The validity of serum alkaline phosphatase to identify nutritional rickets in Nigerian children on a calcium-deprived diet

2021 ◽  
Author(s):  
Tom D Thacher ◽  
Christopher T Sempos ◽  
Ramon A Durazo-Arvizu ◽  
Philip R Fischer ◽  
Craig F Munns ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Likelihood Ratio ◽  
Serum Alkaline Phosphatase ◽  
Low Cost ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Activity Levels ◽  
Nigerian Children ◽  
Nutritional Rickets

Abstract Context Nutritional rickets results from the interaction of low vitamin D status and limited calcium intake. Serum alkaline phosphatase (AP) activity is a biomarker of impaired mineralization in rickets. Objective To assess the performance of serum AP activity in identifying nutritional rickets in calcium-deprived Nigerian children. Design, setting, and participants We reanalyzed data from a case-control study of children with active rickets and matched control subjects without rickets, using a multivariate logistic regression to assess the odds of rickets associated with AP activity, adjusting for age, sex, and weight for age z-score. Results A total of 122 children with rickets and 119 controls were included. Rachitic children had a mean (±SD) age of 54±29 months, and 55 (45.1%) were male. Cases and controls had low dietary calcium intakes (216±87 and 214±96 mg/day, respectively). Serum AP activity levels in cases and controls were 812±415 and 245±78 U/L, respectively (P<0.001). AP was negatively associated with 25-hydroxyvitamin D values (r=-0.34; P<0.001). In the adjusted model, the odds ratio (95% confidence interval) for rickets was 6.7 (4.1-12.2) for each 100 U/L increase in AP. The area under the receiver operating characteristic curve was 0.978. AP >350 U/L identified nutritional rickets in Nigerian children with sensitivity 0.93, specificity 0.92, positive likelihood ratio 11.3, and negative likelihood ratio 0.07. Conclusions An AP >350 U/L effectively discriminated between Nigerian children with and without nutritional rickets. AP is a low-cost biochemical test that could be used to screen for nutritional rickets, but cut-off values require validation in other populations, and laboratory values need to be standardized for widespread population studies.

The validity of serum alkaline phosphatase to identify nutritional rickets in Nigerian children on a calcium-deprived diet

2019 ◽  
Author(s):  
Tom Thacher ◽  
Christopher Sempos ◽  
Ramon Durazo-Arvizu ◽  
Craig Munns ◽  
Philip Fischer ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Serum Alkaline Phosphatase ◽  
Nigerian Children ◽  
Nutritional Rickets

scholarly journals A20 DIAGNOSTIC ACCURACY OF A LOW COST, WIDELY AVAILABLE TEST STRIP FOR PREDICTING A POSITIVE FECAL CALPROTECTIN TEST

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 210-212
Author(s):  
R Trasolini ◽  
S Wong ◽  
B Salh
Keyword(s):  
Sample Size ◽  
Likelihood Ratio ◽  
Gold Standard ◽  
Low Cost ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Rapid Test ◽  
Test Strip ◽  
Fecal Calprotectin ◽  
Type I

