Copeptin in the Differential Diagnosis of Hyponatremia

Abstract Background: Treatment of patients with hyponatremia varies widely; thus, convenient diagnostic parameters are needed to guide the correct treatment strategy. This study was designed to evaluate the diagnostic potential of copeptin, the C-terminal part of provasopressin, as a new marker in the differential diagnosis of hyponatremia. Methods: In this prospective observational study, 106 consecutive hyponatremic patients were classified based on their history, clinical evaluation, and laboratory tests. In patients and 32 healthy control subjects, plasma copeptin concentration and standard biochemical parameters were tested for their utility of diagnosing the syndrome of inappropriate antidiuresis (SIAD). Results: Four patients (4%) were diagnosed as primary polydipsia, nine (8%) as diuretic-induced hyponatremia, 42 (40%) as SIAD, 29 (27%) as hypovolemic hyponatremia, and 22 patients (21%) as hypervolemic hyponatremia. In controls, a close correlation between plasma copeptin and serum sodium (r2 = 0.62, P < 0.001) or urine osmolality (r2 = 0.39, P = 0.001) was observed. Plasma copeptin levels were significantly higher in patients with hypo- and hypervolemic hyponatremia compared with SIAD (P < 0.005, respectively) and primary polydipsia (P < 0.001). The copeptin to U-Na ratio differentiated accurately between volume-depleted and normovolemic disorders (area under the receiver-operating characteristic curve 0.88, 95% confidence interval 0.81–0.95; P < 0.001), resulting in a sensitivity and specificity of 85 and 87% if a cutoff value of 30 pmol/mmol was used. The combined information of plasma copeptin less than 3 pmol/liter and urine osmolality less than 200 mOsm/kg ensured primary polydipsia in 100% of suspected patients. Conclusion: Copeptin measurement reliably identifies patients with primary polydipsia but has limited utility in the differential diagnosis of other hyponatremic disorders. In contrast, the copeptin to U-Na ratio is superior to the reference standard in discriminating volume-depleted from normovolemic hyponatremic disorders.

Download Full-text

Stratified Threshold Values of QuantiFERON Assay for Diagnosing Tuberculosis Infection in Immunocompromised Populations

Tuberculosis Research and Treatment ◽

10.1155/2011/940642 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Haruyuki Ariga ◽

Hideaki Nagai ◽

Atsuyuki Kurashima ◽

Yoshihiko Hoshino ◽

Syunsuke Shoji ◽

...

Keyword(s):

Operating Characteristic ◽

Characteristic Curve ◽

Latent Tuberculosis ◽

Absolute Number ◽

Threshold Values ◽

Risk Of Progression ◽

Healthy Control ◽

Ifn Γ ◽

The Relationship ◽

Hiv Negative

Background. The detection of latent tuberculosis (TB) is essential for TB control, but T-cell assay might be influenced by degree of immunosuppression. The relationship between immunocompetence and interferon (IFN)-γ response in QuantiFERON-TB Gold (QFT) is uncertain, especially in HIV-negative populations.Methods and Results. QFT has been performed for healthy subjects and TB suspected patients. Of 3017 patients, 727 were diagnosed as pulmonary TB by culture. The absolute number of blood lymphocyte in TB patients was significantly associated with QFT. Definitive TB patients were divided into eight groups according to lymphocyte counts. For each subgroup, receiver operating characteristic curve analysis was conducted from 357 healthy control subjects. The optimal cut-off for the patient group with adequate lymphocyte counts was found, but this was reduced for lymphocytopenia.Conclusions. The lymphocyte count was positively associated with QFT. Positive criteria should be calibrated in consideration of cell-mediated immunocompetence and risk of progression to active TB.

Download Full-text

The Value of Serum Midkine Level in Diagnosis of Hepatocellular Carcinoma

International Journal of Hepatology ◽

10.1155/2015/146389 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Karim Y. A. Shaheen ◽

Abeer I. Abdel-Mageed ◽

Eslam Safwat ◽

Ashraf M. AlBreedy

Keyword(s):

