scholarly journals Deep learning for accurately recognizing common causes of shoulder pain on radiographs

2021 ◽  
Author(s):  
Nils F. Grauhan ◽  
Stefan M. Niehues ◽  
Robert A. Gaudin ◽  
Sarah Keller ◽  
Janis L. Vahldiek ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Clinical Situation ◽  
Assistive Device ◽  
Test Dataset ◽  
Joint Dislocation ◽  
Independent Expert ◽  
Common Causes

Abstract Objective Training a convolutional neural network (CNN) to detect the most common causes of shoulder pain on plain radiographs and to assess its potential value in serving as an assistive device to physicians. Materials and methods We used a CNN of the ResNet-50 architecture which was trained on 2700 shoulder radiographs from clinical practice of multiple institutions. All radiographs were reviewed and labeled for six findings: proximal humeral fractures, joint dislocation, periarticular calcification, osteoarthritis, osteosynthesis, and joint endoprosthesis. The trained model was then evaluated on a separate test dataset, which was previously annotated by three independent expert radiologists. Both the training and the test datasets included radiographs of highly variable image quality to reflect the clinical situation and to foster robustness of the CNN. Performance of the model was evaluated using receiver operating characteristic (ROC) curves, the thereof derived AUC as well as sensitivity and specificity. Results The developed CNN demonstrated a high accuracy with an area under the curve (AUC) of 0.871 for detecting fractures, 0.896 for joint dislocation, 0.945 for osteoarthritis, and 0.800 for periarticular calcifications. It also detected osteosynthesis and endoprosthesis with near perfect accuracy (AUC 0.998 and 1.0, respectively). Sensitivity and specificity were 0.75 and 0.86 for fractures, 0.95 and 0.65 for joint dislocation, 0.90 and 0.86 for osteoarthrosis, and 0.60 and 0.89 for calcification. Conclusion CNNs have the potential to serve as an assistive device by providing clinicians a means to prioritize worklists or providing additional safety in situations of increased workload.

Diagnostic studies

2010 ◽  
pp. 339-351
Author(s):  
Janet L. Peacock ◽  
Philip J. Peacock
Keyword(s):  
Receiver Operating Characteristic ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Diagnostic Testing ◽  
Roc Curves ◽  
Clinical Situation ◽  
Post Test ◽  
Receiver Operating

Sensitivity and specificity 340 Calculations for sensitivity and specificity 342 Effect of prevalence 344 Likelihood ratio, pre-test odds, post-test odds 346 Receiver operating characteristic (ROC) curves 348 Links to other statistics 350 In this chapter we describe how statistical methods are used in diagnostic testing to obtain different measures of a test’s performance. We describe how to calculate sensitivity, specificity, and positive and negative predictive values, and show the relevance of pre- and post-test odds and likelihood ratio in evaluating a test in a clinical situation. We also describe the receiver operating characteristic curve and show how this links with logistic regression analysis. All methods are illustrated with examples....

scholarly journals Application of Scheimpflug-Based Biomechanical Analyzer and Tomography in Early Detecting of Subclinical Keratoconus in Chinese Patients

2020 ◽  
Author(s):  
Yan Liu ◽  
Yu Zhang ◽  
Yue-guo Chen
Keyword(s):  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Roc Curves ◽  
Chinese Patients ◽  
Youden Index ◽  
Biomechanical Property ◽  
Surgical Safety ◽  
Morphological Index ◽  
Diagnostic Capacity

