A hematologic scoring system and C-reactive protein compared to blood cultures for diagnosing bacterial neonatal sepsis

Background Neonatal sepsis is the leading cause of death after pneumonia. Definitive bacterial sepsis diagnoses are made by blood culture results, which require a lengthy time. C-reactive protein (CRP) levels and a hematologic scoring system by Rodwell et al. are rapid tests that may be useful for diagnosing neonatal sepsis. Objective To determine the diagnostic value of CRP measurement and a hematologic scoring system compared to blood culture as the gold standard for diagnosing neonatal sepsis. Methods A cross-sectional study was conducted from April to August 2015 in the Neonatology Ward of Haji Adam Malik Hospital, Medan. A total of 43 neonates who were clinically suspected to have sepsis underwent CRP, hematologic scoring, and blood cultures. The IT ratio and procalcitonin indices were also examined. Diagnostic values were analyzed by a 2x2 table.Results Fourteen percent from all sample had positive bacterial culture. The CRP measurements had a sensitivity of 92.8%, specificity of 62%, positive predictive value (PPV) of 54.1%, negative predictive value (NPV) of 94.7%, positive likelihood ratio (PLR) of 2.44, and negative likelihood ratio (NLR) of 0.11. The hematologic scoring system had a sensitivity of 100%, specificity of 82.7%, PPV of 73.6%, NPV of 100%, PLR of 5.78, and NLR of 0. Procalcitonin and IT ratio show a good value of sensitivity and NPV, respectively. Conclusion The hematologic scoring system has better specificity than CRP measurement as compared to blood culture. However, both tests have good sensitivity for diagnosing neonatal sepsis.

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Diagnostic accuracy of septic markers for neonatal sepsis

Paediatrica Indonesiana ◽

10.14238/pi48.5.2008.299-305 ◽

2016 ◽

Vol 48 (5) ◽

pp. 299

Author(s):

Thermiany AS ◽

W Retayasa ◽

M Kardana ◽

IN Lila

Keyword(s):

Blood Culture ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Likelihood Ratio ◽

Neonatal Sepsis ◽

Predictive Value ◽

Gold Standard ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Suspected Sepsis

Background Neonatal sepsis is a major cause of morbidity andmortality. A positive blood culture is the gold standard fordiagnosis of neonatal sepsis. The signs and symptoms suggestingneonatal sepsis are non-specific. There is no rapid and reliablelaboratory test findings for confirmation of etiologic diagnosis.Clinical signs, symptoms, and laboratory examinations are notperceived as sensitive or specific for diagnosis of sepsis.Objective The purpose of this study was to evaluate the accuracyof the septic markers for diagnosis of neonatal sepsis.Methods Blood culture was used as gold standard to compareseptic markers to diagnose neonatal sepsis. Sensitivity, specificity,positive predictive value (PPV), negative predictive value (NPV),positive and negative likelihood ratio (LR), and accuracy werecalculated.Results We identified 130 cases suspected of neonatal sepsis duringSeptember 2005 until March 2006. Four patients were excludedbecause of major congenital anomalies. The mean age was 2.2 daysand 51.6% were boys. We found fifty six (44.4%) neonates havepositive blood culture. All of septic markers had sensitivity morethan 80%. Immature to Total Neutrophil ratio (Iff) ratio had thehighest sensitivity (96.4%) and C-Reactive Protein (CRP) had thelowest sensitivity (80.4o/o). Combination among leukocyte count,thrombocyte, and Iff ratio had the highest sensitivity (sensitivitywas 85. 7%, specificity was 97.1 o/o, positive predictive value was95.9%, negative predictive value was 89.5%, accuracy was 94.4%,and positive likelihood ratio was 30.0).Conclusion Septic markers can be used in the diagnosticevaluation of neonates with suspected sepsis.

