Specific Cut-off Values Research Articles

P0351 Differential Cutoff Values of Fecal Calprotectin Based on Disease Extent of Ulcerative Colitis

Abstract Background Fecal calprotectin (FC) is a well-established biomarker for bowel inflammation in ulcerative colitis (UC). However, its utility across different disease extents remains poorly defined. This study investigates the correlation between FC levels and endoscopic severity according to disease extent in UC, aiming to establish specific cutoff values for each disease extent Methods From January 2013 to December 2020, UC patients slated for colonoscopy at our institution were recruited. Fecal samples were collected pre-procedure for FC analysis. Demographic and clinical data were recorded, categorizing patients by UC extent. Disease activity was evaluated using the Partial Mayo Score and Mayo Endoscopic Subscore (MES). Results We performed 404 colonoscopies on 165 UC patients. Analysis demonstrated varying correlations between FC and MES, particularly showing diminished correlation in patients with proctitis (E1/E2/E3 correlations: 0.298/0.533/0.574; p-values: 0.010/0.001/0.001). Cutoff values for FC varied with disease extent: 77 for proctitis (AUC: 0.752; Sensitivity: 64%; Specificity: 84%), 164 for left-sided colitis (AUC: 0.821; Sensitivity: 83%; Specificity: 100%), and 222 for pancolitis (AUC: 0.870; Sensitivity: 86%; Specificity: 83%). FC was superior to C-reactive protein in discriminating remission across all extents. Conclusion FC levels correlate with UC disease extent, suggesting that differential cutoff values should be utilized to enhance diagnostic accuracy. Specifically, lower correlations in proctitis highlight the need for adjusted diagnostic thresholds, underlining FC’s varied utility in managing UC.

The diagnostic performance of phase angle for sarcopenia among older adults: A systematic review and diagnostic meta-analysis.

Phase angle is a promising tool for diagnosing sarcopenia. This study aimed to summarize its diagnostic performance by performing a systematic review and meta-analysis. We conducted a systematic search of PubMed, Web of Science, Embase, and Scopus. The Quality Assessment of Diagnostic Accuracy Studies, Version 2, was used to evaluate the quality of the studies. A bivariate random effects model was employed for data synthesis, and diagnostic performance was reported in terms of pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve (AUC). Additionally, meta-regression, subgroup analyses, and sensitivity analyses were performed. A total of 15 studies were included in this meta-analysis, involving 4,063 participants. The overall risk of bias in the included studies was high. The meta-analysis revealed that the pooled sensitivity and specificity across all studies were 0.74 [95 % confidence interval (CI): 0.71-0.78] and 0.75 (95 % CI: 0.70-0.79), respectively, with an AUC of 0.79 (95 % CI: 0.76-0.83). Meta-regression indicated that study design, country, population, sex-specificity, and age may influence the diagnostic performance of phase angle. The optimal diagnostic performance was observed in the cut-off interval of 4.20 to 4.50°. The phase angle demonstrated moderate diagnostic performance for sarcopenia, and the possible cut-off interval is 4.20 to 4.50 °. However, large-scale, multicenter prospective studies are necessary to assess its clinical applicability at specific cut-off values.

Plasma D-Dimer Changes and Clinical Value in Acute Lower Extremity Deep Venous Thrombosis Treated with Catheter-Directed Thrombolysis.

This study sought to investigate the changes in plasma D-dimer levels during catheter-directed thrombolysis (CDT) in patients with acute lower extremity deep venous thrombosis (DVT), analyze imaging results, and assess their clinical implications. We retrospectively analyzed 62 patients diagnosed with acute lower extremity DVT who underwent CDT between March 2019 and December 2022. Plasma D-dimer levels were measured before CDT, at regular intervals after CDT, and at the end of CDT. Lower limb venography was performed every two days during CDT to assess the thrombus clearance rate and level of thrombus dissolution. Statistical analysis was conducted to observe the D-dimer concentration changes and analyze the correlation between D-dimer concentration and thrombus clearance rate. Additionally, a receiver operating characteristic (ROC) curve was constructed to determine the diagnostic performance of D-dimer in assessing the efficacy of thrombolysis, including the calculation of the area under the curve (AUC), sensitivity, specificity, and optimal cut-off value. During CDT for acute lower extremity DVT, plasma D-dimer levels rapidly increased, peaking on CDT day 1, and then gradually decreased, followed by a rapid decline but remained slightly elevated compared to normal levels. There was a positive correlation between D-dimer levels and thrombolysis efficacy (r = 0.809, P = 0.00). The linear regression equation for this correlation was Y = 0.161 + 0.028X. The AUC of D-dimer was 0.95, with a cut-off value of 9.935 mg/L (sensitivity 93.2% and specificity 95.4%). Plasma D-dimer concentration can serve as an indicator for evaluating the efficacy of thrombolysis during CDT in acute lower extremity DVT.

