Prediction Rule for Scrub Typhus Meningoencephalitis in Children: Emerging Disease in North India

2020 ◽  
Vol 35 (12) ◽  
pp. 820-827
Author(s):  
Areesha Alam ◽  
Pranshi Agarwal ◽  
Jayanti Prabha ◽  
Amita Jain ◽  
Raj Kumar Kalyan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Scrub Typhus ◽  
Characteristic Curve ◽  
Prediction Rule ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
Operating Characteristic Curve ◽  
Cerebrospinal Fluid Protein

Objectives: To evaluate the proportion of scrub typhus meningoencephalitis among children with acute encephalitis syndrome and to outline its differentiating features. To develop a prediction rule for scrub typhus meningoencephalitis. Methods: A prospective cohort study was conducted at a tertiary care public hospital in Northern India. Consecutive patients of acute encephalitis syndrome who met our inclusion criteria were enrolled over 2 years. Standardized workup including serum IgM against Orientia tsutsugamushi was performed. Clinical and laboratory features were compared between IgM-positive and IgM-negative patients. The area under the receiver operating characteristic curve of the score derived from “independent predictors” was measured. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated at different cut-offs of the score. Results: Scrub typhus IgM enzyme-linked immunosorbent assay was positive in 66/352 patients (18.8%). Longer duration of fever and prodromal stage along with eschar, hepatomegaly, lymphadenopathy, and pneumonia were significantly more prevalent in scrub typhus meningoencephalitis. However, petechiae were frequent in non–scrub typhus patients. Leucocytosis, lymphocytosis, thrombocytopenia, hypoalbuminemia, and elevated levels of serum bilirubin, serum transaminases, and cerebrospinal fluid protein were associated with scrub typhus meningoencephalitis. Logistic regression revealed fever for >8 days, pneumonia, absence of petechiae, cerebrospinal fluid protein >1000 mg/L, and serum glutamic oxaloacetic transaminase >100 IU/L as independent “predictors” of scrub typhus meningoencephalitis. The area under the receiver operating characteristic curve (95% confidence interval) of the prediction score was 0.832 (0.78-0.89). Score at cutoff ≥1 had 91% sensitivity, 96.1% negative predictive value, and at cutoff ≥4 had 99.7% specificity, 88.9% positive predictive value, 83.1% negative predictive value, 40.3 positive likelihood ratio, 0.88 negative likelihood ratio for identifying scrub typhus meningoencephalitis. Conclusion: Prediction score may help physicians in peripheral areas to identify and treat scrub typhus meningoencephalitis, an emerging cause of acute encephalitis syndrome in India.

Diagnostic Value of CD4/CD8 in Scrub Typhus

2021 ◽  
Author(s):  
Kangkang Hong ◽  
Ziping Shu ◽  
Laodong Li ◽  
Yu Zhong ◽  
Weiqian Chen ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Bloodstream Infection ◽  
Operating Characteristic ◽  
Scrub Typhus ◽  
Characteristic Curve ◽  
Community Acquired Pneumonia ◽  
Curve Analysis ◽  
Control Groups ◽  
Infection Group ◽  
Operating Characteristic Curve

Scrub typhus is often misdiagnosed in febrile patients, leading to antibiotic abuse and multiple complications. We conducted a retrospective record review at the Fourth Affiliated Hospital of Guangxi Medical University in China. Data were collected on 52 patients with a confirmed diagnosis of scrub typhus and complete clinical data. In addition, data were collected on 52 patients with bloodstream infection, 25 patients with HIV infection, 112 patients with common community-acquired pneumonia (CCAP), and 36 patients with severe community-acquired pneumonia (SCAP) to serve as control groups. The peripheral blood CD4 and CD8 counts, CD4/CD8 ratio, C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, and β2 microglobulin levels; and the white blood cell count and neutrophil percentage were compared between the scrub typhus and the control groups. The value of these biomarkers in the diagnosis of scrub typhus was assessed using receiver–operating characteristic curve analysis. The scrub typhus group had a significantly lower CD4 count and CD4/CD8 ratio than the bloodstream infection, CCAP, and SCAP groups, and a significantly greater CD4 count and CD4/CD8 ratio than the HIV infection group. In contrast, the scrub typhus group had a significantly greater CD8 count than the bloodstream infection and CCAP and SCAP groups, and it had a lower level of CD8 than the HIV infection group. The areas under the curve of CD4/CD8 were more than 0.93 in the receiver–operating characteristic curve analysis. These findings suggest that the CD4/CD8 ratio is a useful ancillary test for diagnosing scrub typhus.