Healthy Subjects ◽

Operating Characteristic ◽

Diagnostic Marker ◽

Characteristic Curve ◽

Area Under The Curve ◽

Tumor Diameter ◽

Control Groups ◽

Tumor Number ◽

Healthy Control ◽

Operating Characteristic Curve

Background and Aim. Identification of sensitive biomarkers to improve early diagnosis of HCC is needed. We aimed to evaluate serum midkine (MDK) as a biomarker for HCC diagnosis.Patients and Methods. 40 HCCs, 30 liver cirrhosis patients, and 30 healthy subjects were enrolled. Serum MDK using ELISA was measured in all included subjects.Results. Serum MDK was significantly elevated in HCC group compared to cirrhotic and healthy control groups (0.625 versus 0.15 and 0.125 ng/mL), respectively. No significant association was found between MDK and either BCLC stage, tumor diameter, tumor number, or AFP level. Receiver operating characteristic curve showed that best cutoff for MDK and AFP was 0.387 and 88.5 ng/mL, respectively. Area under the curve of MDK was significantly larger than that of AFP (0.941 versus 0.671). The sensitivity of MDK at 0.387 ng/mL for HCC diagnosis was significantly higher than that of AFP at cutoffs 20, 88.5, and 200 ng/mL (92.5 versus 62.5, 40, and 25%), respectively. Sensitivity of MDK reached 93.3% in patients with AFP <20 ng/mL. Moreover, MDK at 0.387 ng/mL had significant better sensitivity than AFP at 20 ng/mL in distinguishing HCC from BCLC 0/A (90 versus 40%).Conclusion. Serum MDK might be a potential diagnostic marker for HCC particularity in its early stages.

Download Full-text

Intraoperative hand strength as an indicator of consciousness during awake craniotomy: a prospective, observational study

Scientific Reports ◽

10.1038/s41598-021-04026-9 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Chinatsu Umaba ◽

Yohei Mineharu ◽

Nan Liang ◽

Toshiyuki Mizota ◽

Rie Yamawaki ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Awake Craniotomy ◽

Hand Strength ◽

Unaffected Side ◽

Brain Functions ◽

Level Of Consciousness

AbstractAwake craniotomy enables mapping and monitoring of brain functions. For successful procedures, rapid awakening and the precise evaluation of consciousness are required. A prospective, observational study conducted to test whether intraoperative hand strength could be a sensitive indicator of consciousness during the awake phase of awake craniotomy. Twenty-three patients who underwent awake craniotomy were included. Subtle changes of the level of consciousness were assessed by the Japan Coma Scale (JCS). The associations of hand strength on the unaffected side with the predicted plasma concentration (Cp) of propofol, the bispectral index (BIS), and the JCS were analyzed. Hand strength relative to the preoperative maximum hand strength on the unaffected side showed significant correlations with the Cp of propofol (ρ = − 0.219, p = 0.007), the BIS (ρ = 0.259, p = 0.002), and the JCS (τ = − 0.508, p = 0.001). Receiver operating characteristic curve analysis for discriminating JCS 0–1 and JCS ≥ 2 demonstrated that the area under the curve was 0.76 for hand strength, 0.78 for Cp of propofol, and 0.66 for BIS. With a cutoff value of 75% for hand strength, the sensitivity was 0.76, and the specificity was 0.67. These data demonstrated that hand strength is a useful indicator for assessing the intraoperative level of consciousness during awake craniotomy.

Download Full-text

Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children

Cardiology in the Young ◽

10.1017/s1047951112001266 ◽

2012 ◽

Vol 23 (3) ◽

pp. 400-404 ◽

Cited By ~ 6

Author(s):

Jinyan Yang ◽

Lulu Zhu ◽

Stella Chen ◽

Xueying Li ◽

Qingyou Zhang ◽

...

Keyword(s):

Differential Diagnosis ◽

Receiver Operating Characteristic Curve ◽

Operating Characteristic ◽

Clinical Investigation ◽

Characteristic Curve ◽

Postural Orthostatic Tachycardia Syndrome ◽

Age Group ◽

Score System ◽

Cardiac Syncope ◽

Operating Characteristic Curve

AbstractThe present study was designed to analyse the usefulness of a modified Calgary score system during differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope through a large sample sized clinical investigation. The study included 213 children, including 101 boys and 112 girls, with cardiac syncope or postural orthostatic tachycardia syndrome-associated syncope in the age group of 2–19 years (mean 11.8 ± 2.9 years). A modified Calgary score was created, which was analysed to predict differential diagnoses between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope using a receiver operating characteristic curve. The median of modified Calgary scores for cardiac syncope was −5.0, which significantly differed from that of postural orthostatic tachycardia syndrome (0.0; p < 0.01). The sensitivity and specificity of a differentiation score of less than −2.5 was 96.3% and 72.7%, respectively. Owing to the fact that the modified Calgary score was an integer, when less than −3.0 the diagnosis could be considered as cardiac syncope. The modified Calgary score could be used to make an initial differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in the clinic.