The Effect of Blood Lipid Profiles on Chronic Kidney Disease in a Prospective Cohort: Based on a Regression Discontinuity Design

ObjectivePrevious studies on the association between lipid profiles and chronic kidney disease (CKD) have yielded inconsistent results and no defined thresholds for blood lipids. MethodsA prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted. Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD. A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD. ResultsOver a median follow-up time of 2.2 (0.5, 4.2) years, 648 (2.00%) subjects developed CKD. The lipid profiles that were significantly and linearly related to CKD included total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C, and TG/HDL-C, whereas lowdensity lipoprotein cholesterol (LDL-C) and LDL-C/HDL-C were nonlinearly correlated with CKD. TC, TG, TC/HDL-C, and TG/HDL-C showed an upward jump at the cutoff value, increasing the risk of CKD by 0.90%, 1.50%, 2.30%, and 1.60%, respectively, whereas HDL-C showed a downward jump at the cutoff value, reducing this risk by 1.0%. Female and participants with dyslipidemia had a higher risk of CKD, while the cutoff values for the different characteristics of the population were different. ConclusionThere was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China, while TG, TC/HDL-C, and TG/HDL-C showed a stronger risk association. The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.

Oxygenation indices and early prediction of outcome in hypoxemic patients with COVID-19 pneumonia requiring noninvasive respiratory support in pulmonary intermediate care unit

BackgroundEarly prediction of non-invasive respiratory therapy (NIRT) failure is crucial to avoid needless prolongation of respiratory support and delayed endotracheal intubation. Data comparing the predictive value of oxygenation indices (OI) in COVID-19 receiving NIRT are scant.The aim of this monocentric retrospective study of prospectively collected data was to assess the effectiveness of different OI in predicting NIRT outcome at baseline (t0), 12 h (t12) and 24 h (t24) of treatment in hypoxemic patients with COVID-19-related pneumonia, managed in a Pulmonary Intermediate Care Unit (October 2020-June 2021).MethodsWe assessed the predictive value of SpO2/FiO2, PaO2/FiO2, standardised PaO2/FiO2 ratio (s-PaO2/FiO2), respiratory index (RI), arterial–alveolar oxygen gradient (a-ADO2), age adjusted arterial–alveolar oxygen ratio (adj-a-ADO2D). Receiver operating characteristics (ROC), AUC and best sensitivity–specificity cut-off values were calculated at t0, t12, t24. NIRT failure risk was adjusted for non-oxygenation predictors.ResultsAmong 590 patients with COVID-19 infection, 368 met the eligibility criteria for inclusion in the study [mean (CI95%): PaO2/FiO2 214(206,8–221,9); PaCO2 mean 32,9 mmHg,(32,4–33,4)]. NIRT failure and hospital mortality rate were 23,4% and 19,6%, respectively. Older age, male gender, agitation/confusion, need for sedation, inability to tolerate prone positioning were independent predictors of NIRT failure. SpO2/FiO2, a-ADO2 and adj-aADO2 at t12 and t24, PaO2/FiO2 and RI at t24 were associated with NIRT failure. Prognostic predictivity of OI increased from t0 to t24. Greater ROC-AUC values were obtained with SpO2/FiO2 0,662 (0,60–0,72) (t0), PaO2/FiO2 0,697 (0,63–0,76) (t12) and s-PaO2/FiO2 0,769 (0,71–0,83) (t24). NIRT failure was independently predicted by PaO2/FiO2, s-PaO2/FiO2 and RI at any observation time and by SpO2/FiO2 and O2 gradients respectively at t0 and t24. SaO2/FiO2 ≤ 300 (t0), PaO2/FiO2 ≤ 151,7 (t12) and s-PaO2/FiO2 ≤ 160,4 (t24) turned out to be the best predictors of NIRT outcome.ConclusionsOI showed different effectiveness in predicting NIRT failure within 24 h of treatment in COVID-19 related pneumonia. This may be due to the multi-factorial pathophysiology of hypoxemia. Our study empathises furthermore the role of non-oxygenation-related parameters in contributing to the outcome. These findings may be useful to build a predictive model also in no COVID-19 related hypoxemic pneumonia.

A New Laboratory Tool for COVID-19 Severity Prediction, CENIL Score.

