Modified zwolle score with delta-creatinine: enhancing the safety of early discharge after STEMI

Abstract Introduction The Zwolle score (ZS) is recommended to identify low-risk patients eligible for early discharge after acute ST-segment elevation myocardial infarction (STEMI), but as only one-third of STEMIs have a low ZS, the discharge is often postponed. Creatinine variation (Δ-Cr) also provide prognostic information after STEMI. Purpose The authors intend to study the “modified Zwolle Score” (MZS) model, which encompasses Δ-Cr as a variable that may enhance the discriminative power of the standard ZS. The outcome is 30-day mortality, time range that starts right after the ACS. Methods This is a retrospective study with data from a national multicentre registry. We have included 3.296 patients with STEMI. Zwolle score was calculated for each patient. It is defined as shown in figure 1. Δ-Cr was defined as maximum serum creatinine minus admission serum creatinine. A Δ-Cr≥0.3 was assigned 2 points in the Modified Zwolle Score, after interpretation of odds ratio via multivariate analysis. For prediction quality assessment, we have performed ROC curve analysis with both scoring systems versus 30-day mortality. Regarding survival analysis, we have performed Kaplan-Meier curves with Log-rank analysis. We have also registered complications during hospital stay. Results The sample mean age is 63±14, and it is composed by 76.8% of males. The majority of patients presented Killip Class I (87.3%). The STEMI was anterior in 49.7% of patients and inferior in 49.8% of patients. The mean admission time was 5 days. Intrahospital mortality was 3% and 30-day mortality was 4%. The mean ZS was 3.1±2.8 points, the mean MZS was 3±2.1 points and the mean Δ-Cr was 0.2±0.6mg/dL. The ROC curve analysis between ZS and early mortality revealed a c-statistic of 0.810 (CI 0.796–0.823), whereas the ROC curve between MZS and early mortality revealed a c-statistic of 0.853 (95% CI: 0.841–0.865). The ROC curves comparison showed superiority of the MZS c-statistic, with a difference between AUC of 0.043 (p<0.001, 95% CI: 0.024–0.063). Regarding low-risk patients, 30-day mortality was 3.3% using ZS (0–2 points) and 2.4% using modified ZS (0–2 points). Fifty patients (1.5%) died between 3rd and 10th day after ACS: original ZS low-risk criteria registered 0.09% and modified ZS low-risk criteria 0.06% fatalities. Kappa coefficient for intergroup concordance was good (0.73). Conclusion We conclude that by adding Δ-Cr to the standard ZS, a renal function parameter that was lacking in the ZS, its predicting capacity regarding early mortality in patients admitted with STEMI was increased. Comparing both scores, low-risk patients defined by MZS registered less complications, 3–10 day mortality and 30-day mortality than low-risk patients defined by the original ZS. This fact may lead to better distinction of patients who will benefit from early discharge. Zwolle Score, ROC curves and survival Funding Acknowledgement Type of funding source: None

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Presepsin values and prognostic nutritional index predict mortality in intensive care unit patients with sepsis: a pilot study

BMC Research Notes ◽

10.1186/s13104-021-05659-9 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Yuichiro Shimoyama ◽

Osamu Umegaki ◽

Noriko Kadono ◽

Toshiaki Minami

Keyword(s):

Multivariate Analysis ◽

Roc Curve ◽

Operating Characteristic ◽

Prognostic Nutritional Index ◽

Early Mortality ◽

Curve Analysis ◽

Rank Test ◽

Roc Curve Analysis ◽

Log Rank Test ◽

Nutritional Index

Abstract Objective Sepsis is a major cause of mortality for critically ill patients. This study aimed to determine whether presepsin values can predict mortality in patients with sepsis. Results Receiver operating characteristic (ROC) curve analysis, Log-rank test, and multivariate analysis identified presepsin values and Prognostic Nutritional Index as predictors of mortality in sepsis patients. Presepsin value on Day 1 was a predictor of early mortality, i.e., death within 7 days of ICU admission; ROC curve analysis revealed an AUC of 0.84, sensitivity of 89%, and specificity of 77%; and multivariate analysis showed an OR of 1.0007, with a 95%CI of 1.0001–1.0013 (p = 0.0320).