Download Full-text

Skin imprints to provide noninvasive metabolic profiling of COVID-19 patients

10.1101/2021.04.17.21255518 ◽

2021 ◽

Author(s):

Jeany Delafiori ◽

Rinaldo Focaccia Siciliano ◽

Arthur Noin de Oliveira ◽

José Carlos Nicolau ◽

Geovana Manzan Sales ◽

...

Keyword(s):

Operating Characteristic ◽

Characteristic Curve ◽

Endocannabinoid System ◽

Skin Lesions ◽

Routine Care ◽

Fatty Acid Amides ◽

Non Invasive ◽

Diagnostic Potential ◽

Curve Model ◽

System Maintenance

As the current COVID-19 pandemic progresses, more symptoms and signals related to how the disease manifests in the human body arise in the literature. Skin lesions and coagulopathies may be confounding factors on routine care and patient management. We analyzed the metabolic and lipidic profile of the skin from COVID-19 patients using imprints in silica plates as a non-invasive alternative, in order to better understand the biochemical disturbances caused by SARS-CoV-2 in the skin. One hundred and one patients (64 COVID-19 positive patients and 37 control patients) were enrolled in the study from April 2020 to June 2020 during the first wave of COVID-19 in São Paulo, Brazil. Fourteen biomarkers were identified related to COVID-19 infection (7 increased and 7 decreased in COVID-19 patients). Remarkably, oleamide has shown promising performance, providing 79.0% of sensitivity on a receiver operating characteristic curve model. Species related to coagulation and immune system maintenance such as phosphatidylserines were decreased in COVID-19 patients; on the other hand, cytokine storm and immunomodulation may be affected by molecules increased in the COVID-19 group, particularly primary fatty acid amides and N-acylethanolamines, which are part of the endocannabinoid system. Our results show that skin imprints may be a useful, noninvasive strategy for COVID-19 screening, by electing a pool of biomarkers with diagnostic potential.

Download Full-text

Anti-α-Gal antibodies detected by novel neoglycoproteins as a diagnostic tool for Old World cutaneous leishmaniasis caused byLeishmania major

Parasitology ◽

10.1017/s0031182018000860 ◽

2018 ◽

Vol 145 (13) ◽

pp. 1758-1764 ◽

Cited By ~ 4

Author(s):

Krishanthi S. Subramaniam ◽

Victoria Austin ◽

Nathaniel S. Schocker ◽

Alba L. Montoya ◽

Matthew S. Anderson ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Operating Characteristic ◽

Leishmania Major ◽

Characteristic Curve ◽

Area Under The Curve ◽

Old World ◽

Logistic Regression Models ◽

Resource Limited ◽

Diagnostic Potential ◽

Potential Area

AbstractOutbreaks of Old World cutaneous leishmaniasis (CL) have significantly increased due to the conflicts in the Middle East, with most of the cases occurring in resource-limited areas such as refugee settlements. The standard methods of diagnosis include microscopy and parasite culture, which have several limitations. To address the growing need for a CL diagnostic that can be field applicable, we have identified five candidate neoglycoproteins (NGPs): Galα (NGP3B), Galα(1,3)Galα (NGP17B), Galα(1,3)Galβ (NGP9B), Galα(1,6)[Galα(1,2)]Galβ (NGP11B), and Galα(1,3)Galβ(1,4)Glcβ (NGP1B) that are differentially recognized in sera from individuals withLeishmania majorinfection as compared with sera from heterologous controls. These candidates contain terminal, non-reducing α-galactopyranosyl (α-Gal) residues, which are known potent immunogens to humans. Logistic regression models found that NGP3B retained the best diagnostic potential (area under the curve from receiver-operating characteristic curve = 0.8). Our data add to the growing body of work demonstrating the exploitability of the human anti-α-Gal response in CL diagnosis.