Several studies investigated the risk factors for severe COVID-19-related outcomes. Early identification and proper treatment of COVID-19 patients who may develop severe pneumonia are crucial. The aim of this study was to detect the importance of the laboratory parameters for risk prediction of severe pneumonia in COVID-19 patients. This retrospective cohort study included COVID-19 patients' laboratory parameters at admission. Biochemical, hematological, coagulation, and inflammatory parameters values were compared between the non-severe and severe groups. A total of 534 COVID-19 patients were screened, and 472 of them were included in this study. The mean age of patients was 64 (±3.1) years; 242 (51.3%) were men. A total of 204 (43.2%) patients were diagnosed as severe cases. The independent predictors of severe illness were C-reactive peptide, Eosinophil, neutrophil-lymphocyte ratio, interleukin-6, and lactate dehydrogenase. These parameters were named as CENIL scores from 0 to 5 points. The findings of this study indicate that these biomarkers identified tend to increase progressively with disease severity in severe COVID-19 patients. Additionally, the CENIL risk score identified a specific cut-off value of 3, highlighting it as a critical threshold for identifying patients at high risk of severe COVID-19 progression. In this study, we identified biomarkers-including CRP, eosinophil count, NLR, IL-6, and LDH-named as CENIL risk score that can help predict the likelihood of severe disease at diagnosis. Clinicians may be more vigilant regarding the development of severe disease in patients with high CENIL risk scores, guided by clinical and radiological findings.

Phase angle as a marker of muscle quality: A systematic review and meta-analysis

Background & aimsPhase angle (PhA) is a biomarker derived from raw bioelectrical impedance analysis (BIA) values: resistance (R) and reactance (Xc). PhA reflects cellular membrane integrity and, as a result, has been considered a marker of fluid distribution, making it a potential prognostic indicator. A growing body of research demonstrates independent associations between PhA and muscle strength, mass, and composition. In this context, PhA has the extra potential to serve as a marker of muscle quality. However, the evidence supporting its use for this purpose is not well established. This study aimed to investigate the relationship between PhA and markers of muscle quality. MethodsThis systematic review and meta-analysis (Internal Prospective Register of Systematic Reviews – PROSPERO on a registration code: CRD42024507853) focused on observational studies assessing the relationship between PhA and markers of both concepts of muscle quality: the muscle quality index (MQI: strength by a unit of mass) and the muscle composition (i.e., skeletal muscle radiodensity [SMD], muscle echogenicity, muscle fat fraction, inter- and intramuscular adiposity). Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), while the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Meta-analyses with a random-effects model were conducted. ResultsSeventeen studies were included in this systematic review, encompassing 2,710 participants. Meta-analyses demonstrated that PhA had a moderate positive correlation coefficient with SMD (4 studies, 924 participants; r = 0.54, 95% confidence interval (CI) 0.38 to 0.69, heterogeneity (I2) = 92%) and good accuracy (85%) for classifying low SMD (2 studies, 390 participants; Area Under the Curve – AUC pooled 0.85, 95% CI 0.78 to 0.92, I2 = 0%). PhA was inversely-moderately correlated with muscle echogenicity (8 studies, 1,401 participants; r = - 0.42, 95% CI - 0.57 to - 0.24, I2 = 82%) and positively-weakly correlated with MQI (2 studies, 191 participants; r = 0.36, 95% CI 0.21 to 0.49, I2 = 17%). All studies had a higher risk of bias. The certainty of evidence ranged from low to very low. ConclusionDespite technical challenges, this study demonstrates the potential of PhA as a surrogate marker for muscle quality, particularly expressing muscle composition (SMD). Future studies should utilize BIA with standardized protocols to potentially establish specific cutoff values for PhA, thereby enhancing its diagnostic accuracy and clinical applicability. These studies could additionally explore the mechanisms underlying the associations between PhA and muscle quality aspects. In cases where technical factors are not easily controlled, the use of standardized PhA (SPhA), which converts PhA into Z-scores, could be beneficial. Although this warrants investigation, this approach (SPhA) has the potential to account for variables such as age, sex, device differences, and health status.

Assessment of right ventricular function in patients with severe secondary tricuspid regurgitation, following to the TVARC recommendations: association with outcome