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CLINICAL SIGNIFICANCE OF PROCALCITONIN AND C-REACTIVE PROTEIN IN THE PREDICTION OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i9.19524 ◽

2017 ◽

Vol 10 (9) ◽

pp. 297

Author(s):

Hanaa H. Ahmed ◽

Wafaa Gh Shousha ◽

Hatem A El Mezayen ◽

Ibrahim A Emara ◽

Marwa E Hassan

Keyword(s):

Roc Curve ◽

Cardiovascular Complication ◽

Curve Analysis ◽

Diabetic Patients ◽

C Reactive Protein ◽

Roc Curve Analysis ◽

Reactive Protein ◽

The Mean ◽

Type 2 Diabetic

Objective: This work was delineated to assess procalcitonin (PCT) and C-reactive protein (CRP) as prognostic markers for cardiovascular complication in type 2 diabetic patients.Methods: Forty diabetic patients without cardiovascular disease (CVD), 40 diabetic patients with CVD, and 20 healthy control counterparts were participated in this study. Serum PCT and CRP levels were assayed and correlated with metabolic parameters. Receiver operating characteristic (ROC) curve analysis was done for each biochemical marker.Results: The mean level of PCT was 707.17±99.19 ng/l in diabetic patients versus 881.30±123.56 ng/l for the cardio-diabetic patients (p<0.0001). The mean value of CRP was 34.43±17.27 mg/l in diabetic patients versus 50.32±20.19 mg/l for the cardio-diabetic patients (p=0.0003). PCT levels were significantly amplified in the cardio-diabetic patients with increasing CRP, triglycerides (TG), fasting blood glucose (FBG), and cholesterol (p=0.004, 0.0005, 0.002, and 0.01, respectively). CRP levels were significantly enhanced in the cardio-diabetic patients with increasing TG, FBG, cholesterol, and microalbumin (p=0.002, 0.047, 0.003, and 0.001 respectively). ROC curve analysis for PCT and CRP revealed that the area under curve (AUC) was 0.878 and 0.727, respectively. These findings indicate the good validity of the above biomarkers especially PCT as a prognostic marker for cardiovascular complication in type 2 diabetic patients.Conclusion: This study evidences the usefulness of measuring serum levels of PCT and CRP in diagnosis of cardiovascular complication in type 2 diabetic patients.

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ROC Curve Analysis: An Example Showing the Relationships Among Serum Lipid and Apolipoprotein Concentrations in Identifying Patients with Coronary Artery Disease

Clinical Chemistry ◽

10.1093/clinchem/38.8.1425 ◽

1992 ◽

Vol 38 (8) ◽

pp. 1425-1428 ◽

Cited By ~ 31

Author(s):

M H Zweig ◽

S K Broste ◽

R A Reinhart

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Roc Curve ◽

Serum Lipid ◽

Fundamental Property ◽

Roc Curves ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Clinical Sensitivity ◽

Artery Disease

Abstract Clinical accuracy, defined as the ability to discriminate between states of health, is the fundamental property of any diagnostic test or system. It is readily expressed as clinical sensitivity and specificity, and elegantly represented by the receiver operating characteristic (ROC) curve. To demonstrate the use of ROC curves, we reexamine a study of the ability of serum lipid and apolipoprotein measures to discriminate among degrees of coronary artery disease in patients undergoing coronary angiography. ROC curve analysis reveals that none of these indexes is highly accurate, but demonstrates a modest increase in the accuracy of apolipoprotein over lipid indexes.

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Screening for cognitive deficits with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale

Clinical Rehabilitation ◽

10.1177/0269215518787324 ◽

2018 ◽

Vol 33 (1) ◽

pp. 113-119 ◽

Cited By ~ 1

Author(s):