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Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score

International Surgery Journal ◽

10.18203/2349-2902.isj20201854 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1473

Author(s):

Amulya Aggarwal ◽

Alok V. Mathur ◽

Ram K. Verma ◽

Megha Gupta ◽

Dheeraj Raj

Keyword(s):

Acute Pancreatitis ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Severe Acute Pancreatitis ◽

Predictive Value ◽

Scoring System ◽

Treatment Protocol ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Clinical Scoring

Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.

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Diagnostic Utility of C-Reactive Protein and Permutation Combination of Quantitative and Qualitative Haematological Parameters in Neonatal Sepsis

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/50366.15483 ◽

2021 ◽

Author(s):

Sapna Shreyas Deshpande ◽

Mohasin Jakirhusain Halgale ◽

Ravindra Vilas Ramteke

Keyword(s):

Blood Culture ◽

Peripheral Blood ◽

Neonatal Sepsis ◽

Predictive Value ◽

Blood Smear ◽

Peripheral Blood Smear ◽

Haematological Parameters ◽

Diagnostic Utility ◽

C Reactive Protein ◽

Reactive Protein

Introduction: Neonatal sepsis at times is subclinical and lacks specific symptoms. The C-Reactive Protein (CRP) which is an acute phase reactant protein is thought to be an alternative biomarker to blood culture. Haematological parameters of sepsis are indirect biomarkers of infection. Authors found it worthwhile to discern efficacy of haematological parameters obtained by such three part haematology analysers in diagnosis of neonatal sepsis, when used in their pure form or with peripheral blood smear or with CRP, in isolation or in their combinations. Aim: To find out the diagnostic utility of combinations of haematological parameters as obtained by three part differential automated haematology analyser and peripheral blood smear along with CRP in neonatal sepsis. Materials and Methods: This observational and analytical study of diagnostic test outcome was carried out over a period of 12 months from January-December 2016 in Rajarshi Chhatrapati Shahu Maharaj Medical College and Chhatrapati Pramilaraje Rugnalaya, Kolhapur, Maharashtra, India, with special reference to clinical profile, blood culture, qualitative and quantitative haematological parameters and CRP. The statistical analysis included calculating diagnostic utility of isolated and combination of parameters and performing Chi-square test to study difference in frequency of occurrence and significance of association. Results: There were 104 cases of neonatal sepsis out of which culture proven sepsis was seen in 73 (70.2%) cases while probable sepsis was seen in 31 (29.8%) cases. There were 32 (30.8%) fatalities. With parallel method with OR values, combination of haemoglobin, platelet parameters and White Blood Cells (WBC) parameters as obtained by analyser and peripheral blood smear exhibited sensitivity of 98.6%, specificity and Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 96.9% and Diagnostic Accuracy (DA) of 99%. This was surpassed by combination of CRP and all these parameters to attend values of 100%. Combination of all haematological parameters obtained purely by analyser showed these values to be 89%, 100%, 79.5% and 92.3%. Immature to Total WBC (I:T) ratio and platelet count influenced clinical outcome of fatality. Conclusion: The liberal use of combination of haematological parameters is rewarding in supporting diagnosis of neonatal sepsis. The same was obtained by purely using analyser which showed remarkable diagnostic utility suitable for resource poor settings.

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Quick BSI Score to Identify Bloodstream Infection at the Emergency Department

10.21203/rs.3.rs-33769/v3 ◽

2020 ◽

Author(s):

Pariwat Phungoen ◽

Nunchalit Lerdprawat ◽

Kittisak Sawanyawisuth ◽

Verajit Chotmongkol ◽

Kamonwon Ienghong ◽

...