Abstract Introduction Severe tricuspid regurgitation (TR) is associated with increased mortality if left untreated. Recently, the Tricuspid Valve Academic Research Consortium (TVARC) has published standardized definitions of disease aetiology and severity, as well as endpoints for future clinical trials. Right ventricular (RV) function assessment represents one of the cornerstones for risk stratification in these patients, but current guidelines do not propose specific cut-off values for the echocardiographic measures. Also, the thresholds proposed by the TVARC have been derived from normative value and not yet validated in large cohorts of TR patients. Purpose To test the prognostic value of the TVARC proposed echocardiographic cut-offs for grading RV-dysfunction (figure1) in a large real-world cohort of patients with severe secondary TR (STR). Methods Consecutive patients from a single centre with first diagnosis of severe secondary STR, and without a cardiac implantable electronic device, were included. Tricuspid annulus plane systolic excursion (TAPSE), RV global and free wall strain (RVGLS and RVFWLS) and fractional area change (FAC) were used to measure RV function. The study endpoint was all-cause mortality, censored for tricuspid valve intervention. Results A total of 1043 patients (mean age 69 ± 13 years, 43% male), were included. Approximately half of the population (45%) was in NYHA class III or IV and 52% was treated with loop diuretics. Overall patients showed mild RV-dilatation (RV end-diastolic area indexed 12.2 [10.1-15.2cm2/m2]) and moderate-to-severe right atrial dilatation (right atrial maximal area indexed: 13.9 [11.0-17.5cm2/m2]). Using the proposed cut-off values, strain analysis identified a higher number of patients with impaired RV function as compared to standard echocardiographic parameters (89% based on RVGLS; 80% based on RVFWS, 61% based on TAPSE and 54% based on RVFAC). During a median follow-up of 51 [IQR 6 - 98] months, 445 (43%) patients died. The Kaplan-Meier survival curves for each echocardiographic parameter of RV-function are shown in Figure 1. TAPSE, which is the most widely used RV-function parameter, was able to clearly identify patients at high and intermediate risk when mildly, moderately and severely impaired. However, patients with normal TAPSE were still at intermediate risk when RVFWLS was (even mildly) reduced (figure 2). We therefore propose a stepwise practical approach including the measure of RVFWLS when measuring normal TAPSE, in order to possibly re-stratify patients into a higher risk group (Figure 2). This novel grading approach remained independently associated with all-cause mortality after correcting for relevant clinical and echocardiographic variables on multivariable analysis. Conclusion Novel TAVRC cut-off values for RV function show prognostic value in patients with severe STR; particularly the combination of TAPSE and RVFWLS could be use in clinical practice for risk stratification.Figure 1Figure 2

FORTA Score and Negative Outcomes in Older Adults: Insights from Italian Internal Medicine Wards

Objectives: The study aimed to assess the relationship between the Fit fOR The Aged (FORTA) score – a classification system designed to evaluate medication appropriateness in older adults – and several negative outcomes, including impaired cognitive performance, functional status, adverse clinical events, and all-cause mortality at 3, 6, and 12 months after hospital discharge. Methods: This retrospective study utilized data from the ELICADHE cohort, a cluster-randomized trial conducted across 20 Italian internal medicine and geriatric wards. The study included patients aged 75 and older with complete FORTA score assessments. Demographics, medication history, and comorbidities were collected. The FORTA classification system assessed medication appropriateness. FORTA scores were calculated and FORTA score cut-offs (3 and 5) were applied. Statistical analyses included descriptive statistics, survival analysis with Cox regression, logistic regression, and negative-binomial regression using SAS 9.4 and RStudio 12.1. Ethical approval was obtained. Results: Of the 506 patients included, 171 (33.8%) were fully assessable with complete FORTA scores. The study found no significant association between higher FORTA scores and impaired cognitive performance, functional status, or mortality. Additionally, no clear relationship was observed between FORTA scores and adverse clinical events or mortality. The analysis indicated that age was a significant factor associated with mortality and adverse clinical events. Conclusion: The study did not find a significant relationship between the FORTA score and negative outcomes in older patients discharged from internal medicine and geriatric wards. Further research is needed to define specific FORTA score cut-off values and expand the criteria to improve medication assessment in this population.

Discriminant analysis using feature extraction from spectral domain responses to achieve accurate delineation for robust evaluation or classification of soil properties

ABSTRACT Soil spectroscopy offers a method for quantitatively analysing soil chromophores and employing a screening approach. However, utilizing general models with this data at once doesn’t consistently yield accurate results in determining soil parameters. Ambiguities in response within certain domains of the reflectance spectrum are observed. To address this issue, a method is proposed where quantities associated with spectral response are outputted within well-defined domains corresponding to specific parameters. This article introduces a novel approach centred on identifying features from reflectance spectra to assess soil properties and mitigate issues arising from a heterogeneous soil dataset. The focus is on swiftly automating the classification of soil spectral data by extracting features directly related to the varied composition of chromophores in the samples. These features are categorized for each chromophore parameter and analysed using linear discriminant analysis (LDA). The study employs the ‘309 soil samples’ from the GEO-CRADLE open spectral soil library in Greece. Specifically, relevant data from six spectral responses are extracted to separate and quantify certain soil parameters such as clay content, NO3− levels, and SOM (Soil Organic Matter), despite their interrelations. We developed a method to visually represent the determination outcomes quantitatively by establishing three threshold parameter values: 1.6% for SOM, 19% for clay, and 13.6 ppm for NO3−. These determinations will span the explored ranges of ’0.3 to 4.18%’ for SOM, “3 to 48%” for clay, and ’0 to 661.2 ppm’ for NO3−. Utilizing supervised LDA proves notable classification rates of 93.3% for the SOM task, 90% for the Clay task, and 86.6% for NO3− with the specific cut-off value parameter. The final result is presented as a map showing the positions of various prediction samples, highlighting the percentages of clay and organic matter relative to 19% and 1.6%, respectively, as well as the nitrate concentration in these samples relative to 13.6 ppm.