Download Full-text

Predicting rehospitalization in patients treated with antipsychotics: a prospective observational study

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125318762373 ◽

2018 ◽

Vol 8 (8) ◽

pp. 213-229 ◽

Cited By ~ 1

Author(s):

Heshu Abdullah-Koolmees ◽

Helga Gardarsdottir ◽

Lotte A. Minnema ◽

Kamjar Elmi ◽

Lennart J. Stoker ◽

...

Keyword(s):

Healthcare Professional ◽

Psychiatric Hospital ◽

Prospective Observational Study ◽

Operating Characteristic ◽

Characteristic Curve ◽

Global Assessment Of Functioning ◽

Medicine Use ◽

Duration Of Hospitalization ◽

Operating Characteristic Curve ◽

Additional Support

Background: Prediction of rehospitalization in patients treated with antipsychotics is important for identifying patients in need of additional support to prevent hospitalization. Our aim was to identify factors that predict rehospitalization in patients treated with antipsychotics at discharge from a psychiatric hospital. Methods: Adult patients suffering from schizophrenia, psychotic or bipolar I disorders who had been hospitalized in a psychiatric hospital for ⩾7 days and were treated with oral antipsychotics at discharge were included. The main outcome was rehospitalization within 6 months after discharge. A prediction model for rehospitalization was constructed including: patient/disease and medication characteristics, patients’ beliefs about medicines, and healthcare-professional-rated assessment for all patients. The patients were stratified by diagnosis (schizophrenia and nonschizophrenia). Area under the receiver operating characteristic curve (AUCROC) was also assessed. Results: A total of 87 patients were included and 33.3% of them were rehospitalized within 6 months after discharge. The variables that predicted rehospitalization were duration of hospitalization, patients’ attitude towards medicine use, and healthcare-professional-rated assessment with an AUCROC of 0.82. Rehospitalization for patients with schizophrenia could be predicted (AUCROC = 0.71) by the Global Assessment of Functioning score, age, and harm score. Rehospitalization was predicted (AUCROC = 0.73) for nonschizophrenia patients with, for example rehospitalization predicted by the nurse. Conclusions: Rehospitalization was predicted by a combination of variables from the patient/disease and medication characteristics, patients’ attitude towards medicine use, and healthcare-professional-rated assessment. These variables can be assessed relatively easily at discharge to predict rehospitalization within 6 months.

Download Full-text

Gastrin-17 Combined With CEA, CA12-5 and CA19-9 Improves the Sensitivity For the Diagnosis of Gastric Cancer

10.21203/rs.3.rs-390531/v1 ◽

2021 ◽

Author(s):

Zhen Wang ◽

Tang-ming Mo ◽

Lei Tian ◽

Jun-qiang Chen

Keyword(s):

Gastric Cancer ◽

Area Under Curve ◽

Operating Characteristic ◽

Characteristic Curve ◽

Diagnostic Value ◽

Serum Markers ◽

Control Group ◽

Positive Rate ◽

Healthy Control ◽

Operating Characteristic Curve

Abstract Background: Previous studies reported the utility of serum tumor markers (such as CEA, CA12-5 and CA19-9) and gastrin-17 in the diagnosis of gastric cancer (GC). However, the value of these serum markers for diagnosing GC is still under debate.Methods: The level of CEA, CA12-5, CA19-9 and gastrin-17 was tested in 230 GC patients and 99 healthy people. The value of the four markers for diagnosing GC was analyzed.Results: The positive rate of Gastrin-17, CEA, CA199 and CA125 were much higher in GC group (22.61%, 22.61%, 20.00% and 8.26%, respectively) than that of healthy control group (5.05%, 2.02%, 1.01% and 2.02%, respectively). The sensitivity of Gastrin-17, CEA, CA125 and CA199 in the diagnosis of GC were 22.61%, 22.61%, 6.96% and 20.00%, respectively, and the corresponding specificity were 94.95%, 97.98%, 98.99% and 98.99%, respectively. By using the optimal cut-off value derived from the area under curve (AUC) of receiver operating characteristic curve, the AUC of gastin-17, CEA, CA125, CA199 increased to 0.72, 0.64, 0.61 and 0.65, respectively. After combining the four markers, the AUC increased to 0.79 (95% CI: 0.75-0.84), and the corresponding sensitivity and specificity were 65.22% (95% CI: 58.70% - 71.40%) and 84.85% (95% CI: 76.20% - 91.30%), respectively.Conclusion: CEA, CA12-5, CA19-9 and gastrin-17 were all valuable in the diagnosis of GC, and gastrin-17 had the best diagnostic value among the four markers. Gastrin-17 combined with CEA, CA12-5 and CA19-9 could improve the diagnostic value of GC significantly. Prospective, multi-center studies are needed to validate our findings.

