Anogenital distance in adult women is a strong marker of endometriosis: results of a prospective study with laparoscopic and histological findings

Abstract STUDY QUESTION Could anogenital distance (AGD) be a non-invasive marker of endometriosis and correlated to the American Society for Reproductive Medicine revised score (r-ASRM) and ENZIAN classifications? SUMMARY ANSWER Surgically and histologically proven endometriosis is associated with a short AGD in women of reproductive age but not correlated either to the severity or to the location of the disease. WHAT IS KNOWN ALREADY AGD is a marker of intrauterine androgen exposure and exposure to oestrogen-like chemicals such as phthalates. Moreover, exposure to endocrine disruptors, such as organochlorine chemicals, is associated with endometriosis. It has been suggested that a short AGD in women is associated with an increased risk of endometriosis based on clinical and ultrasound exams. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted from January 2018 to June 2019 in a tertiary-care centre including 168 adult women undergoing pelvic surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 168 women included, 98 patients had endometriosis (endometriosis group) and 70 did not (non-endometriosis group). An operator (not the surgeon) measured the distance from the clitoral surface to the anus (AGD-AC) and from the posterior fourchette to the anus (AGD-AF) before surgery using a millimetre accuracy ruler. Endometriosis was diagnosed on exploration of the abdominopelvic cavity, and the r-ASRM and ENZIAN scores were calculated. All removed tissues underwent pathological examination. MAIN RESULTS AND THE ROLE OF CHANCE Mean (±SD) AGD-AF measurements were 21.5 mm (±6.4) and 32.3 mm (±8.1), and average AGD-AC measurements were 100.9 mm (±20.6) and 83.8 mm (±12.9) in the endometriosis and non-endometriosis groups (P < 0.001), respectively. Mean AGD-AF and AGD-AC measurements were not related to r-ASRM stage (P = 0.73 and 0.80, respectively) or ENZIAN score (P = 0.62 and 0.21, respectively). AGD-AF had a better predictive value than AGD-AC for discriminating the presence of endometriosis (AUC = 0.840 (95% CI 0.782–0.898) and 0.756 (95% CI 0.684–0.828)), respectively. For AGD-AF, an optimal cut-off of 20 mm had a specificity of 0.986 (95% CI 0.923–0.999), sensitivity of 0.306 (95% CI 26.1–31.6) and positive predictive value of 0.969 (95% CI 0.826–0.998). In multivariable analysis, the diagnosis of endometriosis was the only variable independently associated with the AGD-AF (β = −9.66 mm 95% CI −12.20–−7.12), P < 0.001). LIMITATIONS, REASONS FOR CAUTION The sample size was relatively small with a high proportion of patients with colorectal endometriosis reflecting the activity of an expert centre. Furthermore, we did not include adolescents and the AGD-AF measurement could be particularly relevant in this population. WIDER IMPLICATIONS OF THE FINDINGS The measurement of AGD could be a useful non-invasive tool to predict endometriosis. This could be especially relevant for adolescents and virgin women to avoid diagnostic laparoscopy and empiric treatment. STUDY FUNDING/COMPETING INTEREST(S) None.

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Evaluation of the Diagnostic Accuracy of the Interview and Physical Examination in the Diagnosis of Endometriosis as the Cause of Chronic Pelvic Pain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126606 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6606

Author(s):

Jolanta Nawrocka-Rutkowska ◽

Iwona Szydłowska ◽

Aleksandra Rył ◽

Sylwester Ciećwież ◽

Magdalena Ptak ◽

...

Keyword(s):

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Pelvic Pain ◽

Predictive Value ◽

Chronic Pelvic Pain ◽

Reproductive Age ◽

Pelvic Surgery ◽

History Of Surgery ◽

Previous Surgery ◽

History Of

Background: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20–40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12–18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination. Materials and methods: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated. Results: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery (p < 0.05). Conclusions: Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.

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Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy

Viruses ◽

10.3390/v13061064 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1064

Author(s):

Gitana Scozzari ◽

Cristina Costa ◽

Enrica Migliore ◽

Maurizio Coggiola ◽

Giovannino Ciccone ◽

...