8117 Late-night Salivary Cortisol in the Diagnosis of Cushing's Disease Recurrence

Abstract Disclosure: A.E. Alexandre: None. P.C. Elias: None. M. De Castro: None. L.M. Mermejo: None. D.C. Aragon: None. A.C. Moreira: None. Cushing’s Disease (CD) remission following transsphenoidal surgery (TSS) is most often defined by low morning cortisol levels and the requirement of glucocorticoid (GC) replacement therapy. However, CD recurrence is not a well studied event. There is no standard definition of remission criteria and no accurate cutoff for biochemical tests on CD recurrence. Late-night salivary cortisol (LNSC) has been shown to have higher accuracy in confirming CD recurrence than urinary free cortisol and dexamethasone suppression test (DST). However, few studies addressed LNSC performance following remission after TSS. The study aimed to establish cutoff values of LNSC with higher sensitivity (S) and specificity (E) in CD recurrence diagnosis.In a retrospective cohort study of 65 patients with remitted CD after TSS, remission was defined as improvement of sign and symptoms related to CD and a plasma cortisol <5mcg/dL in 30 days following TSS. Eleven patients progressed to permanent adrenal insufficiency and were excluded from the study. All 54 patients had at least four LNSC sampling and a minimal follow-up of 24 months after TSS. LNSC was determined by RIA. A cutoff value of 270 ng/dl for LNSC is used for the diagnosis of CD. Patients were divided in three different groups: Overt Recurrence (OR): elevated LNSC and worsening of CD`s signs and symptoms. Remission (RM): normal LNSC and no clinical signs of CD recurrence. Biochemical Recurrence (BR): at least 2 elevated biochemical parameters (LNSC or DST) but no worsening of signs and symptoms associated with CD. The mean of the 2 LNSC last values when OR was diagnosed and the mean of 2 LNSC last values of follow up for RM patients were used to estimate the accuracy of LNSC for diagnosing recurrence using a ROC curve (AUC) and its 95% confidence interval. Of the 54 patients included, 46 females; 8 males; mean age at diagnosis: 32 years, (5 – 58 yrs); mean time of follow-up: 12.8 years (4 – 31.7 yrs). Thirteen were classified as OR, 18 as RM and 23 as BR; and mean time of GC use after TSS was: 8.7; 34 and 17 yrs, respectively, significantly lower in OR compared to RM (p:0.046). A LNSC cutoff value of 272 mcg/dL had sensitivity of 85% and specificity of 95% (AUC: 0.97; 95% IC = [0.93; 1,00]) for CD recurrence diagnosis. BR patients presented LSNC fluctuation along follow-up.LNSC is a useful tool for CD recurrence screening. Setting LSNC specific assay cutoff values might be needed. LSNC cutoff values were similar for the initial CD diagnosis, as well as for CD recurrence diagnosis. Shorter time of GC replacement may be an important predictor of CD recurrence. Patients with BR should be followed more carefully as they may be at higher risk of recurrence. Multiple LNSC sampling on successive days can be easily performed and may detect subtle changes in cortisol rhythm. Presentation: 6/1/2024

Rapid Access Diagnostics for Asthma (RADicA): protocol for a prospective cohort study to determine the optimum series of investigations to diagnose asthma using conventional and novel tests

IntroductionThe diagnosis of asthma is often based on characteristic patterns of symptoms in the absence of an alternative explanation, resulting in over and under diagnosis. Therefore, diagnostic guidelines usually recommend...

Association between longitudinal changes in phase angle and mortality rate in adults critically ill with COVID-19: A retrospective cohort study.