Abstract PurposeTo evaluate the value of Scheimpflug-based biomechanical analyzer combined with tomography in detecting early keratoconus by distinguishing normal eyes from frank keratoconus (KC) and forme frusta keratoconus (FFKC) eyes in Chinese patients. MethodsThis study included 31 bilateral frank keratoconus patients, 27 unilateral clinical manifest keratoconus patients with very asymmetric eyes, and 79 control subjects with normal corneas. Corneal morphological and biomechanical parameters were measured using the Pentacam HR and Corvis ST (OCULUS, Wetzlar, Germany). The diagnostic capacity of computed parameters reflecting corneal biomechanical and morphological traits [including Belin-Ambrósio deviation index (BAD_D), Corvis biomechanical index (CBI) and tomographic and biomechanical index (TBI)] was determined using receiver operating characteristic (ROC) curves and compared by DeLong test. Additionally, the area under the curve (AUC), the best cutoff values, and Youden index for each parameter were reported. The novel corneal stiffness parameter (Stress-Strain Index or SSI) was also compared between KC, FFKC and normal eyes.ResultsEvery morphological and biomechanical index analyzed in this study was significantly different between KC, FFKC and normal eyes (p=0.000). TBI was most valuable for detecting subclinical keratoconus (FFKC eyes) with an AUC of 0.928 (P=0.000), and any forms of corneal ectasia (FFKC and frank KC eyes) with an AUC of 0.966 (P=0.000). The sensitivity and specificity of TBI for detecting FFKC was 97.5% and 77.8%, for detecting any KC was 97.5% and 89.7%, with a cut-off value of 0.375. Morphological index BAD_D and biomechanical index CBI were also very useful in distinguishing any KC eyes from normal eyes with an AUC of 0.965 and 0.934, respectively. SSI was significantly different between KC, FFKC and normal eyes (P=0.000), indicating an independent decrease in corneal stiffness in KC eyes.Conclusion Combination of Scheimpflug-based biomechanical analyzer and tomography could increase the accuracy of detecting early keratoconus in Chinese patients. TBI was the most valuable index for detecting subclinical keratoconus with high sensitivity and specificity. Evaluation of corneal biomechanical property in refractive surgery candidates is helpful to recognize potential keratoconic eyes and increase surgical safety.

scholarly journals Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

2020 ◽  
Vol 12 (6) ◽  
pp. 33-41
Author(s):  
S. A. Mekhryakov ◽  
A. A. Kulesh ◽  
L. I. Syromyatnikova ◽  
К. V. Sobyanin
Keyword(s):  
Ischemic Stroke ◽  
Sensitivity And Specificity ◽  
Considerable Increase ◽  
Cryptogenic Stroke ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Cardioembolic Stroke ◽  
Threshold Values ◽  
Intensive Search

Studies of the biomarkers of atrial cardiopathy seem to be promising for identifying patients with cryptogenic stroke (CS), in which an intensive search for atrial fibrillation is indicated. Nevertheless, the diagnostic value of these markers and their threshold values require clarification.Objective: to present the characteristics of echocardiographic markers for atrial cardiopathy and the serum concentration of N-terminal pro-Btype natriuretic peptide (NT-proBNP) in embolic CS versus cardioembolic stroke (CES) and non-cardioembolic stroke (non-CES) to determine the threshold values of parameters with the highest sensitivity and specificity in differentiating CES and non-CES.Patients and methods. A total of 259 patients with ischemic stroke were examined. The standard examination additionally involved calculation of the parameters that reflected left atrial LA) function (LAF): LA emptying fraction (LAEF), and LA functional index (LAFI). The serum NT-proBNP concentration was also determined in 75 patients.Results and discussion. The patients with CES versus those with CS and non-CES were characterized by a considerable increase in LA diameter (4.3 [3.5; 4.5] cm vs 3.7 [3.4; 4.0] cm vs 3.7 [3.4; 3.9] cm; p=0.005 and p=0.009, respectively), LAVI (35.7 [30.5; 39.9] ml/m2 vs 28.5 [25.6; 34.6] ml/m2 vs 27.1 [24.5; 31.2] ml/m2 ; p< 0.001) and NT-proBNP level (559 [409; 1144] pg/ml vs 164 [65; 308] pg/ml vs 191 [63; 446] pg/ml; p=0.002 and p=0.019, respectively), as well as by a lower LAEF value [50.3 [48.5; 51.1]% vs 54.7 [51.6; 56.6]% vs 54.9 [52.5; 56.8]%; p< 0.001). The only parameter that showed significant differences between all the three groups (CES, CS, and nonCES) was LAFI (0.24 [0.2; 0.32] units vs 0.37 [0.3; 0.47] units vs 0.40 [0.34; 0.47] units; p<0.00 1), while maintaining the differences in the values for the two groups (CS and non-CES) (p=0.004). The following threshold values of biomarkers were obtained for CES and nonCES; these were a LA diameter of 41.5 mm (p< 0.001), a LAVI of 36.3 ml/m2 (p< 0.001), a LAEF of 51.8% (p< 0.001), a LAFI of 0.28 units (p< 0.001), and an NT-proBNP of 316 pg/ml (p< 0.001). Analysis of the ROC curves and the area under the curve (AUC) revealed that the most informative criteria for sensitivity and specificity were LAEF (79 and 88%, AUC 0.89), NT-proBNP (67 and 91%, AUC 0.89) and LAFI (93 and 72%, AUC 0.81).Conclusion. The CS group and non-CES one are comparable in the echocardiographic manifestations of atrial cardiopathy and in serum NTproBNP values. LAEF and NT-proBNP concentrations are promising biomarkers to classify CS patients into potential arterio- and cardioembolic types.