scholarly journals Machine learning for identification of surgeries with high risks of cancellation

2018 ◽  
Vol 26 (1) ◽  
pp. 141-155 ◽  
Author(s):  
Li Luo ◽  
Fengyi Zhang ◽  
Yao Yao ◽  
RenRong Gong ◽  
Martina Fu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Random Forest ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Sampling Methods ◽  
Characteristic Curve ◽  
Support Vector ◽  
Chi Square ◽  
Stable Performance ◽  
Operating Characteristic Curve

Surgery cancellations waste scarce operative resources and hinder patients’ access to operative services. In this study, the Wilcoxon and chi-square tests were used for predictor selection, and three machine learning models – random forest, support vector machine, and XGBoost – were used for the identification of surgeries with high risks of cancellation. The optimal performances of the identification models were as follows: sensitivity − 0.615; specificity − 0.957; positive predictive value − 0.454; negative predictive value − 0.904; accuracy − 0.647; and area under the receiver operating characteristic curve − 0.682. Of the three models, the random forest model achieved the best performance. Thus, the effective identification of surgeries with high risks of cancellation is feasible with stable performance. Models and sampling methods significantly affect the performance of identification. This study is a new application of machine learning for the identification of surgeries with high risks of cancellation and facilitation of surgery resource management.

scholarly journals Predictive value of a novel lncRNA LINC02518 in evaluating the prognosis of patients with hepatocellular carcinoma

2021 ◽  
Author(s):  
Wei Cui ◽  
Jingzhi Huang ◽  
Ruiqi Wang ◽  
Yu Wang ◽  
Xiaoming Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Predictive Value ◽  
Long Noncoding Rna ◽  
Noncoding Rna ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Operating Characteristic Curve ◽  
Receiver Operating

Aim: The potential of long noncoding RNA in hepatocellular carcinoma (HCC) has led to promising insights into therapeutic intervention. The clinical significance of LINC02518 in HCC is unclear. This study aimed to evaluate the predictive value of a novel long noncoding RNA, LINC02518, for the prognosis of patients with HCC. Methods: Between December 2005 and November 2011, 125 and 75 HCC patients in the training and validation groups, respectively, who underwent liver surgery were included in our study. The LINC02518 expression of HCC and corresponding nontumor liver tissues was detected using microarray and reverse transcription quantitative polymerase chain reaction (RT-qPCR). These HCC patients were assigned into high and low LINC02518 expression groups based on the threshold of the receiver operating characteristic curve. Kaplan-Meier analysis was performed to determine the prognosis of HCC patients. Results: LINC02518 expression was upregulated in paired tumor samples compared with corresponding nontumor samples in the two groups. The area under the receiver operating characteristic curve for the levels of LINC02518 in the diagnosis of HCC was 0.66, 95% CI: 0.59–0.73. HCC patients with high LINC02518 expression had significantly worse tumor recurrence-free, metastasis-free, disease-free and overall survival than those with low LINC02518 expression. Conclusion: LINC02518 is negatively correlated with the prognosis of HCC and provides a promising strategy for the treatment and prognosis of HCC.

scholarly journals Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department

2021 ◽  
Author(s):  
Agustín Julián-Jiménez ◽  
◽  
Juan González del Castillo ◽  
Eric Jorge García-Lamberechts ◽  
Rafael Rubio Díaz ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Predictive Value ◽  
Emergency Departments ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Community Acquired Pneumonia ◽  
Prognostic Performance ◽  
Operating Characteristic Curve

Objective. To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. Patients and methods. Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. Results. A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. Conclusion. The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

scholarly journals Using The Random Forest Algorithm To Detect The Activity of Thyroid-Associated Ophthalmopathy

2021 ◽  
Author(s):  
Minghui Wang ◽  
Hanqiao Zhang ◽  
Li Dong ◽  
Yang Li ◽  
Zhijia Hou ◽  
...  
Keyword(s):  
Random Forest ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Random Forest Model ◽  
Random Forest Algorithm ◽  
Forest Model ◽  
Thyroid Associated Ophthalmopathy ◽  
Operating Characteristic Curve