Phase angle (PhA) obtained by bioelectrical impedance analysis (BIA) works as a predictor of clinical outcomes. Specific cutoff values for longitudinal changes and their relationship with clinical outcomes are still undetermined for patients with critical illness. Thus, the aim of this study was to analyze the association between longitudinal changes in PhA during intensive care unit (ICU) stay and all-cause 90-day mortality in patients critically ill with COVID-19. This was a retrospective cohort study of adults critically ill with COVID-19 undergoing invasive mechanical ventilation with a length of stay >14 days. BIA was performed at ICU admission and at days 7 and 14 of ICU stay; PhA and hydration parameters were collected. Differences between survivors and nonsurvivors were assessed. Longitudinal changes were evaluated using repeated-measures analysis of variance. A receiver operating characteristics curve for PhA declined (%) during the first 14 days, and all-cause 90-day mortality was performed. Survival probability was reported using hazard ratios (HR). One-hundred nine patients were included. The change in the value of PhA was close to 17.1%. Nonsurvivors had a higher prevalence of individuals with a decrease in PhA >22.2% (area under the curve = 0.65) in the first 14 days in comparison with survivors (70% vs 34.8%, P < 0.01). PhA decrease >22.2% at 14 days was a significant predictor of all-cause 90-day mortality (HR = 2.2, 95% CI 1.71-3.6, P = 0.04). Changes in PhA are associated with all-cause 90-day mortality. Future studies should be directed to interventions to prevent changes in this nutrition marker.

Validation of the Spanish Version of the Voice-Related Quality of Life Questionnaire: Psychometric Properties and Clinical Applications

Introduction: The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish. Methods: The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects’ V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group). Results: This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials. Conclusion: A validation of the V-RQOL for Spanish in Chilean population was achieved.

New Immunological Indexes for the Effect of Systemic Inflammation on Oocyte and Embryo Development in Women With Unexplained Infertility: Systemic Immune Response Index and Pan-Immune-Inflammation Value.

Predicting the impact of systemic inflammation on oocyte and embryonic development in unexplained infertile women using the new immunological indexes. This retrospective cohort study was conducted using the records of the In Vitro Fertilization Department of Ankara Gülhane Training and Research Hospital. After reviewing the records of patients who had undergone in vitro fertilization (IVF) for unexplained infertility (UI) and excluding all known factors that could cause systemic immune inflammation, the systemic immune response index (SIRI), and pan-immune score were calculated from the pre-treatment hemogram parameters between the embryo arrest (EA) group and the embryo transfer group. It was investigated whether there was a statistical difference between the two groups and whether an SIRI value affecting embryo quality was found. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values for inflammatory markers to predict EA. The 108 EA group (embryos that were arrested during their development and could not be transferred) and the 140 embryo transfer group showed statistically significant differences in the parameters of systemic inflammatory index (SII), SIRI, pan-immune inflammation value (PIV), and neutrophil/lymphocyte ratio (NLR) (p < 0.05). These inflammatory parameters, which were examined before ovulation induction, also correlated positively with the required total dose of gonadotropin and negatively with the ovarian sensitivity index (OSI). SII, SIRI, PIV, and NLR have specific cut-off values with ROC analysis and determine the effect of the inflammatory status of the environment in which the oocyte develops on EA (p < 0.005). In women with UI, high levels of systemic immune inflammation have a negative impact on oocyte and embryo development, and treatments to suppress inflammation may improve IVF success.

The impact of cut-off values on the prevalence of short cervical length in pregnancy

BackgroundA prior study suggested that implementing a cut-off value of ≤30 mm for a short cervical length (CL) could potentially introduce selection bias and alter the distribution of CL measurements. As such, the objective of this study is to evaluate how CL distribution and incidence of short CL are affected when using different cut-off values for a short CL. Study designThis is a secondary analysis of the Quadruple P (QP) Screening study; a prospective cohort study that included low-risk patients with singleton pregnancies undergoing fetal anomaly scan at 18–22 weeks of gestation, including a CL measurement. Patients with a short cervix, defined as ≤35 mm, were subsequently counseled for the QP trial; a randomized controlled trial (RCT) comparing progesterone to cervical pessary for the prevention of preterm birth. If participation to the RCT was refused, patients with a CL ≤25 mm were advised to use progestogen. The primary objective of this current study was to assess the normal distribution of CL across the entire cohort and to assess the incidence of short CL when using the cut-off values of ≤35 and ≤25 mm. Normal distributions for CL were simulated based on mean and standard deviation(SD) of the original data. The Kolmogorov-Smirnov test was used to evaluate the distribution of the CL measurements. Moreover, to evaluate the motives behind ultrasound measurements around the cut-off value, sonographers were asked to fill out a qualitative questionnaire. ResultsThe total cohort included 19.171 eligible participants who underwent CL measurement, with a mean CL of 43.9 mm (±8.1 SD). The distribution of all CL observed measurements deviated significantly from the normal distribution (p < 0.001). A total of 1.852 (9.7%) patients had short CL ≤35 mm, which was significantly lower than expected when compared to the simulated normal distribution (n = 2.661, 13.9%; p < 0.001). The incidence of short CL ≤25 mm in our cohort statistically differed from the simulated normal distribution (238, 1.2% vs 177, 0.9%; p=0.003). When comparing our data to the simulated normal distribution, the difference in distributions is most pronounced when examining the difference between 35 and 36 mm. Results of the questionnaire reveal sonographers claimed not to be influenced by a cut-off value for study participation or progesterone treatment. ConclusionThis study demonstrates that using any cut-off value for a short CL influences the incidence and distribution of CL. When using a cut-off value of ≤35 mm for study inclusion, the incidence of measurements of a short CL is lower than the anticipated incidence compared to a normal distribution. However, when using a cut-off value of ≤25 mm for progesterone treatment, the frequency of CL measurements is higher than expected below this threshold compared to a normal distribution. This study highlights the risk of introducing selection bias, most likely unintentionally, when cut-off values for short CL are used, regardless of the specific value chosen. Therefore healthcare providers should measure the CL with caution if essential decisions depend on a specific cut-off value.