scholarly journals The role of fibrinogen in predicting reinfection after DAIR for periprosthetic joint infections

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dacheng Zhao ◽  
Jinwen He ◽  
Xingwen Wang ◽  
Xiaobing Zhao ◽  
Yayi Xia ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Characteristic Curve ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Reactive Protein ◽  
Joint Infections ◽  
Implant Retention ◽  
Sensitivity Specificity

Abstract Background Fibrinogen (FIB) has been found to be a promising marker in diagnosing periprosthetic joint infection (PJI), however, the value of FIB in predicting reinfection of PJI is unknown. The purpose of this study was to evaluate the value of FIB in predicting reinfection after debridement, antibiotics, and implant retention (DAIR) for PJI. Methods We retrospectively analyzed the clinical data of patients who were diagnosed with PJI and underwent DAIR from 2013 to 2019. The levels of the FIB, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured before DAIR. After DAIR, patients were followed and reinfections were identified. For both acute and chronic PJI, the predictive value of FIB was evaluated by calculating the sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic curve (ROC), and was compared with traditional inflammatory markers including ESR and CRP. Results The expression of FIB differed between patients reinfected and those not reinfected in both acute and chronic PJI (p < 0.05). In patients who underwent DAIR for acute PJI, the sensitivity and specificity of FIB were 81.82 and 83.33%, respectively, which were significantly higher than that of CRP (sensitivity, 72.73%; specificity, 50%; p < 0.05), while the specificity was higher than that of ESR (specificity, 41.67%; p < 0.05). In patients who underwent DAIR for chronic PJI, the sensitivity and specificity of FIB were 80.00 and 66.66%, respectively, which were significantly higher than that of CRP (sensitivity, 53.33%; specificity, 66.66%; p < 0.05) and ESR (sensitivity was 66.00%; specificity, 16.66%; p < 0.05). The ROC curves showed that FIB demonstrated the highest AUC among the biomarkers in both acute and chronic PJI. Conclusion FIB is a promising indicator in predicting reinfection after DAIR for both acute and chronic PJI, and it seems to perform better than ESR and CRP.

Preliminary Data from a Field Trial of the PFA-100™ System

1995 ◽  
Vol 21 (S 02) ◽  
pp. 113-121 ◽  
Author(s):  
Eberhard Mammen ◽  
Rasheed Alshameeri ◽  
Philip Comp
Keyword(s):  
Sensitivity And Specificity ◽  
Sodium Citrate ◽  
Area Under The Curve ◽  
Roc Curves ◽  
A Value ◽  
Additional Testing ◽  
Primary Platelet ◽  
Receiver Operator Characteristics ◽  
Precision Testing