Abstract Background Fecal calprotectin is a non-invasive test of colonic inflammation used for monitoring inflammatory bowel disease activity and for risk stratifying non-specific colonic symptoms. Calprotectin is a leukocyte specific enzyme. A similar test, leukocyte esterase is used to detect leukocytes in urine and is widely available as a low-cost point-of-care test strip. We hypothesize that an unmodified version of the urine test strip would be highly accurate in predicting a positive fecal calprotectin test in a real world sample of patients. Aims To explore a low cost, rapid alternative to the fecal calprotectin test Methods All inpatient and outpatient stool samples tested for calprotectin by the Vancouver General Hospital laboratory from February 2020 to November 2020 were included prospectively. Samples were simultaneously tested for fecal leukocyte esterase using an unmodified Roche Cobas Chemstrip urinalysis test strip by central lab personnel. An identical aliquot was sent to LifeLabs for calprotectin as per standard protocol. All samples were suspended in buffer using established laboratory protocols prior to testing. Fecal leukocyte esterase results were reported as 0–4+ based on visual interpretation, calprotectin results were reported as mcg/g of stool. REB review and approval was obtained prior to data collection. Sensitivity, Specificity and AUROC were calculated using Microsoft Excel and JROCFIT. Results 26 samples were collected. Using a fecal calprotectin greater than 120 mcg/g as a gold standard an AUROC of 0.89 (SE= .06) was calculated. A leukocyte esterase reading of 2+ or greater had the best test characteristics based on ROC curve analysis. Using this cutoff, 21/26 samples were concordant, giving an accuracy of 80.8%, sensitivity of 90.9% and specificity of 73.3%. Positive likelihood ratio was 8.07 and negative likelihood ratio was 0.29. Assuming an AUROC of 0.8, the sample size N=26 is 90% powered (β=0.9) to predict the true AUROC within 0.1 with a type I error rate of .05 (α<.05). Conclusions This study suggests application of a prepared stool sample to a urinalysis test strip gives a result highly predictive of a positive fecal calprotectin test. Further results are being collected prospectively to improve the robustness of these preliminary data. Secondary outcomes including comparison to endoscopy and biopsy results where available are planned if an adequate sample size can be accrued. Future studies justifying independent clinical use of leukocyte esterase would require a common gold standard comparator such as endoscopy. Fecal calprotectin testing is not universally insured and is not available as a rapid test strip. Use of fecal leukocyte esterase may reduce costs and shorten time to results if proven to be independently reliable. Funding Agencies None

scholarly journals Evaluation of GeneXpert vanA/vanB in the early diagnosis of vancomycin-resistant enterococci infection

2021 ◽  
Vol 15 (11) ◽  
pp. e0009869
Author(s):  
Zhuo-Lei Li ◽  
Qi-Bing Luo ◽  
Shan-Shan Xiao ◽  
Ze-Hong Lin ◽  
Ye-Ling Liu ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Clinical Problem ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Purpose Vancomycin-resistant enterococci infection is a worrying worldwide clinical problem. To evaluate the accuracy of GeneXpert vanA/vanB in the diagnosis of VRE, we conducted a systematic review in the study. Methods Experimental data were extracted from publications until May 03 2021 related to the diagnostic accuracy of GeneXpert vanA/vanB for VRE in PubMed, Embase, Web of Science and the Cochrane Library. The accuracy of GeneXpert vanA/vanB for VRE was evaluated using summary receiver to operate characteristic curve, pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Results 8 publications were divided into 3 groups according to two golden standard references, vanA and vanB group, vanA group, vanB group, including 6 researches, 5 researches and 5 researches, respectively. The pooled sensitivity and specificity of group vanA and vanB were 0.96 (95% CI, 0.93–0.98) and 0.90 (95% CI, 0.88–0.91) respectively. The DOR was 440.77 (95% CI, 37.92–5123.55). The pooled sensitivity and specificity of group vanA were 0.86 (95% CI, 0.81–0.90) and 0.99 (95% CI, 0.99–0.99) respectively, and those of group vanB were 0.85 (95% CI, 0.63–0.97) and 0.82 (95% CI, 0.80–0.83) respectively. Conclusion GeneXpert vanA/vanB can diagnose VRE with high-accuracy and shows greater accuracy in diagnosing vanA.

Pleuraerguss: Vereinfachte Kriterien zur Unterscheidung zwischen Exsudat und Transsudat

2019 ◽  
Vol 7 (6) ◽  
pp. 331-332
Author(s):  
Franz Stanzel
Keyword(s):  
Lactate Dehydrogenase ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Likelihood Ratio ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Serum Lactate Dehydrogenase ◽  
Pleural Effusions

Background: An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. Objectives: The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. Methods: An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. Results: Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94-99]) and negative likelihood ratio (0.04 [95% CI 0.02-0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light's criteria. Findings were similar in the validation cohort. Conclusions: Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light's criteria. It avoids simultaneous blood sampling, thus reducing patient discomfort and potential costs.

scholarly journals Diagnostic Value of T-SPOT.TB Assay for Tuberculous Peritonitis: A Meta-Analysis

