scholarly journals Decision Threshold for Kryptor sFlt‐1/PlGF Ratio in Women With Suspected Preeclampsia: Retrospective Study in a Routine Clinical Setting

2021 ◽  
Author(s):  
Lise Lotte Torvin Andersen ◽  
Annemarie Helt ◽  
Lene Sperling ◽  
Martin Overgaard
Keyword(s):  
Retrospective Study ◽  
Early Onset ◽  
Operating Characteristic ◽  
Late Onset ◽  
Characteristic Curve ◽  
Predictive Performance ◽  
Decision Threshold ◽  
Operating Characteristic Curve ◽  
Early Onset Preeclampsia ◽  
Plgf Ratio

Background The objective was to evaluate predictive performance and optimal decision threshold of the Kryptor soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio when implemented for routine management of women presenting with symptoms of preeclampsia. Methods and Results Observational retrospective study of a cohort of 501 women with suspected preeclampsia after 20 weeks of gestation. Women referred to maternity ward for observation of preeclampsia had an sFlt‐1/PlGF ratio test included in routine diagnostic workup. Maternal and offspring characteristic data included maternal risk factors, outcomes, delivery mode, and indication for suspected preeclampsia. Biochemical measurements to determine sFlt‐1/PlGF ratio were performed using the BRAHMS/Kryptor sFlt‐1/PlGF ratio immunoassays. Results were analyzed by area under receiver‐operating characteristic curve. Preeclampsia occurred in 150 of 501 (30%) of symptomatic women with an sFlt‐1/PlGF ratio determined before the time of diagnosis. Area under receiver‐operating characteristic curve for diagnosis of early‐onset preeclampsia within 1 and 4 weeks was 0.98 (95% CI, 0.96–1.00) and 0.95 (95% CI, 0.92–0.98), respectively. For late‐onset preeclampsia, predictive performance within 1 and 4 weeks was lower: 0.90 (95% CI, 0.85–0.94) and 0.85 (95% CI, 0.80–0.90), respectively. The optimal single sFlt‐1/PlGF ratio threshold for all preeclampsia and late‐onset preeclampsia within 1 and 4 weeks was 66. The negative and positive predictive values for ruling out and ruling in developing preeclampsia within 1 week were 96% and 70%, respectively. Conclusions The Kryptor sFlt‐1/PlGF ratio is a useful clinical tool ruling out and in preeclampsia within 1 week. Prediction within 4 weeks is superior for early‐onset preeclampsia. A single decision threshold of 66 is indicated for use in clinical routine.

scholarly journals Is obstructive sleep apnoea associated with hypoxaemia and prolonged ICU stay after type A aortic dissection repair? A retrospective study in Chinese population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xin Xi ◽  
Yu Chen ◽  
Wei-Guo Ma ◽  
Jiang Xie ◽  
Yong-Min Liu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Aortic Dissection ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Sleep Apnoea ◽  
Type A Aortic Dissection ◽  
Icu Stay ◽  
Obstructive Sleep ◽  
Operating Characteristic Curve ◽  
Prolonged Icu Stay

Abstract Background Although obstructive sleep apnoea (OSA) is prevalent among patients with aortic dissection, its prognostic impact is not yet determined in patients undergoing major vascular surgery. We aimed to investigate the association of OSA with hypoxaemia and with prolonged intensive care unit (ICU) stay after type A aortic dissection (TAAD) repair. Methods This retrospective study continuously enrolled 83 patients who underwent TAAD repair from January 1 to December 31, 2018. OSA was diagnosed by sleep test and defined as an apnoea hypopnea index (AHI) of ≥ 15/h, while an AHI of > 30/h was defined severe OSA. Hypoxaemia was defined as an oxygenation index (OI) of < 200 mmHg. Prolonged ICU stay referred to an ICU stay of > 72 h. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of postoperative OI for prolonged ICU stay. Multivariate logistic regression was performed to assess the association of OSA with hypoxaemia and prolonged ICU stay. Results A total of 41 (49.4%) patients were diagnosed with OSA using the sleep test. Hypoxaemia occurred postoperatively in 56 patients (67.5%). Postoperatively hypoxaemia developed mostly in patients with OSA (52.4% vs. 83.0%, p = 0.003), and particularly in those with severe OSA (52.4% vs. 90.5%, p = 0.003). The postoperative OI could fairly predict a prolonged ICU stay (area under the receiver-operating characteristic curve, 0.72; 95% confidence intervals [CI] 0.60–0.84; p = 0.002). Severe OSA was associated with both postoperative hypoxaemia (odds ratio [OR] 6.65; 95% CI 1.56–46.26, p = 0.008) and prolonged ICU stay (OR 5.58; 95% CI 1.54–20.24, p = 0.009). Conclusions OSA was common in patients with TAAD. Severe OSA was associated with postoperative hypoxaemia and prolonged ICU stay following TAAD repair.