The PFA-100™ system *(Dade International Inc., Miami, FL) is a platelet function anaIyzer, the design of which is based on the technology of the Thrombostat 4000 VDG, Seeon, Germany. † It was developed to measure primary, platelet dependent hemostasis in citrated whole blood in vitro. A first pilot study was conducted with the instrument to assess performance characteristics. Healthy subjects (normals) who had not ingested any medications, and patients (abnormals) with primary, platelet-related hemostasis defects, which included users of aspirin, were studied with two test cartridges; collagen/ADP and collagen/epinephrine. Before the study certain variables were tested that ascertained that blood drawn into either 3.8% or 3.2% sodium citrate containing vacutainers (rather than syringes) could be used for testing. Tests must be performed within a five-hour time span from drawing to testing, and blood must be kept at room temperature. Normal reference values were 77–133 seconds closure times for collagen/ADP and 98-185 seconds for collagen/ epinephrine. Precision testing revealed a CV of >10% for within-day and between-day (five days) analyses on collagen/ADP cartridges and a CV of 5–14% for both runs on the collagen/epinephrine cartridges. No clinically important differences were found between measurements in the two positions of the instrument, although one follows the other. Tests on 99 normals and 70 abnormals were performed and data expressed as receiver/operator characteristics (ROC) curves that assess the combined sensitivity and specificity of a procedure. An area under the curve of 1.0 means that all samples (normals + abnormals) were accurately identified; a value of 0.5 indicates that the test is noninformative. Using collagen/ADP cartridges a value of 0.76 was found when testing 99 normals and 52 abnormals. All aspirin users had been omitted from the abnormals. With the collagen/epinephrine cartridges, evaluating 99 normals and 70 abnormals, a value of 0.89 was obtained. This analysis entailed also aspirin users. Of 24 known aspirin users the collagen/epinephrine cartridges identified 20 that had normal closure times with the collagen/ADP cartridges. Three aspirin users had abnormal values with both cartridges, one subject was normal with both. When the traditional Ivy bleeding times were plotted as an ROC curve, an area under the curve of 0.698 was found. The data suggest that the PFA-100™ system identifies normals and abnormals (subjects with primary, platelet related hemostasis defects) with greater sensitivity and specificity than the present widely used bleeding time. The instrument is easy to use and could be adapted to routine laboratory use. The data presented are preliminary and need to be confirmed by additional testing.†Not commercially available in the U.S.A.

scholarly journals Epidemiologic Behavior and Estimation of an Optimal Cut-Off Point for Homeostasis Model Assessment-2 Insulin Resistance: A Report from a Venezuelan Population

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Valmore Bermúdez ◽  
Joselyn Rojas ◽  
María Sofía Martínez ◽  
Vanessa Apruzzese ◽  
Mervin Chávez-Castillo ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Sensitivity And Specificity ◽  
Adult Population ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Reference Population ◽  
Point Estimation ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Cross Sectional

Background. Mathematical models such as Homeostasis Model Assessment have gained popularity in the evaluation of insulin resistance (IR). The purpose of this study was to estimate the optimal cut-off point for Homeostasis Model Assessment-2 Insulin Resistance (HOMA2-IR) in an adult population of Maracaibo, Venezuela. Methods. Descriptive, cross-sectional study with randomized, multistaged sampling included 2,026 adult individuals. IR was evaluated through HOMA2-IR calculation in 602 metabolically healthy individuals. For cut-off point estimation, two approaches were applied: HOMA2-IR percentile distribution and construction of ROC curves using sensitivity and specificity for selection. Results. HOMA2-IR arithmetic mean for the general population was 2.21±1.42, with 2.18±1.37 for women and 2.23±1.47 for men (P=0.466). When calculating HOMA2-IR for the healthy reference population, the resulting p75 was 2.00. Using ROC curves, the selected cut-off point was 1.95, with an area under the curve of 0.801, sensibility of 75.3%, and specificity of 72.8%. Conclusions. We propose an optimal cut-off point of 2.00 for HOMA2-IR, offering high sensitivity and specificity, sufficient for proper assessment of IR in the adult population of our city, Maracaibo. The determination of population-specific cut-off points is needed to evaluate risk for public health problems, such as obesity and metabolic syndrome.