Keyword(s):

Tertiary Care ◽

Multivariable Analysis ◽

Northern Italy ◽

University Hospital ◽

Care Workers ◽

Increased Risk ◽

Never Smokers ◽

The University ◽

Job Profile ◽

Pandemic Wave

This observational study evaluated SARS-CoV-2 IgG seroprevalence and related clinical, demographic, and occupational factors among workers at the largest tertiary care University-Hospital of Northwestern Italy and the University of Turin after the first pandemic wave of March–April 2020. Overall, about 10,000 individuals were tested; seropositive subjects were retested after 5 months to evaluate antibodies waning. Among 8769 hospital workers, seroprevalence was 7.6%, without significant differences related to job profile; among 1185 University workers, 3.3%. Self-reporting of COVID-19 suspected symptoms was significantly associated with positivity (Odds Ratio (OR) 2.07, 95%CI: 1.76–2.44), although 27% of seropositive subjects reported no previous symptom. At multivariable analysis, contacts at work resulted in an increased risk of 69%, or 24% for working in a COVID ward; contacts in the household evidenced the highest risk, up to more than five-fold (OR 5.31, 95%CI: 4.12–6.85). Compared to never smokers, being active smokers was inversely associated with seroprevalence (OR 0.60, 95%CI: 0.48–0.76). After 5 months, 85% of previously positive subjects still tested positive. The frequency of SARS-COV-2 infection among Health Care Workers was comparable with that observed in surveys performed in Northern Italy and Europe after the first pandemic wave. This study confirms that infection frequently occurred as asymptomatic and underlines the importance of household exposure, seroprevalence (OR 0.60, 95%CI: 0.48–0.76).

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Non-invasive predictors for infranodal conduction delay in patients with left bundle branch block after TAVR

Clinical Research in Cardiology ◽

10.1007/s00392-021-01924-w ◽

2021 ◽

Author(s):

Chloé Auberson ◽

Patrick Badertscher ◽

Antonio Madaffari ◽

Meriton Malushi ◽

Luc Bourquin ◽

...

Keyword(s):

Left Bundle Branch Block ◽

Predictive Value ◽

Conduction Delay ◽

Bundle Branch Block ◽

Non Invasive ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

Surface Ecg ◽

Pr Interval ◽

Electrocardiographic Parameters

Abstract Aims Left bundle branch block (LBBB) is the most common conduction disorder after transcatheter aortic valve replacement (TAVR) with an increased risk of atrioventricular (AV) block. The aim of the current study was to identify non-invasive predictors for infranodal conduction delay in patients with LBBB. Methods We analyzed consecutive patients undergoing TAVR with pre-existing or new-onset LBBB between August 2014 and August 2020. His ventricular (HV) interval measurement was performed on day 1 after TAVR. Baseline, procedural, as well as surface and intracardiac electrocardiographic parameters were included. Infranodal conduction delay was defined as HV interval > 55 ms. Results Of 825 patients screened after TAVR, 151 patients (82 ± 6 years, 39% male) with LBBB were included. Among these, infranodal conduction delay was observed in 25%. ΔPR (difference in PR interval after and before TAVR), PR and QRS duration after TAVR were significantly longer in the group with HV prolongation. In a multivariate analysis in patients with sinus rhythm (n = 123), ΔPR (OR per 10 ms increase: 1.52; 95%CI: 1.19–2.01; p = 0.002) was the only independent factor associated with infranodal conduction delay. A change in PR interval by 20 ms yielded a specificity of 83% and a sensitivity of 46%, with a negative predictive value of 84% and a positive predictive value of 45% to predict HV prolongation. Conclusions Simple analysis of surface ECG and a calculated ΔPR < 20 ms can be used as predictor for the absence of infranodal conduction delay in post-TAVR patients with LBBB. Graphical abstract

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The intersection of age and tumor biology with postoperative outcomes in patients after cytoreductive surgery and HIPEC.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.184 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 184-184

Author(s):

Michael K. Turgeon ◽

Adriana C. Gamboa ◽

Rachel M. Lee ◽

Mohammad Yahya Zaidi ◽

Charles Kimbrough ◽

...