Paul Roux ◽

Mathieu Urbach ◽

Sandrine Fonteneau ◽

Fabrice Berna ◽

Lore Brunel ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Processes ◽

Roc Curve ◽

Standardized Test ◽

Curve Analysis ◽

Index Test ◽

Neuropsychological Battery ◽

Roc Curve Analysis ◽

Cognitive Domains ◽

The Mean

Objective: This study aimed to evaluate the validity of the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale (ECPDS) to discriminate for cognitive impairment in schizophrenia. Design: This multicentre cross-sectional study used a validation design with receiver operating characteristic (ROC) curve analysis. Settings: The study was undertaken in a French network of seven outward referral centres. Subjects: We recruited individuals with clinically stable schizophrenia diagnosed based on the Structured Clinical Interview for assessing Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; DSM-IV-R) criteria. Main measures: The index test for cognitive impairment was ECPDS (independent variable), a 13-item scale completed by a relative of the participant. The reference standard was a standardized test battery that evaluated seven cognitive domains. Cognitive impairment was the dependent variable and was defined as an average z-score more than 1 SD below the normative mean in two or more cognitive domains. Results: Overall, 97 patients were included (67 with schizophrenia, 28 with schizoaffective disorder, and 2 with schizophreniform disorder). The mean age was 30.2 (SD 7.7) years, and there were 75 men (77.3%). There were 59 (60.8%) patients with cognitive impairment on the neuropsychological battery, and the mean ECPDS score was 27.3 (SD 7.3). The ROC curve analysis showed that the optimal ECPDS cut-off was 29.5. The area under the curve was 0.77, with 76.3% specificity and 71.1% sensitivity to discriminate against cognitive impairment. Conclusion: The ECPDS is a valid triage tool for detecting cognitive impairment in schizophrenia, before using an extensive neuropsychological battery, and holds promise for use in everyday clinical practice.

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Validation of a Novel Intermittent W′ Model for Cycling Using Field Data

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2013-0471 ◽

2014 ◽

Vol 9 (6) ◽

pp. 900-904 ◽

Cited By ~ 25

Author(s):

Philip F. Skiba ◽

David Clarke ◽

Anni Vanhatalo ◽

Andrew M. Jones

Keyword(s):

Roc Curve ◽

Field Data ◽

Critical Power ◽

Intermittent Exercise ◽

Work Capacity ◽

Curve Analysis ◽

Receiver Operator Characteristic ◽

Roc Curve Analysis ◽

New Development ◽

The Mean

Recently, an adaptation to the critical-power (CP) model was published, which permits the calculation of the balance of the work capacity available above the CP remaining (W′bal) at any time during intermittent exercise. As the model is now in use in both amateur and elite sport, the purpose of this investigation was to assess the validity of theW′balmodel in the field. Data were collected from the bicycle power meters of 8 trained triathletes.W′balwas calculated and compared between files where subjects reported becoming prematurely exhausted during training or competition and files where the athletes successfully completed a difficult assigned task or race without becoming exhausted. CalculatedW′balwas significantly different between the 2 conditions (P< .0001). The meanW′balat exhaustion was 0.5 ± 1.3 kJ (95% CI = 0–0.9 kJ), whereas the minimumW′balin the nonexhausted condition was 3.6 ± 2.0 kJ (95% CI = 2.1–4.0 kJ). Receiver-operator-characteristic (ROC) curve analysis indicated that theW′balmodel is useful for identifying the point at which athletes are in danger of becoming exhausted (area under the ROC curve = .914, SE .05, 95% CI .82–1.0,P< .0001). TheW′balmodel may therefore represent a useful new development in assessing athlete fatigue state during training and racing.

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Lung ultrasound in patients with rheumatoid arthritis and the definition of significant interstitial lung disease

10.21203/rs.3.rs-18869/v2 ◽

2020 ◽

Author(s):