Abstract Objective: The aim of this study is to establish a random forest model to detect active and quiescent phases of patients with Thyroid-associated ophthalmopathy (TAO) and to evaluate its diagnostic performance.Methods：A total of 146 patients (292 eyes) who were diagnosed with TAO and were treated in the Ophthalmology Outpatient Clinic of Beijing TongRen hospital were retrospectively included in the study. We took the clinical activity score of TAO as the target; took gender, age, smoking status, I-131 treatment history, thyroid nodules, thyromegaly, thyroid hormone and TSH-receptor antibodies (TRAb) as predictive characteristic variables to establish a random forest model. The proportion of the training group to the testing group was 7:3. We analyzed the model’s accuracy, precision, sensitivity, specificity, positive predictive value (PPV), negative predictive value (PPV), F1 score and out-of-bag (OOB) error, with the accuracy, the brier loss and the area under the receiver operating characteristic curve compared with logistic regression model.Results：Our model has an accuracy of 0.93, a sensitivity of 0.88, a specificity of 0.96, a positive predictive value of 0.94, a negative predictive value of 0.93, an F1 score of 0.91 and an OOB error of 0.12. The accuracy of the random forest model and the logistic regression model were 0.93 and 0.79, respectively, the brier loss were 0.06 and 0.20, and the area under the receiver operating characteristic curve were 0.95 and 0.86.Conclusion：By integrating these high-risk factors, the random forest algorithm can be used as a complementary diagnostic method to determine the activity of TAO, showing prominent diagnostic performance.

scholarly journals Postoperative Ultrasound, Unassisted Maturation, and Subsequent Primary Patency of Arteriovenous Fistulas

2018 ◽  
Vol 13 (9) ◽  
pp. 1364-1372 ◽  
Author(s):  
Crystal A. Farrington ◽  
Michelle L. Robbin ◽  
Timmy Lee ◽  
Jill Barker-Finkel ◽  
Michael Allon
Keyword(s):  
Blood Flow ◽  
Logistic Regression ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Multivariable Logistic Regression ◽  
Ultrasound Measurements ◽  
Operating Characteristic Curve

Background and objectivesPostoperative ultrasound is commonly used to assess arteriovenous fistula (AVF) maturation for hemodialysis, but its utility for predicting unassisted AVF maturation or primary AVF patency for hemodialysis has not been well defined. This study assessed the predictive value of postoperative AVF ultrasound measurements for these clinical AVF outcomes.Design, setting, participants, & measurementsWe queried a prospective vascular access database to identify 246 patients on catheter-dependent hemodialysis who underwent AVF creation between 2010 and 2016 and obtained a postoperative ultrasound within 90 days. Multivariable logistic regression was used to evaluate the association of clinical characteristics and postoperative ultrasound measurements with unassisted AVF maturation. A receiver operating characteristic curve estimated the predictive value of these factors for unassisted AVF maturation. Finally, multivariable survival analysis was used to identify factors associated with primary AVF patency in patients with unassisted AVF maturation.ResultsUnassisted AVF maturation occurred in 121 out of 246 patients (49%), assisted maturation in 55 patients (22%), and failure to mature in 70 patients (28%). Using multivariable logistic regression, unassisted AVF maturation was associated with AVF blood flow (odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.18 to 1.45 per 100 ml/min increase; P<0.001), forearm location (OR, 0.37; 95% CI, 0.08 to 1.78; P=0.21), presence of stenosis (OR, 0.45; 95% CI, 0.23 to 0.88; P=0.02); AVF depth (OR, 0.88; 95% CI, 0.77 to 1.00 per 1 mm increase; P=0.05), and AVF location interaction with depth (OR, 0.50; 95% CI, 0.28 to 0.84; P=0.02). The area under the receiver operating characteristic curve, using all these factors, was 0.84 (95% CI, 0.79 to 0.89; P<0.001). Primary AVF patency in patients with unassisted maturation was associated only with AVF diameter (hazard ratio, 0.84; 95% CI, 0.76 to 0.94 per 1 mm increase; P=0.002).ConclusionsUnassisted AVF maturation is predicted by AVF blood flow, location, depth, and stenosis. AVF patency after unassisted maturation is predicted only by the postoperative AVF diameter.

scholarly journals Predictive Value of 5 Early Warning Scores for Critical COVID-19 Patients

2020 ◽  
pp. 1-8
Author(s):  
Hai Hu ◽  
Ni Yao ◽  
Yanru Qiu
Keyword(s):  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Early Warning ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Early Warning Score ◽  
Early Warning Scores ◽  
Operating Characteristic Curve ◽  
Receiver Operating