Keyword(s):

Cytoreductive Surgery ◽

Independent Predictor ◽

Multivariable Analysis ◽

Postoperative Outcomes ◽

High Risk Population ◽

Complication Rates ◽

Non Invasive ◽

Major Complications ◽

Home Discharge ◽

Increased Risk

184 Background: Patient age is often a significant factor in preoperative selection for major abdominal surgery. Its association with postoperative outcomes in patients undergoing cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) remains ill-defined. Methods: The US HIPEC Collaborative database(2000-2017) was reviewed for patients who underwent a CCR0/1 CRS/HIPEC. Age was categorized into < 65 or >65yrs. Primary outcomes were postoperative major complications, readmission, 30-day mortality, and non-home discharge(NHD). Analysis was stratified by disease histology: non-invasive(appendiceal LAMN/HAMN), and invasive(appendiceal/colorectal adenocarcinoma). Results: Of 1090pts identified, 22% were >65yrs(n = 240), 59% were female(n = 646), 25% had non-invasive(n = 276) and 51% had invasive(n = 555) histology. Median PCI was 13(IQR7-20). Patients >65yrs had a higher rate of major complications(37vs26%, p = 0.02), readmission(28vs22%,p = 0.05), 30-day mortality(3vs1%,p = 0.02), and NHD(12vs5%,p < 0.01) compared to those < 65yrs. On multivariable analysis accounting for extent of disease as measured by PCI, for non-invasive histology, age >65yrs was an independent predictor for NHD(OR:2.54,95%CI:1.08-5.99,p = 0.03), but not major complications. For invasive histology, even when accounting for PCI, age >65yrs was an independent predictor for both NHD(OR:2.54,95%CI:1.08-5.98,p = 0.03) and major complications(OR:2.04,95%CI:1.16-3.59,p = 0.05). Age was not associated with hospital readmission or 30-day mortality for any histology. Conclusions: Regardless of histology, patients >65yrs are nearly at three-fold increased risk for non-home discharge after CRS/HIPEC. For invasive histology, age >65yrs is also associated with increased major complication rates, but the procedure seems to be better tolerated when performed for indolent biology. These data inform preoperative counseling and risk stratification. Early planning for discharge disposition in this high-risk population can potentially translate to cost savings.

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Endovascular stroke therapy may be safe in patients with elevated international normalized ratio

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012757 ◽

2016 ◽

Vol 9 (12) ◽

pp. 1187-1190 ◽

Cited By ~ 14

Author(s):

Sibu Mundiyanapurath ◽

Anne Tillmann ◽

Markus Alfred Möhlenbruch ◽

Martin Bendszus ◽

Peter Arthur Ringleb

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Tertiary Care ◽

Multivariable Analysis ◽

International Normalized Ratio ◽

Unfavorable Outcome ◽

Favorable Outcome ◽

University Hospital ◽

Increased Risk

IntroductionEndovascular therapy in acute ischemic stroke is safe and efficient. However, patients receiving oral anticoagulation were excluded in the larger trials.ObjectiveTo analyze the safety of endovascular therapy in patients with acute ischemic stroke and elevated international normalized ratio (INR) values.MethodsRetrospective database review of a tertiary care university hospital for patients with anterior circulation stroke treated with endovascular therapy. Patients with anticoagulation other than vitamin K antagonists were excluded. The primary safety endpoint was defined as symptomatic intracranial hemorrhage (sICH; ECASS II definition). The efficacy endpoint was the modified Rankin scale (mRS) score after 3 months, dichotomized into favorable outcome (mRS 0–2) and unfavorable outcome (mRS 3–6).Results435 patients were included. 90% were treated with stent retriever. 27 (6.2%) patients with an INR of 1.2–1.7 and 21 (4.8%) with an INR >1.7. 33 (7.6%) had sICH and 149 patients (34.3%) had a favorable outcome. Patients with an elevated INR did not have an increased risk for sICH or unfavorable outcome in multivariable analysis. The additional use of IV thrombolysis in patients with an INR of 1.2–1.7 did not increase the risk of sICH or unfavorable outcome. These results were replicated in a sensitivity analysis introducing an error of the INR of ±5%. They were also confirmed using other sICH definitions (Safe Implementation of Thrombolysis in Stroke (SITS), National Institute of neurological Disorders and Stroke (NINDS), Heidelberg bleeding classification).ConclusionsEndovascular therapy in patients with an elevated INR is safe and efficient. Patients with an INR of 1.2–1.7 may be treated with combined IV thrombolysis and endovascular therapy.