Marco Di Carlo ◽

Marika Tardella ◽

Emilio Filippucci ◽

Marina Carotti ◽

Fausto Salaffi

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Roc Curve ◽

Lung Ultrasound ◽

Smoking Habit ◽

Curve Analysis ◽

Roc Curve Analysis ◽

The Mean ◽

B Lines

Abstract Background. In recent years, a growing interest has grown around interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). While high resolution computed tomography (HRCT) of the chest remains the diagnostic method of choice, increasing attention has been directed towards lung ultrasound (LUS) in the diagnosis of ILD in connective tissue diseases. However, in patients with RA it is not yet clear how to interpret, in quantitative terms, the presence of B-lines, the LUS artifact indicative of ILD. The aim of this study was to determine the cut-off number of LUS B-lines that identifies a significant RA-ILD.Methods. A cross sectional study was conducted on consecutive RA patients with suspected RA-ILD. The inclusion criteria were clinical (dyspnea, velcro sounds), instrumental (suggestive anomalies on conventional radiography, DLco reduction), or in presence of at least two of the following risk factors for RA-ILD: smoking habit, male sex, advanced age, and ACPA presence.Patients underwent LUS (carried out in 14 defined intercostal spaces), chest HRCT, pulmonary function tests, and clinical evaluation. The diagnosis of RA-ILD was based on a semi-quantitative evaluation of chest HRCT using a computer-aided method (CaM). The discriminative validity of the LUS versus HRCT has been studied by using the receiver operating characteristic (ROC) curve analysis.Results. 72 consecutive RA patients (21 male, 51 female) were evaluated, with a mean age of 63.0 (SD 11.5 years). The mean estimate of pulmonary fibrosis using the CaM was 11.20% (SD 7.48) at chest HRCT, while at LUS the mean number of B-lines was 10.65 (SD 15.11). A significant RA-ILD, as measured by the CaM at HRCT, was detected in 25 patients (34.7%). The presence of 9 B-lines was found to be the optimal cut-off at ROC curve analysis. This LUS cut-off defines the presence of significant RA-ILD with a sensitivity of 70.0%, a specificity of 97.62%, and a positive likelihood ratio of 29.4.Conclusion. The present study provided data to determine the number of B-lines to identify a significant RA-ILD. LUS may represent a useful technique to select RA patients to be assessed by chest HRCT.

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The Value of Magnetic Resonance Imaging Histograms in the Preoperative Differential Diagnosis of Endometrial Stromal Sarcoma and Degenerative Hysteromyoma

Frontiers in Surgery ◽

10.3389/fsurg.2021.726067 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiao-Nan Zhang ◽

Man Bai ◽

Ke-Ran Ma ◽

Yong Zhang ◽

Cheng-Ru Song ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Differential Diagnosis ◽

Roc Curve ◽

Endometrial Stromal Sarcoma ◽

Curve Analysis ◽

Resonance Imaging ◽

Roc Curve Analysis ◽

Diagnostic Efficacy ◽

Stromal Sarcoma ◽

The Mean

Objective: The present study aimed to explore the application value of magnetic resonance imaging (MRI) histograms with multiple sequences in the preoperative differential diagnosis of endometrial stromal sarcoma (ESS) and degenerative hysteromyoma (DH).Methods: The clinical and preoperative MRI data of 20 patients with pathologically confirmed ESS and 24 patients with pathologically confirmed DH were retrospectively analyzed, forming the two study groups. Mazda software was used to select the MRI layer with the largest tumor diameter in T2WI, the apparent diffusion coefficient (ADC), and enhanced T1WI (T1CE) images. The region of interest (ROI) was outlined for gray-scale histogram analysis. Nine parameters—the mean, variance, kurtosis, skewness, 1st percentile, 10th percentile, 50th percentile, 90th percentile, and 99th percentile—were obtained for intergroup analysis, and the receiver operating curves (ROCs) were plotted to analyze the differential diagnostic efficacy for each parameter.Results: In the T2WI histogram, the differences between the two groups in seven of the parameters (mean, skewness, 1st percentile, 10th percentile, 50th percentile, 90th percentile, and 99th percentile) were statistically significant (P < 0.05). In the ADC histogram, the differences between the two groups in three of the parameters (skewness, 10th percentile, and 50th percentile) were statistically significant (P < 0.05). In the T1CE histogram, no significant differences were found between the two groups in any of the parameters (all P > 0.05). Of the nine parameters, the 50th percentile was found to have the best diagnostic efficacy. In the T2WI histogram, ROC curve analysis of the 50th percentile yielded the best area under the ROC curve (AUC; 0.742), sensitivity of 70%, and specificity of 83.3%. In the ADC histogram, ROC curve analysis of the 50th percentile yielded the best area under the ROC curve (AUC; 0.783), sensitivity of 81%, and specificity of 76.9%.Conclusion: The parameters of the mean, 10th percentile and 50th percentile in the T2WI histogram have good diagnostic efficacy, providing new methods and ideas for clinical diagnosis.