scholarly journals Sensitivity and Specificity of Spectral Oct in Patients with Early Glaucoma

2019 ◽  
Vol 75 (5) ◽  
pp. 260-264
Author(s):  
Magdaléna Bočková ◽  
Petr Veselý ◽  
Svatopluk Synek ◽  
Lubomír Hanák ◽  
Pavel Beneš
Keyword(s):  
Retrospective Study ◽  
Visual Field ◽  
Sensitivity And Specificity ◽  
Area Under Curve ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Test Statistics ◽  
Early Glaucoma ◽  
Spectral Oct ◽  
Operating Characteristic Curve

The study examines the sensitivity and specificity of spectral OCT in detecting early glaucoma. The aim was to evaluate data obtained by RNFL analysis in 4 observed quadrants and to compare it with the resulting diagnosis of glaucoma neuropathy determined subsequently on the basis of changes in the visual field. This concerns a retrospective study numbering 31 probands who underwent OCT examination at our centre in the period from 2008 to 2017. Test statistics demonstrated sensitivity of OCT examination (specific RNFL analysis) of 63.64% and specificity of 90%. The used ROC (receiver operating characteristic curve) test showed an AUC (area under curve) value of 0.734 on a statistically significant level of p = 0.0097. We therefore found that the instrument Spectral OCT SLO, with the aid of RNFL analysis, was effective in determining probands in whom development of glaucoma pathology was subsequently confirmed.

Circulating Angiogenic Factors and the Risk of Preeclampsia in Systemic Lupus Erythematosus Pregnancies

2015 ◽  
Vol 42 (7) ◽  
pp. 1141-1149 ◽  
Author(s):  
Alfredo Leaños-Miranda ◽  
Inova Campos-Galicia ◽  
María Guadalupe Berumen-Lechuga ◽  
Carlos José Molina-Pérez ◽  
Yolanda García-Paleta ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Early Onset ◽  
Late Onset ◽  
Angiogenic Factors ◽  
Systemic Lupus ◽  
Serum Samples ◽  
Early Onset Preeclampsia ◽  
Nested Case Control ◽  
Plgf Ratio

Objective.To investigate whether angiogenic factors are associated with risk of developing preeclampsia in pregnant women with systemic lupus erythematosus (SLE).Methods.We performed a nested case–control study within a cohort of SLE women with singleton pregnancies. The study included 42 patients with SLE who eventually developed preeclampsia and 75 normal SLE pregnancies. Serum samples were collected at 4-week intervals (from weeks 12 to 36). Serum samples were analyzed for soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng).Results.Women destined to develop preeclampsia had lower PlGF levels and higher sFlt-1 and sEng levels, and a higher sFlt-1/PlGF ratio than normal pregnancies. These changes became significant at 12 weeks in patients destined to develop either early onset (< 34 weeks, p ≤ 0.003) or late-onset preeclampsia (≥ 34 weeks, p ≤ 0.02). The risk to develop preeclampsia was higher among patients with PlGF concentration values in the lowest quartile or with sFlt-1 and sEng levels, and sFlt-1/PlGF ratio, in the highest quartile of the normal SLE pregnancies distribution. The OR were higher and appeared earlier in patients destined to develop early onset preeclampsia (OR ≥ 16.2, from Week 12 onward) than in patients who presented preeclampsia later (OR ≥ 8.9, from Week 24 onward).Conclusion.Changes in circulating concentrations of sFlt-1, PlGF, sEng, and the sFlt-1/PlGF ratio precede the onset of preeclampsia in SLE pregnancies. The risk profile of circulating angiogenic factors for developing preeclampsia distinctly evolves depending on whether this condition is manifested earlier or later.

scholarly journals Elecsys® and Kryptor immunoassays for the measurement of sFlt-1 and PlGF to aid preeclampsia diagnosis: are they comparable?