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Demographic, lifestyle, and reproductive determinants of serum anti-Müllerian hormone levels in adult women of reproductive age in Ilorin, North-Central Nigeria

Middle East Fertility Society Journal ◽

10.1186/s43043-021-00069-0 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Oyinkansola Islamiyat Lawal ◽

Jameelu-deen Omokunmi Yusuff

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Cycle Length ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Negative Relationship ◽

Reproductive Age ◽

Enzyme Linked Immunosorbent Assay ◽

Adult Women ◽

Women Of Reproductive Age

Abstract Background Anti-Müllerian hormone is a dimeric glycoprotein produced by the granulosa cells of preantral and small antral follicles of the ovaries. It is a reliable biomarker of ovarian reserve, ageing, and response in the management of women with infertility. However, there are few studies on the determinants of serum anti-Müllerian hormone in Nigerian women. This study aimed to investigate determinants of serum anti-Müllerian hormone among adult women of reproductive age. The study was a hospital-based cross-sectional study involving 161 women of reproductive age attending the gynaecology clinic and immunisation clinic of a Nigerian tertiary hospital. Baseline characteristics were collected using a semi-structured questionnaire. Serum anti-Müllerian hormone was quantified using enzyme-linked immunosorbent assay. Results In univariate analysis, age (B = − 0.035, P = 0.000), parity (B = − 0.080, P = 0.001), and infertility duration (B = − 0.050, P = 0.011) had a negative relationship with serum anti-Müllerian hormone, while ethnicity (B = 0.180, P = 0.040), body mass index (B = 0.015, P = 0.010), and cycle length (B = 0.042, P = 0.000) had a positive relationship with serum anti-Müllerian hormone. In multivariable analysis, all relationships except infertility duration persisted. Conclusion We found that age, ethnicity, parity, infertility duration, body mass index, and cycle length were associated with serum anti-Müllerian hormone. A large prospective population-based study is required to better understand factors that are associated with serum anti-Müllerian hormone in an ethnically diverse country like Nigeria.

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Should Women with Sickle Cell Disease be Administered Prophylactic Transfusions to Avoid Complications during Pregnancy?

Blood ◽

10.1182/blood-2018-99-112133 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3679-3679

Author(s):

Patricia Palcu ◽

Kevin H. M. Kuo ◽

Richard Ward ◽

Nusrat Zaffar ◽

Ann Kinga Malinowski ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Pregnancy Outcomes ◽