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Lung ultrasound in patients with rheumatoid arthritis and the definition of significant interstitial lung disease

10.21203/rs.3.rs-18869/v1 ◽

2020 ◽

Author(s):

Marco Di Carlo ◽

Marika Tardella ◽

Emilio Filippucci ◽

Marina Carotti ◽

Fausto Salaffi

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Roc Curve ◽

Lung Ultrasound ◽

Smoking Habit ◽

Curve Analysis ◽

Roc Curve Analysis ◽

The Mean ◽

B Lines

Abstract Background In recent years, a growing interest has grown around interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). While high resolution computed tomography (HRCT) of the chest remains the diagnostic method of choice, increasing attention has been directed towards lung ultrasound (LUS) in the diagnosis of ILD in connective tissue diseases. However, it is not yet well defined how to interpret the LUS findings under suspicion of RA-ILD. The aim of this study was to determine the cut-off number of LUS B-lines that identifies a significant RA-ILD. Methods A cross sectional study was conducted on consecutive RA patients with suspected RA-ILD. The inclusion criteria were clinical (dyspnea, velcro sounds), instrumental (suggestive anomalies on conventional radiography, DLco reduction), or in presence of at least two of the following risk factors for RA-ILD: smoking habit, male sex, advanced age, and ACPA presence. Patients underwent LUS (carried out in 14 defined intercostal spaces), chest HRCT, pulmonary function tests, and clinical evaluation. The diagnosis of RA-ILD was based on a semi-quantitative evaluation of chest HRCT using a computer-aided method (CaM). The discriminative validity of the LUS versus HRCT has been studied by using the receiver operating characteristic (ROC) curve analysis. Results 72 consecutive RA patients (21 male, 51 female) were evaluated, with a mean age of 63.0 (SD 11.5 years). The mean estimate of pulmonary fibrosis using the CaM was 11.20% (SD 7.48) at chest HRCT, while at LUS the mean number of B-lines was 10.65 (SD 15.11). A significant RA-ILD, as measured by the CaM at HRCT, was detected in 25 patients (34.7%). The presence of 9 B-lines was found to be the optimal cut-off at ROC curve analysis. This LUS cut-off defines the presence of significant RA-ILD with a sensitivity of 70.0%, a specificity of 97.62%, and a positive likelihood ratio of 29.4. Conclusion The present study provided data to determine the number of B-lines to identify a significant RA-ILD. LUS may represent a useful technique to select RA patients to be assessed by chest HRCT.

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A new “ASAP Scoring System and Risk Table” to predict second prostate biopsy outcomes

Archives of Medical Science ◽

10.5114/aoms/131789 ◽

2021 ◽

Author(s):

Caner Ediz ◽

Serkan Akan ◽

Neslihan Kaya Terzi ◽

Aysenur Ihvan

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Roc Curve ◽

Scoring System ◽

Area Under The Curve ◽

Roc Curve Analysis ◽

Atypical Small Acinar Proliferation ◽

Risk Patients ◽

The Mean ◽

New Criteria

IntroductionThis study aimed to discuss the necessity of a second prostate biopsy in patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table to be used as new criteria for a second biopsy.Material and methodsThe study reviewed the data of 2,845 patients; who underwent transrectal ultrasonography-guided prostate biopsy in the period between January 2008 and May 2019. A total of 128 patients with ASAP were included in the study. The tPSA, fPSA, f/tPSA, and PSA-Density levels before the first and second biopsies and changes in the measured levels between the values obtained before the first and the second biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy.ResultsThe mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of prostate cancer patients were significantly higher compared to patients without prostate cancer (p: 0.001). In the ROC curve analysis of ASS-RT, the area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT scores in diagnosing cancer was ≥ 7 with 60.8% sensitivity and 80.5% specificityConclusionsThe cut-off value of 7 determined for the ASS-RT score in this study suggests that patients with ASS-RT scores of ≥7 should undergo a second prostate biopsy. We think that there may be no need for a second biopsy if the ASS-RT score is <7, especially for low-risk patients.

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