2020 ◽  
Vol 7 ◽  
Author(s):  
Ying Luo ◽  
Ying Xue ◽  
Liyan Mao ◽  
Qun Lin ◽  
Guoxing Tang ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Abdominal Tuberculosis ◽  
Tuberculous Peritonitis ◽  
Summary Receiver Operating Characteristic ◽  
Sensitivity Specificity

Background: Tuberculous peritonitis (TP) is a common form of abdominal tuberculosis (TB). Diagnosing TP remains challenging in clinical practice. The aim of the present meta-analysis was to evaluate the diagnostic accuracy of peripheral blood (PB) T-SPOT and peritoneal fluid (PF) T-SPOT for diagnosing TP.Methods: PubMed, EmBase, Cochrane, Scopus, Google scholar, China national knowledge internet, and Wan-Fang databases were searched for relevant articles from August 1, 2005 to July 5, 2020. Statistical analysis was performed using Stata, Revman, and Meta-Disc software. Diagnostic parameters including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic curve was used to determine the area under the curve (AUC).Results: Twelve studies were eligible and included in the meta-analysis. The analysis showed that the pooled sensitivity and specificity of PB T-SPOT in diagnosing TP were 0.91 (95% CI, 0.88–0.94) and 0.78 (95% CI, 0.73–0.81), respectively, while the pooled PLR, NLR, and DOR were 4.05 (95% CI, 2.73–6.01), 0.13 (95% CI, 0.07–0.23), and 37.8 (95% CI, 15.04–94.98), respectively. On the other hand, the summary estimates of sensitivity, specificity, PLR, NLR, and DOR of PF T-SPOT for TP diagnosis were 0.90 (95% CI, 0.85–0.94), 0.78 (95% CI, 0.72–0.83), 6.35 (95% CI, 2.67–15.07), 0.14 (95% CI, 0.09–0.21), and 58.22 (95% CI, 28.76–117.83), respectively. Furthermore, the AUC of PB T-SPOT and PF T-SPOT for TP diagnosis were 0.91 and 0.94, respectively.Conclusions: Our results indicate that both PB T-SPOT and PF T-SPOT can be served as sensitive approaches for the diagnosis of TP. However, the unsatisfactory specificities of these two methods limit their application as rule-in tests for TP diagnosis. Furthermore, the standardization of the operating procedure of PF T-SPOT is further needed.

scholarly journals The Diagnostic Accuracy of HE4 in Lung Cancer: A Meta-Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Daye Cheng ◽  
Ying Sun ◽  
Hu He
Keyword(s):  
Lung Cancer ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Large Sample Size ◽  
Summary Receiver Operating Characteristic ◽  
Diagnosis Of Lung Cancer

The diagnostic value of serum HE4 in patients with lung cancer remains controversial. Thus, we performed a systematic review and meta-analysis to assess the diagnostic accuracy of serum HE4 for lung cancer. We conducted a comprehensive literature search in PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and WANFANG databases between Jan. 1966 and Nov. 2014. The diagnostic sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic curve (SROC) were pooled by Meta-DiSc 1.4 software. A total of seven articles including 715 cases and 549 controls were included for analysis. The summary estimates for serum HE4 in the diagnosis of lung cancer in these studies were pooled SEN 0.72 (95% CI: 0.68–0.75), SPE 0.85 (95% CI: 0.81–0.88), PLR 4.68 (95% CI: 3.23–6.78), NLR 0.31 (95% CI: 0.24–0.39), and DOR 17.14 (95% CI: 9.72–30.20), and the area under the curve (AUC) was 0.8557. This meta-analysis indicated that serum HE4 is a potential tool in the diagnosis of lung cancer. In addition, considering the high heterogeneity and potential publication bias, further studies with rigorous design and large sample size are needed in the future.

scholarly journals Artificial Intelligence in Gastric Cancer: Identifying Gastric Cancer Using Endoscopic Images with Convolutional Neural Network

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5253
Author(s):  
Md. Mohaimenul Islam ◽  
Tahmina Nasrin Poly ◽  
Bruno Andreas Walther ◽  
Ming-Chin Lin ◽  
Yu-Chuan (Jack) Li
Keyword(s):  
Gastric Cancer ◽  
Likelihood Ratio ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Work Load ◽  
Diagnostic Odds Ratio ◽  
Summary Receiver Operating Characteristic ◽  
Sensitivity Specificity