Tertiary Care ◽

Reproductive Age ◽

Cell Disease ◽

Fetal Outcomes ◽

Hemoglobin F ◽

Increased Risk ◽

Rbc Transfusion

Abstract BACKGROUND: Increasing numbers of women with sickle cell disease (SCD) are reaching reproductive age. There is an array of possible pregnancy outcomes that women with SCD may experience. Many have described adverse maternal and fetal outcomes in pregnant patients with SCD including increased risk of pre-eclampsia, infections, painful vaso-occlusive crises as well as increased risk of intrauterine growth restriction, pre-term delivery and pregnancy loss. Not all women with SCD have complicated pregnancies, however. Limited data are available to categorize the proportion of patients who have uncomplicated pregnancies and protective characteristics for good pregnancy outcomes. Identifying these features potentially informs practice and reduces exposure to blood products as red blood cell (RBC) transfusion is associated with an increased risk of alloimmunization, particularly in pregnancy. OBJECTIVE: To determine the proportion and characteristics of pregnant patients with SCD who have uncomplicated pregnancies. METHODS: We retrospectively reviewed medical records of pregnant women with SCD from 1980 to 2018 at Mount Sinai Hospital, a university affiliated tertiary care centre in Toronto, Canada. We defined a pregnancy to be uncomplicated if the pregnancy was not associated with a hospitalization, RBC transfusion was not administered peripartum and/or the delivery was at term (37 or more weeks gestation). RESULTS: A total of 179 pregnancies were included (Figure 1). Preliminary results show that 57% of pregnancies had hemoglobin SS disease. The median maternal age was 27 years (range 16-43 years) (n=179). Median hemoglobin concentration, platelet count and leukocyte count were 91g/L (n=141), 304 x 10(9)/L (n=140) and 11 x 10(9)/L (n=140), respectively. Hospital admission was required in 61% of pregnancies (n=171) and RBC transfusion in 49% of pregnancies (n=173). The median hemoglobin F level was 0.05 (range 0.01-0.87). Nineteen percent had coexisting alpha gene deletion (s). The median birth weight was 2863 grams (n=155). Analysis is ongoing to determine characteristics associated with the pre-defined pregnancy outcomes. CONCLUSIONS: Women with SCD frequently have adverse maternal and fetal outcomes with pregnancy. However, 39% of pregnancies with SCD in this study did not require hospitalization and 51% did not require RBC transfusion. Additional analysis will attempt to identify protective features so as not to expose all patients to RBC transfusion unless it is required. These initial results suggest that risk scores should be developed for pregnant patients with sickle cell disease to identify who may benefit from RBC transfusion. Disclosures No relevant conflicts of interest to declare.

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A study of metabolic syndrome in women with polycystic ovary syndrome at tertiary care center

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212187 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2427

Author(s):

Chelsae Kuntal ◽

Jyotsna Vyas ◽

Asha Chaudhary ◽

Sunita Hemani ◽

Lata Rajoria

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Polycystic Ovary Syndrome ◽

Urban Areas ◽

Polycystic Ovary ◽

Tertiary Care ◽

Reproductive Age ◽

Ovary Syndrome ◽

Hormonal Profile ◽

Increased Risk

Background: Polycystic ovary syndrome is a common endocrinopathy in women of reproductive age with prevalence of 6-10% which is characterized by hyper androgenic features and chronic oligo – anovulation and polycystic ovary morphology. Most women with polycystic ovary syndrome are also characterized by metabolic abnormalities like insulin resistance, hyperinsulinemia, dyslipidemia and abdominal obesity, these forming risk factors for metabolic syndrome. The objective of the study was to compare the clinical, biochemical and hormonal profile of polycystic ovary syndrome patients with and without metabolic syndrome.Methods: A comparative cross- sectional study was undertaken on 79 PCOS women diagnosed with PCOS according to Rotterdam criteria, in which the clinical data and hormonal profile of two groups of polycystic ovary syndrome women with and without metabolic syndrome was compared.Results: The mean age of 79 patients in this study group with and without metabolic syndrome was 26.17±3.18 and 25.57±3.41 years respectively. There were more patients from urban areas as compared to rural areas and maximum patients. Significantly higher number of PCOS women with metabolic syndrome had hirsutism and acanthosis nigricans than those without metabolic syndrome. Mean value of Waist circumference, systolic BP pressure, diastolic BP, S. Triglyceride and fasting glucose were higher and HDL levels were lower in women with metabolic syndrome than those without metabolic syndrome. Fasting insulin and HOMA-IR values were significantly higher in PCOS women with metabolic syndrome in comparison to those without metabolic syndrome.Conclusion: PCOS is not only is the most frequent cause of anovulation, but it is also associated with characteristic metabolic disturbances that may have important implications for the long term health. Metabolic syndrome is a cluster of endocrine disturbances, including insulin resistance, dyslipidemia, obesity, and hypertension. It is associated with a two-fold increased risk of cardiovascular disease and a five-fold increased risk of type 2 diabetes. This illustrates the importance of early detection of insulin resistance and metabolic syndrome with subsequent application of preventive measures in women with polycystic ovary syndrome.