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods:  A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

scholarly journals Magnetic resonance cisternography imaging findings related to the leakage of Gadolinium into the subarachnoid space

2021 ◽  
Author(s):  
Rei Nakamichi ◽  
Toshiaki Taoka ◽  
Hisashi Kawai ◽  
Tadao Yoshida ◽  
Michihiko Sone ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Predictive Performance ◽  
Roc Curves ◽  
Imaging Findings ◽  
Spearman’S Rank Correlation ◽  
Sagittal Sinus ◽  
Magnetic Resonance Cisternography

Abstract Purpose To identify magnetic resonance cisternography (MRC) imaging findings related to Gadolinium-based contrast agent (GBCA) leakage into the subarachnoid space. Materials and methods The number of voxels of GBCA leakage (V-leak) on 3D-real inversion recovery images was measured in 56 patients scanned 4 h post-intravenous GBCA injection. Bridging veins (BVs) were identified on MRC. The numbers of BVs with surrounding cystic structures (BV-cyst), with arachnoid granulations protruding into the superior sagittal sinus (BV-AG-SSS) and the skull (BV-AG-skull), and including any of these factors (BV-incl) were recorded. Correlations between these variables and V-leak were examined based on the Spearman’s rank correlation coefficient. Receiver-operating characteristic (ROC) curves were generated to investigate the predictive performance of GBCA leakage. Results V-leak and the number of BV-incl were strongly correlated (r = 0.609, p < 0.0001). The numbers of BV-cyst and BV-AG-skull had weaker correlations with V-leak (r = 0.364, p = 0.006; r = 0.311, p = 0.020, respectively). The number of BV-AG-SSS was not correlated with V-leak. The ROC curve for contrast leakage exceeding 1000 voxels and the number of BV-incl had moderate accuracy, with an area under the curve of 0.871. Conclusion The number of BV-incl may be a predictor of GBCA leakage and a biomarker for waste drainage function without using GBCA.

Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V.L Malavasi ◽  
E Fantecchi ◽  
V Tordoni ◽  
L Melara ◽  
A Barbieri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Factors Affecting ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
History Of ◽  
Unselected Population ◽  
Cox Proportional Hazard Regression

Abstract Background Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one. Aim To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF. Methods In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter. Results Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc &lt;0.001, HATCH p=0.001). At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (&gt;42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score &gt;2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs &gt;2 led to a statistically significant difference (χ2=16.080 p&lt;0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078). Conclusions In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF. Funding Acknowledgement Type of funding source: None

Gestational Age Dependency of Umbilical Cord Serum IL-6 Levels for Detecting Fetal Inflammation

2020 ◽  
Author(s):  
Sota Iwatani ◽  
Takao Kobayashi ◽  
Sachiko Matsui ◽  
Akihiro Hirata ◽  
Miwa Yamamoto ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Gestational Age ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Cord Serum ◽  
Very Preterm ◽  
Key Points ◽  
Extremely Preterm ◽  
Preterm Newborns

Objective The fetal inflammatory response syndrome (FIRS) is characterized by elevated concentrations of inflammatory cytokines in fetal blood, with preterm delivery and morbidity. Umbilical cord serum interleukin-6 (UC-s-IL-6) is an ideal marker for detecting FIRS. However, the effect of gestational age (GA) on UC-s-IL-6 levels has not been reported. This study aimed to determine the relationship between GA and UC-s-IL-6 levels, and GA-dependent cutoff values of UC-s-IL-6 levels for detecting fetal inflammation. Study Design UC-s-IL-6 concentrations were measured in 194 newborns (44 extremely preterm newborns (EPNs) at 22–27 weeks' GA, 68 very preterm newborns (VPNs) at 28–31 weeks' GA, and 82 preterm newborns (PNs) at 32–34 weeks' GA). Linear regression analyses were used to correlate GA and UC-s-IL-6 levels. Receiver operating characteristic (ROC) curves analyses were performed for detecting the presence of funisitis, as the histopathological counterpart of FIRS. Results A significant negative correlation between GA and UC-s-IL-6 levels was found in newborns with severe funisitis (r s =  − 0.427, p = 0.004) and those with mild funisitis (r s =  − 0.396, p = 0.025). ROC curve analyses revealed the area under the curve for detecting funisitis were 0.856, 0.837, and 0.622 in EPNs, VPNs, and PNs, respectively. The UC-s-IL-6 cutoff value in EPNs (28.1 pg/mL) exceeded those in VPNs and PNs (3.7 and 3.0 pg/mL, respectively). Conclusion UC-s-IL-6 levels were inversely correlated with GA especially in newborns with funisitis. Such GA dependency of UC-s-IL-6 should be considered for detecting fetal inflammation. Key Points

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