ABSTRACT Objectives: A simple evaluation tool for patients with novel coronavirus disease 2019 (COVID-19) could assist the physicians to triage COVID-19 patients effectively and rapidly. This study aimed to evaluate the predictive value of 5 early warning scores based on the admission data of critical COVID-19 patients. Methods: Overall, medical records of 319 COVID-19 patients were included in the study. Demographic and clinical characteristics on admission were used for calculating the Standardized Early Warning Score (SEWS), National Early Warning Score (NEWS), National Early Warning Score2 (NEWS2), Hamilton Early Warning Score (HEWS), and Modified Early Warning Score (MEWS). Data on the outcomes (survival or death) were collected for each case and extracted for overall and subgroup analysis. Receiver operating characteristic curve analyses were performed. Results: The area under the receiver operating characteristic curve for the SEWS, NEWS, NEWS2, HEWS, and MEWS in predicting mortality were 0.841 (95% CI: 0.765-0.916), 0.809 (95% CI: 0.727-0.891), 0.809 (95% CI: 0.727-0.891), 0.821 (95% CI: 0.748-0.895), and 0.670 (95% CI: 0.573-0.767), respectively. Conclusions: SEWS, NEWS, NEWS2, and HEWS demonstrated moderate discriminatory power and, therefore, offer potential utility as prognostic tools for screening severely ill COVID-19 patients. However, MEWS is not a good prognostic predictor for COVID-19.

Significance of red cell distribution width in the differential diagnosis between neurally mediated syncope and arrhythmic syncope in children

2016 ◽  
Vol 27 (4) ◽  
pp. 691-696 ◽  
Author(s):  
Qingyou Zhang ◽  
Yaqi Li ◽  
Ying Liao ◽  
Junbao Du
Keyword(s):  
Receiver Operating Characteristic Curve ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Red Cell Distribution Width ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Neurally Mediated Syncope ◽  
Operating Characteristic Curve

AbstractObjectivesThe aim of the present study was to explore the predictive value of red cell distribution width as a means to differentiate between neurally mediated syncope and arrhythmic syncope in children.MethodPatients were divided into a neurally mediated syncope group (n=72) and an arrhythmic syncope group (n=21) on the basis of clinical history, results of the head-up tilt test, electrocardiography, and 24-hour ambulatory electrocardiography. As controls, we recruited 55 healthy children. Red cell distribution width was determined for children in all groups. A receiver operating characteristic curve was drawn to study the predictive effect of red cell distribution width to differentiate between neurally mediated syncope and arrhythmic syncope.ResultsRed cell distribution width was significantly higher in children with neurally mediated syncope than in children with arrhythmic syncope and the control group. A receiver operating characteristic curve on the predictive value of red cell distribution width in differentiating neurally mediated syncope from arrhythmic syncope showed that the area under the curve was 0.841 (95% confidence interval: 0.737–0.945, p<0.05). A red cell distribution width value of 12.8% as the cut-off value yielded a sensitivity of 80.6% and a specificity of 76.2% in discriminating between patients with neurally mediated syncope and arrhythmic syncope.ConclusionRed cell distribution width value of ⩾12.8% might be a useful adjunct for primary-care physicians to differentiate neurally mediated syncope from arrhythmic syncope in children.

scholarly journals Predictive Value of A Novel lncRNA LINC02518 in Evaluating the Prognosis of Patients With Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Wei Cui ◽  
Jingzhi Huang ◽  
Ruiqi Wang ◽  
Yu Wang ◽  
Xiaoming Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Training Group ◽  
Kaplan Meier ◽  
Operating Characteristic Curve ◽  
Receiver Operating

Abstract BACKGROUND: The potential of lncRNA in hepatocellular carcinoma (HCC) has led to promising insights in therapeutic intervention. The clinical significance of LINC02518 in HCC is unclear. This study aimed to evaluate the predictive value of a novel long non-coding RNA LINC02518 for the prognosis of patients with HCC. METHODS: Between December 2005 and November 2011, 125 HCC patients in training group and 75 HCC patients in validation group who underwent liver surgery were involved in our study. The LINC02518 expression of HCC and corresponding non-tumor liver tissues was detected by microarray and qRT-PCR. These HCC patients were divided into high and low LINC02518 expression groups based on the threshold of the receiver operating characteristic curve. Kaplan-Meier analysis was performed to determine the prognosis of HCC patients.RESULTS: LINC02518 expression was upregulated in paired tumor samples compared to that in corresponding non-tumor samples in two groups. The areas under the receiver operating characteristic curve for the levels of LINC02518 in the diagnosis of HCC was 0.66, 95% CI: 0.59–0.73. HCC patients with high LINC02518 expression had significantly worse tumor recurrence-free, metastasis-free, disease-free, and overall survival than those with low LINC02518 expression.CONCLUSIONS: LINC02518 is negatively correlated with the prognosis of HCC and provides a promising strategy for the treatment and prognosis of HCC.

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