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Risk Factors of Breast Cancer Among Western Algerian Women Under 40 years’ old

Medical & Clinical Research ◽

10.33140/mcr.06.03.03 ◽

2021 ◽

Vol 6 (3) ◽

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Young Adult ◽

Multivariable Analysis ◽

Oral Contraception ◽

Adult Women ◽

Young Adult Women ◽

Nulliparous Women ◽

Increased Risk ◽

Western Algeria

Background: The frequency of patients developing Breast Cancer (BC) among all other types of cancers exceeds 35% in Western Algeria. The main objective here was to determine which risk factors were associated with this high frequency of BC occurrence in young adult women (<40 years old) in Western Algeria. Methods: A BC case-control study matching with the woman age was conducted. The total number of participants was 484 women from Western Algeria. Inclusion criteria were BC and age <40 and women older than 40 or without documented BC were excluded. Results: Univariable analysis showed that i) there was an increased risk of BC; OR = 1.77 [1.06 to 2.93] in married women using oral contraception drugs; ii) in contrast there was a lesser risk; OR = 0.43 [0.28 to 0.65] of BC in multiparous compared to nulliparous women; iii) similarly there was a lesser risk; OR = 0.45 [0.26 to 0.76] of BC in married, divorced and widowed women compared to single women. Multivariable analysis showed a higher risk; OR = 2.34 [1.05 to 5.22] of BC in non-breastfeeding than lactating women. Conclusion: The use of oral contraception drugs, nulliparity, lack of breastfeeding and the single unmarried status are risk factors associated with increased BC in young adult women (<40) from Western Algeria.

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Peripheral Perfusion Index as a Marker of Sepsis in Preterm Neonates

10.21203/rs.3.rs-596749/v1 ◽

2021 ◽

Author(s):

Jasmine Singh ◽

Suksham Jain ◽

Deepak Chawla ◽

Shivani Randev ◽

Supreet Khurana

Keyword(s):

Predictive Value ◽

Tertiary Care ◽

Clinical Manifestations ◽

Perfusion Index ◽

Preterm Neonates ◽

Care Hospital ◽

Suspected Sepsis ◽

Clinical Sepsis ◽

Non Invasive ◽

Hospital Acquired

Abstract Background: Neonatal sepsis is a major contributor to neonatal mortality in India. Blood culture, the gold standard for the diagnosis of sepsis takes 48-72 hours while the serological markers have suboptimal diagnostic test characteristics. Perfusion Index (PI) is a real time, non-invasive marker that can detect microcirculatory changes before other clinical manifestation of sepsis. Objective: To determine the diagnostic accuracy of PI in detecting hospital-acquired sepsis before overt clinical manifestations. Material and Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. Participants: Term and preterm neonates admitted to NICU. Methods: PI was continuously monitored in all enrolled neonates. Clinical sepsis was defined using the Neonatal Krankenhaus-Infektions-Surveillance-System (NeoKISS). PI below 1.24 and 0.88 for term and preterm neonates, respectively, was defined as low PI. The time of fall of PI below this value and time of clinical sepsis as per NeoKISS was noted and the difference was calculated. Results: Among 72 neonates (gestational age:32.2±3.2 weeks, birth weight:1420, IQR 1100-1855 g), a total of 93 events of suspected sepsis were noted, of which 70 were sepsis screen positive. 16 events were associated with culture positive sepsis. Using a cut off of 0.88 in preterm neonates, PI yielded a sensitivity of 89.47% (95% CI 78.48% to 96.04%), specificity of 56% (95% CI 34.93% to 75.60%), positive predictive value of 82.26% (95% CI 74.70% to 87.92%), and negative predictive value of 70% (95% CI 50.36% to 84.29%) in detection of hospital acquired sepsis. The positive and negative likelihood ratios came to be 2.03 (95% CI 1.30 to 3.19) and 0.19 (95% CI 0.08 to 0.43), respectively.Conclusion: This study shows that PI might serve as an early, non-invasive marker of hospital acquired sepsis in preterm neonates.

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