Gastric cancer (GC) is one of the most newly diagnosed cancers and the fifth leading cause of death globally. Identification of early gastric cancer (EGC) can ensure quick treatment and reduce significant mortality. Therefore, we aimed to conduct a systematic review with a meta-analysis of current literature to evaluate the performance of the CNN model in detecting EGC. We conducted a systematic search in the online databases (e.g., PubMed, Embase, and Web of Science) for all relevant original studies on the subject of CNN in EGC published between January 1, 2010, and March 26, 2021. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the risk of bias. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. Moreover, a summary receiver operating characteristic curve (SROC) was plotted. Of the 171 studies retrieved, 15 studies met inclusion criteria. The application of the CNN model in the diagnosis of EGC achieved a SROC of 0.95, with corresponding sensitivity of 0.89 (0.88–0.89), and specificity of 0.89 (0.89–0.90). Pooled sensitivity and specificity for experts endoscopists were 0.77 (0.76–0.78), and 0.92 (0.91–0.93), respectively. However, the overall SROC for the CNN model and expert endoscopists was 0.95 and 0.90. The findings of this comprehensive study show that CNN model exhibited comparable performance to endoscopists in the diagnosis of EGC using digital endoscopy images. Given its scalability, the CNN model could enhance the performance of endoscopists to correctly stratify EGC patients and reduce work load.

scholarly journals ­Silent Existence of Eosinopenia in Sepsis: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Yao Lin ◽  
Jiabing Rong ◽  
Zhaocai Zhang
Keyword(s):  
Likelihood Ratio ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Medical Emergency ◽  
Cochrane Central Register ◽  
Analysis Model ◽  
Potential Biomarker

Abstract BackgroundSepsis is a life-threatening and time-critical medical emergency; therefore, the early diagnosis of sepsis is essential to timely treatment and favorable outcomes for patients susceptible to sepsis. Eosinopenia has been identified as a potential biomarker of sepsis in the past decade. However, its clinical application progress is slow and its recognition is low. Recent studies have again focused on the potential association between Eosinopenia and severe infections. This study analyzed the efficacy of Eosinopenia as a biomarker for diagnosis of sepsis and its correlation with pathophysiology of sepsis.MethodWe searched PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials CENTRAL databases to identify studies that met the inclusion criteria. Two authors performed data extraction independently. The pooled outcomes were calculated by TP (true positive), FP (false positive), FN (false negative), TN (true negative) by using bivariate meta-analysis model in STATA 14.0 software. Meanwhile, possible mechanisms of sepsis induced Eosinopenia was also analyzed.ResultsSeven studies were included in the present study with a total number of 3842 subjects. The incidence of Eosinopenia based on the enrolled studies varied from 23.2% to 92.7%. For diagnosis of sepsis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of Eosinopenia were 0.66 (95%CI [0.53-0.77]), 0.68 (95%CI [0.56-0.79]), 2.09 (95%CI [1.44-3.02]), 0.49 (95%CI [0.34-0.71]) and 4.23 (95%CI [2.15-8.31]), respectively. The area under the summary receiver operator characteristic curve (SROC) was 0.73 (95%CI [0.68-0.76]). Meta-regression analysis revealed that no single parameter accounted for the heterogeneity of pooled outcomes. For each subgroup of different eosinopenia cutoff values (50, 40, ≤25, 100), the sensitivity was 0.61, 0.79, 0.57, 0.54, and the specificity was 0.61, 0.75, 0.83, 0.51, respectively. ConclusionsOur findings suggested that Eosinopenia has a high incidence in sepsis but has no superiority in comparison with conventional biomarkers for diagnosis of sepsis. However, eosinopenia can still be used in clinical diagnosis for sepsis as a simple, convenient, fast and inexpensive biomarker. Therefore, further large clinical trials are still needed to re-evaluate eosinopenia as a biomarker of sepsis.

scholarly journals Multivariable prediction model for predicting deaths in severe dengue cases

