff values of high-sensitivity cardiac troponin I in suspected myocardial infarction

P5595Clinical effect of sex-specific cutoff values of high-sensitivity cardiac troponin I in suspected myocardial infarction

Proposal for New Selection Criteria Considering Pre-Transplant Muscularity and Visceral Adiposity in Living Donor Liver Transplantation

Introduction The significance of preoperative body composition has recently attracted much attention in various diseases. However, cut-off values for these parameters remain undetermined, and these factors are not currently included in selection criteria for recipients of living donor liver transplantation (LDLT). The present study aimed to establish sex-specific cut-offs for body composition using data from healthy general population, and to develop new selection criteria for recipients of LDLT considering pre-transplant nutritional and physical statuses. Methods Using computed tomography of 657 donors for LDLT between April 2005 and July 2016 in our institution, skeletal muscle mass, muscle quality, and visceral adiposity were evaluated using skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). On the basis of younger donor data, we determined sex-specific cut-off values for low SMI, high IMAC, and high VSR (mean ± 2 standard deviations). To evaluate the validity of cut-offs for body composition parameters, we examined data from 277 patients who underwent adult-to-adult LDLT between January 2008 and July 2016. The impact of body composition on outcomes after LDLT was investigated with the aim of establishing new selection criteria for LDLT. Results Among the 277 LDLT recipients, 55 (20.0%), 121 (43.7%), and 83 (30.0%) patients exhibited low SMI, high IMAC, and high VSR, respectively. The overall survival rate was significantly lower for each group of patients with low SMI (P < 0.001), high IMAC (P < 0.001), or high VSR (P < 0.001) compared to the respective normal groups. In addition, low SMI, high IMAC, and high VSR contributed to an increased risk of post-LDLT mortality in an additive manner. Patients with all three factors showed the lowest survival rate after LDLT (1-year survival rate, 41.2%; P < 0.001). On multivariate analysis, low SMI (P = 0.002), high IMAC (P = 0.002), and high VSR (P = 0.001) were identified as independent risk factors for mortality after LDLT. Based on these findings, we have excluded patients showing all 3 factors (low SMI, high IMAC and high VSR) as candidates for LDLT since October 2016. Conclusion Using cut-off values determined from healthy donors, we investigated risk factors for post-LDLT mortality, and extracted the group that exhibited the poorest prognosis after LT, leading to the establishment of our new selection criteria for recipients of LDLT.

Role of sampling times and serum cortisol cut-off concentrations on the routine assessment of adrenal function using the standard cosyntropin test in an academic hospital from Spain: a retrospective chart review

ObjectivesAiming to validate the use of a single poststimulus sampling protocol for cosyntropin test short standard high-dose test (SST) in our institution, our primary objectives were (1) to determine the...

Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network)

BackgroundIn general, women have lower risk for cardiovascular disease. We tested whether this sex-specific protection persists also in the presence of hypertensive left ventricular hypertrophy (LVH). Methods12,329 women and men with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a median of 4.1years. Subjects were grouped according to the absence or the presence of LVH identified by echocardiography using validated sex-specific cut-off values of LV mass index (>47g/m2.7 in women and >50g/m2.7 in men). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). ResultsThe cardiovascular risk profile accompanying LVH did not differ between sexes, but presence of obesity and diabetes carried higher probability for LVH in women, and LVH was more prevalent in women than men (43.4 vs. 32.1%, p<0.001). Among patients without LVH (n=7764), women had a 35% lower hazard rate (HR) for MACE (n=179) than men (95% confidence interval [CI] 0.44–0.96, p=0.031) in Cox regression analysis adjusting for cardiovascular risk factors and antihypertensive treatment during follow up. In contrast, among patients with LVH (n=4565), women had a similar HR for MACE as men (HR 0.94 [95% CI 0.69–1.30], p=0.720). ConclusionThis study demonstrates that presence of LVH in hypertension offsets the female sex-protection in cardiovascular risk. Thus among hypertensive subjects with LVH, women and men have comparable cardiovascular risk.