P130 TO ASSESS THE SENSITIVITY OF ANKLE BRACHIAL INDEX, WAIST TO THIGH RATIO AND HEIGHT TO WAIST RATIO AS A PREDICTOR OF HYPERTENSION

Materials and Methods: This cross-sectional study included 1000 subjects and spanned from August 2021 to December 2023. It compared Height to Waist Ratio (HtWR), Ankle Brachial Index (ABI), Waist to Thigh Ratio (WTR), and Wrist to Arm Ratio (WAR) against established markers like Waist to Height Ratio (WHtR), Waist to Hip Ratio (WHR), and Body Mass Index (BMI) to assess their effectiveness in measuring body composition. Results: Out of 750 participants, 40% (n=400) were males and 60% (n=600) were females. Among them, 44% (n=440) were non-hypertensive, while 56% (n=560) were hypertensive. For males, HtWR (AUROC: 0.677) and Inverse ABI (AUROC: 0.611) showed superior predictive capability for hypertension compared to other measures. Conversely, among females, Waist to Thigh Ratio (AUROC: 0.669) was the most effective predictor. Cut-off values for WTR in females were 1.55, while for males, HtWR and Inverse ABI were 2.3 and 2.84, respectively. Conclusion: Among males, height to waist ratio and inverse ABI proved more reliable for predicting hypertension, while in females, waist to thigh ratio was more sensitive. Among males, HtWR (AUROC: 0.677) and Inverse ABI (AUROC: 0.611) were superior predictors of hypertension, while females showed a higher predictive capability with Waist to Thigh Ratio (AUROC: 0.669). Specific cut-off values were established: 1.55 for WTR in females, and 2.3 for HtWR and 2.84 for Inverse ABI in males. These gender-specific findings inform tailored hypertension risk assessment strategies. This study suggests incorporating inverse ABI into both clinical and community-based hypertension screenings to enable earlier detection.

Voxel-based dosimetry with integrated Y-90 PET/MRI and prediction of response of primary and metastatic liver tumors to radioembolization with Y-90 glass microspheres.

In this study, we aimed to evaluate the response of the primary and metastatic liver tumors to radioembolization with 90Y glass microspheres and investigate its correlations with dosimetric variables calculated with 90Y PET/MRI. In this ambispective study, 44 patients treated with 90Y glass microspheres and imaged with 90Y PET/MRI were included for analysis. Dosimetric analysis was performed for every perfused lesion using dose-volume histograms. Response was assessed by comparing pre-treatment and follow-up total lesion glycolysis (TLG) values derived from 18F-FDG PET imaging. The relationship between ΔTLG and log-transformed dosimetric variables was analyzed with linear mixed effects regression models. ROC analyses were performed to compare discriminatory power of the variables in predicting response and complete response. Regression and ROC analyses demonstrated that mean tumor dose and almost all D values were statistically significant predictors of treatment response and complete treatment response. Specifically, D60, D70 and D80 values exhibited significantly higher discriminatory power for predicting treatment response compared to the mean dose (Dmean) delivered to tumor. High specificity cut-off values to predict response were determined as 160.75 Gy for Dmean, 95.50 Gy for D60, 89 Gy for D70, and 59.50 Gy for D80. Similarly, high-specificity cut-off values to predict complete response were 262.75 Gy for Dmean, 173 Gy for D70, 140.5 Gy for D80, and 100 Gy for D90. In this study, we demonstrated that voxel-based dosimetry with post-treatment 90Y PET/MRI can predict response to treatment. D60, D70 and D80 variables also did have greater discriminatory power compared to Dmean in prediction of response. In addition, we present high-specificity cut-offs to predict response (CR + PR) and complete response (CR) for both Dmean and several D variables derived from dose-volume histograms.