2019 ◽  
Author(s):  
Saiful Safuan Md S ◽  
Masliza Zaid ◽  
Kar Nim Leong ◽  
Rossman Hawari ◽  
Anilawati Mat Jelani ◽  
...  
Keyword(s):  
Prediction Model ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Model Building ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
World Health ◽  
Severe Dengue

Abstract Background. Many predictive models have been developed to predict an outbreak, identify and stratify dengue but none has predicted death in severe dengue cases. To build a predictive model for deaths in severe dengue, a multicentre retrospective cohort study was conducted. Methods. Patients with severe dengue based on the World Health Organisation (WHO) 2009 classification were studied. Demographic, clinical and laboratory data were collected at diagnosis of severe dengue. Penalised regression was used for variable selection and model-building. Ten-fold cross-validation with 1000 repeats were performed for internal validation. Results. A cohort of 786 severe dengue cases, including 35 deaths, was analysed. Our model that predicts death in severe dengue cases comprises eight independent predictors: persistent diarrhoea, body mass index, respiratory rate, platelet count, aspartate transaminase, serum bicarbonate, serum lactate and serum albumin. The area under the receiver operating characteristic curve is 89·6% with a sensitivity of 99·6%, specificity of 23·6%, positive predictive value of 96·6%, negative predictive value of 71·1%, positive likelihood ratio 1·45 and negative likelihood ratio 0·01. We also found that the proportion of patients that were in the febrile phase at diagnosis of severe dengue for the overall cohort, decompensated and compensated shock were 74·3%, 73% and 75·4%, respectively. Conclusions. We developed a high-performance dengue death prediction model comprising clinical and laboratory data, and deployed an open-access web-based tool (www.saifulsafuan.com/REPROSED2017E2) for any centre to utilise for local validation. We additionally found that a large majority of patients developed severe dengue during the febrile phase. Keywords: Dengue; severe; model; predict; deaths; phase.

scholarly journals Diagnostic value of circulating tumor DNA as an effective biomarker in cervical cancer: a meta-analysis

2019 ◽  
Author(s):  
Yulan Gu ◽  
Chuandan Wan ◽  
Jiaming Qiu ◽  
Yanhong Cui ◽  
Tingwang Jiang
Keyword(s):  
Cervical Cancer ◽  
Likelihood Ratio ◽  
Large Scale ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Value ◽  
Circulating Tumor Dna ◽  
Tumor Dna

AbstractThe applications of liquid biopsy have attracted much attention in biomedical research in recent years. Circulating cell-free DNA (cfDNA) in the serum may serve as a unique tumor marker in various types of cancer. Circulating tumor DNA (ctDNA) is a type of serum cfDNA found in patients with cancer and contains abundant information regarding tumor characteristics, highlighting its potential diagnostic value in the clinical setting. However, the diagnostic value of cfDNA as a biomarker in cervical cancer remains unclear. Here, we performed a meta-analysis to evaluate the applications of ctDNA as a biomarker in cervical cancer. A systematic literature search was performed using PubMed, Embase, and WANFANG MED ONLINE databases up to March 18, 2019. All literature was analyzed using Meta Disc 1.4 and STATA 14.0 software. Diagnostic measures of accuracy of ctDNA in cervical cancer were pooled and investigated. Fifteen studies comprising 1109 patients with cervical cancer met our inclusion criteria and were subjected to analysis. The pooled sensitivity and specificity were 0.52 (95% confidence interval [CI], 0.33–0.71) and 0.97 (95% CI, 0.91–0.99), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 16.0 (95% CI, 5.5–46.4) and 0.50 (95% CI, 0.33–0.75), respectively. The diagnostic odds ratio was 32 (95% CI, 10–108), and the area under the summary receiver operating characteristic curve was 0.92 (95% CI, 0.90– 0.94). There was no significant publication bias observed. In the included studies, ctDNA showed clear diagnostic value for diagnosing and monitoring cervical cancer. Our meta-analysis suggested that detection of human papilloma virus ctDNA in patients with cervical cancer could be used as a noninvasive early dynamic biomarker of tumors, with high specificity and moderate sensitivity. Further large-scale prospective studies are required to validate the factors that may influence the accuracy of cervical cancer diagnosis and monitoring.

Sign in / Sign up

Export Citation Format

Share Document