2019 ◽  
Vol 57 (9) ◽  
pp. 1339-1348 ◽  
Author(s):  
Holger Stepan ◽  
Martin Hund ◽  
Peter Dilba ◽  
Johanna Sillman ◽  
Dietmar Schlembach
Keyword(s):  
Pregnant Women ◽  
Early Onset ◽  
Late Onset ◽  
Correlation Coefficients ◽  
Serum Samples ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count ◽  
Early Onset Preeclampsia ◽  
Plgf Ratio ◽  
Control Study

Abstract Background For pregnant women with suspected preeclampsia, the soluble fms-like tyrosine-kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio is a biomarker to aid diagnosis. We performed method comparisons between Elecsys® and Kryptor sFlt-1 and PlGF immunoassays and assessed the diagnostic performance for preeclampsia. Methods Serum samples from a case-control study involving 113 pregnant women with preeclampsia/elevated liver enzymes and low platelet count (HELLP) and 270 controls were analyzed. sFlt-1 and PlGF were measured using Roche Elecsys® and BRAHMS Kryptor sFlt-1/PlGF immunoassays. The sFlt-1/PlGF ratios were calculated, and Passing-Bablok regression/Bland-Altman plots were performed. Gestation-specific cut-offs, ≤33 and ≥85/≥110, were assessed. Results Mean (±2 standard deviation [SD]) differences between the Elecsys® and Kryptor values were: sFlt-1, 173.13 pg/mL (6237.66, −5891.40); PlGF, −102.71 pg/mL (186.06, −391.48); and sFlt-1/PlGF, 151.74 (1085.11, −781.63). The Elecsys® and Kryptor immunoassays showed high correlation: Pearson’s correlation coefficients were 0.913 (sFlt-1) and 0.945 (PlGF). Slopes were 1.06 (sFlt-1) and 0.79 (PlGF), resulting in ~20% lower values for Kryptor PlGF. Sensitivities and specificities using the sFlt-1/PlGF ≥85 cut-off for early-onset preeclampsia (20 + 0 to 33 + 6 weeks) were 88.1%/100.0% (Elecsys®) and 90.5%/96.2% (Kryptor), respectively, and using the ≥110 cut-off for late-onset preeclampsia (≥34 + 0 weeks) were 51.3%/96.5% (Elecsys®) and 78.9%/90.1% (Kryptor), respectively. Using Elecsys® and Kryptor sFlt-1/PlGF, 0% and 3.8% of women, respectively, were falsely ruled-in for early-onset, and 3.5% and 9.9%, respectively, for late-onset preeclampsia. Conclusions Despite high correlation between the Elecsys® and Kryptor immunoassays, we observed significant differences between sFlt-1/PlGF and PlGF results. Therefore, sFlt-1/PlGF cut-offs validated for Elecsys® immunoassays are not transferable to Kryptor immunoassays.

Complications and risk factors for severe outcome in children with measles

2019 ◽  
Vol 105 (9) ◽  
pp. 896-899 ◽  
Author(s):  
Andrea Lo Vecchio ◽  
Andrzej Krzysztofiak ◽  
Carlotta Montagnani ◽  
Piero Valentini ◽  
Nadia Rossi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Retrospective Study ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Multivariable Analysis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Operating Characteristic Curve ◽  
Organ Complications

Objective and designRisk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death.ResultsNineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01).ConclusionThe risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.

scholarly journals Optic nerve sheath diameter as a predictor of altered mental status in drug intoxication patients

2021 ◽  
Keyword(s):  
Mental Status ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Predictive Performance ◽  
Altered Mental Status ◽  
Optic Nerve Sheath Diameter ◽  
Emergency Physicians ◽  
Drug Intoxication ◽  
Nerve Sheath ◽  
Operating Characteristic Curve

Objectives: As far as we know, proposed the predictive performance of optic nerve sheath diameter measured (ONSD) from brain computed tomography to predict poor prognosis in drug intoxication patients. The aim of our study was to evaluate the predictive performance of ONSD for predicting mortality and admission in patients with altered mental status among drug intoxication patients. Method: We retrospectively enrolled patients with drug intoxication patients who underwent brain computed tomography due to altered mental status between January 2018 and December 2019. Two emergency physicians independently measured ONSD at 3 mm behind the globe in each patients. Statistical analysis including multivariate logistic regression analysis were yielded to estimate predictive performance. Results: A total of 18 patients (8.7%) were death and 57 patients (24%) were admitted out of 206 patients. ONSD was independently predictive factors for predicting mortality and admission. ONSD (cut-off = 4.35) had 69.05% sensitivity and 53.33% specificity with area under the receiver operating characteristic curve of 0.824 (95% CI = 0.803–0.927) for predicting mortality among drug intoxication patients while the ONSD (cut-off = 3.96) had 100% sensitivity and 51.5% specificity with area under the receiver operating characteristic curve of 0.824 (95% CI, 0.722–0.927) for predicting admission among patients. There were excellent inter- and intra-observer agreements for measuring ONSD on brain CT. Conclusion: ONSD was demonstrated as feasible predictive marker for predicting admission and mortality among drug intoxication patients with altered mental status. This information can help decision making for emergency physicians to provide prompt treatment in drug intoxication patients.

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