Momentousness of integration of the high-resolution computed tomography scoring systems with pulmonary artery systolic pressure measurement for inference of idiopathic pulmonary fibrosis severity

BackgroundThe importance of high-resolution computed tomography (HRCT) in the diagnosis of idiopathic interstitial pneumonia (IIP) is being recognized more and more. Pulmonary arterial hypertension is common in patients with idiopathic pulmonary fibrosis, the presence of PAH is linked to higher mortality rates and might explain why some people who otherwise have normal pulmonary function are displaying symptoms of deterioration. The aim of this work was to find out the potency of integration of high-resolution computed tomography (HRCT) scoring system with pulmonary artery systolic pressure (PASP) for ascertaining the disease severity of patients with idiopathic pulmonary fibrosis and to predict the prognosis for proper management, along with incorporation of the key disparity of different HRCT scoring systems for the ILD.ResultsThis prospective study included 80 patients, who came with idiopathic pulmonary fibrosis. A strong positive correlation (r = 0.989) was noted between total lung zone HRCT score and PASP, pulmonary artery size, grades of dyspnea and PCO2. Nonetheless, total lung zone HRCT score proved to have good correlation and inversely proportional to (r = − 0.71) 6MWT, PO2, SPO2, FVC and FEV1/FVC. We utilized a ROC curve to identify the optimal cutoff value in HRCT scoring systems, for detecting pulmonary hypertension associated with the IPF. The sensitivity and specificity of Warrick score cutoff value was higher compared to that of the HRCT scoring system-based grading scale. Both HRCT scoring systems attained high correlation coefficient factors with various incorporated parameters in the study.ConclusionWe can safely say that in order to reveal the severity and prognosis of idiopathic pulmonary fibrosis, a high-resolution computed tomography scoring system should be incorporated with echocardiography measurement of pulmonary artery systolic pressure —which proved to be the most potent predictive factor; especially when measured after a specific HRCT score cutoff value—followed by (FEV1/FVC), the 6MWT and the severity of dyspnea. Their integration collectively will aid in precise management and follow-up of IPF cases. Both HRCT scoring systems proved to be potent and perfect for short-term interval follow-up, yet the Warrick score was easier and faster to use and attained relatively increased sensitivity and specificity for the cutoff value of the pulmonary hypertension detection compared to the HRCT scoring system-based grading scale.

Evaluation of aldosterone to direct renin ratio, low renin and related Phenotypes in Afro-Colombian patients with apparent treatment resistant hypertension

Apparent resistant hypertension (aTRH) is a significant public health issue. Once low adherence to antihypertensive treatment has been ruled out and true resistant hypertension is diagnosed, aldosterone-direct-renin-ratio (ADRR) aids in the screening of an aldosterone-producing adenoma (APA) and primary aldosteronism (PA). Once PA and other secondary causes have been ruled out, the values of aldosterone and renin allow patients to be classified into phenotypes such as low renin hypertension (LRH), Liddle’s-like (LLph), and primary hyperaldosteronism (PAph). These classifications could aid in the treatment decision-making process. However, optimal cut-off points for these classifications remain uncertain. This study aims to assess the prevalence of these phenotypes and the behavior of different cut-offs of the ADRR in an Afro-Colombian population with apparent resistant hypertension, as well to describe their sodium consumption. Afro-descendant individuals 18 years of age or older, diagnosed with resistant hypertension and attending to a primary care center in Colombia were recruited as volunteers. As part of the study, their plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) were measured. The phenotypes were categorized into three groups based on multiple cut-off points from different authors: low renin and low aldosterone phenotype (LLph), low renin and high aldosterone phenotype (PAph), and high renin and high aldosterone phenotype, referred to as the renal phenotype (Rph). The prevalence of ADRR values exceeding the cut-off and phenotypes were calculated. A linear regression model was derived to assess the effect of sodium consumption with PAC, PRC and ADRR. A total of 88 patients with aTRH were included. Adherence to at least 3 antihypertensive medications was 62.5%. The median age was 56 years (IQR 48–60), 44% were female, and 20% had diabetes. The study found that the prevalence of ADRR values exceeding the cut-off ranged from 4.5 to 23%, while low-renin hypertension (LRH) varied from 15 to 74%, Rph was found in approximately 30 to 34% of patients, PAph in 30 to 51%, and the LLph in 15 to 41%, respectively, depending on the specific cut-off value by different authors. Notably, sodium consumption was associated with lower aldosterone (β − 0.15, 95% CI [− 0.27, − 0.03]) and renin concentrations (β − 0.75, 95% CI [− 1.5, − 0.02]), but ADRR showed no significant association with sodium consumption. There were no significant differences in prevalences between the groups taking < 3 vs ≥ 3 antihypertensive medications. Altered aldosterone-direct-renin-ratio, low renin hypertension, Liddle’s-like, and primary hyperaldosteronism are prevalent phenotypes in patients within Afro-Colombian patients with apparent treatment-Resistant hypertension.