Download Full-text

Efficiency in the diagnosis of acute pancreatitis increased by improved electrophoresis of amylase isoenzyme P3 on cellulose acetate.

Clinical Chemistry ◽

10.1093/clinchem/31.1.70 ◽

1985 ◽

Vol 31 (1) ◽

pp. 70-75 ◽

Cited By ~ 12

Author(s):

T H Massey

Keyword(s):

Acute Pancreatitis ◽

Complete Resolution ◽

Operating Characteristic ◽

Characteristic Curve ◽

True Positive Rate ◽

Diagnostic Efficiency ◽

Electrophoretic Method ◽

Diagnostic Potential ◽

Positive Rate ◽

Positive Results

Abstract Serum from patients who have suffered acute pancreatitis contains P3, an isoenzyme of pancreatic-derived amylase (EC 3.2.1.1). Heretofore, complete resolution of P3 from the major salivary isoenzyme in serum, S1, has not been possible, thus compromising the diagnostic potential of P3 for pancreatitis. I describe an electrophoretic method for the essentially complete resolution of P3 from S1 by including CaCl2, 1 mmol/L, in the Tris barbiturate electrophoresis buffer (25 mmol/L, pH 8.8). I evaluated the clinical utility of the method for 129 consecutive patients suspected of having pancreatitis, by using receiver operating characteristic curve analysis for results for total amylase, P2, and P3 activity. For a true-positive rate of 90% with a prevalence of pancreatitis of 7.8%, the diagnostic efficiency was increased from 82% (total amylase) to 91% (P2) to 98% (P3). Thus, including P3 activity in the diagnostic criteria will eliminate most false-positive results for pancreatitis based on total amylase activity alone, and should decrease the need for expensive radiologic procedures currently required to confirm the presence of pancreatitis. I conclude that P3 can be of significant value in the differential diagnosis of pancreatitis from other syndromes with hyperamylasemia.

Download Full-text

Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620935201 ◽

2020 ◽

Vol 26 ◽

pp. 107602962093520

Author(s):

Chunxia Wang ◽

Yun Cui ◽

Huijie Miao ◽

Ting Sun ◽

Ye Lu ◽

...

Keyword(s):

Liver Injury ◽

Clinical Utility ◽

Prospective Observational Study ◽

Operating Characteristic ◽

Pediatric Patients ◽

Characteristic Curve ◽

Pediatric Intensive Care ◽

Decision Curve Analysis ◽

Risk Of Mortality ◽

Pediatric Sepsis

Vitronectin (VTN) is a key regulator of coagulation, but clinical relevance of serum VTN in pediatric sepsis remains poorly defined. The aim of this study was to access the value of serum VTN level on pediatric intensive care unit (PICU) admission in children with sepsis. Pediatric patients with sepsis were enrolled from January 2018 to December 2018. The serum VTN levels were determined on PICU admission, and the association of serum VTN level with PICU mortality and organ dysfunction was assessed. Serum VTN levels were significantly lower in nonsurvivors compared with survivors, in patients with septic shock compared with patients with sepsis, or in patients with sepsis-associated acute liver injury (ALI) compared with patients without ALI. Serum VTN level was associated with PICU mortality (odds ratio [OR]: 0.958, 95% CI: 0.927-0.996; P = .010) or ALI (OR: 0.956, 95% CI: 0.915-0.999; P = .046), but not shock (OR: 0.996, 95% CI: 0.977-1.016; P =.716). The area under receiver operating characteristic curve for VTN in predicting the occurrence of ALI during PICU stay and PICU mortality were 0.760 (95% CI: 0.627- 0.893) and 0.737 (95% CI: 0.544-0.931), respectively. Moreover, VTN plus pediatric risk of mortality (PRISM) III had a better clinical utility according to decision curve analysis compared with VTN or PRISM III alone. These findings suggest that serum VTN level is associated with sepsis-associated ALI and PICU mortality, and VTN plus PRISM III is a powerful predictor of PICU mortality in pediatric patients with sepsis, which have a better clinical benefit compared with VTN or PRISM III alone.

Download Full-text