Keyword(s):

Emergency Department ◽

Blood Culture ◽

Bloodstream Infection ◽

Likelihood Ratio ◽

Positive Blood Culture ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Solid Organ ◽

Current Guideline

Abstract Background: Bloodstream infection (BSI) is a common and urgent condition at the emergency department (ED). In order to diagnose BSI, the current guideline fails to mention the juncture at which blood cultures ought to be taken. The decision whether or not to obtain hemoculture is solely based upon clinical judgment and outcomes pertaining to inappropriately ordered blood culture. This study aimed to develop predictive bloodstream infection scoring at the ED employing only clinical factors presented on ED arrival.Methods: This study was conducted retrospectively at the ED, Khon Kaen University Hospital, Thailand. Inclusion criteria encompassed adult patients suspected of infection defined by blood culture collection presented at the ED with intravenous antibiotics initiated during ED visits. Independent positive predictors for positive blood culture were used to create the Quick Bloodstream Infection score (qBSI score) through logistic regression analysis.Results: A total of 169578 patients visited the ED during the study period. Of those, 12556 patients (7.40%) were suspected of infection. 8177 cases met the study criteria and were categorized according to positive blood culture results, i.e. bloodstream infection (741 patients; 9.06%). Probability of positive blood culture was calculated via aged over 55 years + moderate to severe CKD + solid organ tumor + (2 x liver disease) + (2 x history of fever with chills) + (2 x body temperature of over 38.3oC). A score of 1 or over rendered 92.98% sensitivity, 15.40% specificity, 9.87% positive predictive value, 95.66% negative predictive value, positive likelihood ratio of 1.10, and negative likelihood ratio of 0.46.Conclusions: The qBSI score may be a helpful tool to perform blood culture in patients at the ED suspected of infection. Employing this score may facilitate in the determining of those needing blood culture at the ED.

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Circulating tumour DNA methylation in hepatocellular carcinoma diagnosis using digital droplet PCR

Journal of International Medical Research ◽

10.1177/0300060521992962 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199296

Author(s):

Juan Wang ◽

Liu Yang ◽

Yanjun Diao ◽

Jiayun Liu ◽

Jinjie Li ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Dna Methylation ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Control Group ◽

Control Subjects ◽

Droplet Pcr ◽

Healthy Control

Objective To evaluate the performance of a DNA methylation-based digital droplet polymerase chain reaction (ddPCR) assay to detect aberrant DNA methylation in cell-free DNA (cfDNA) and to determine its application in the detection of hepatocellular carcinoma (HCC). Methods The present study recruited patients with liver-related diseases and healthy control subjects. Blood samples were used for the extraction of cfDNA, which was then bisulfite converted and the extent of DNA methylation quantified using a ddPCR platform. Results A total of 97 patients with HCC, 80 healthy control subjects and 46 patients with chronic hepatitis B/C virus infection were enrolled in the study. The level of cfDNA in the HCC group was significantly higher than that in the healthy control group. For the detection of HCC, based on a cut-off value of 15.7% for the cfDNA methylation ratio, the sensitivity and specificity were 78.57% and 89.38%, respectively. The diagnostic accuracy was 85.27%, the positive predictive value was 81.91% and the negative predictive value was 87.20%. The positive likelihood ratio of 15.7% in HCC diagnosis was 7.40, while the negative likelihood ratio was 0.24. Conclusions A sensitive methylation-based assay might serve as a liquid biopsy test for diagnosing HCC.

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C-Reactive Protein as A Fungal Infection Marker in Acute Leukemia Patients

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v27i2.1639 ◽

2021 ◽

Vol 27 (2) ◽

pp. 212

Author(s):

Brigitte Rina Aninda Sidharta ◽

JB. Suparyatmo ◽

Avanti Fitri Astuti

Keyword(s):

Acute Leukemia ◽

Predictive Value ◽

Bacterial Infections ◽

Fungal Infections ◽

Lymphoblastic Leukemia ◽

Negative Likelihood Ratio ◽

Receiver Operating Curve ◽

High Morbidity ◽

C Reactive Protein ◽

Reactive Protein

Invasive Fungal Infections (IFIs) can cause serious problems in cancer patients and may result in high morbidity andmortality. C-reactive protein levels increase in response to injury, infection, and inflammation. C-reactive protein increasesin bacterial infections (mean of 32 mg/L) and in fungal infections (mean of 9 mg/L). This study aimed to determineC-Reactive Protein (CRP) as a marker of fungal infections in patients with acute leukemia by establishing cut-off values ofCRP. This study was an observational analytical study with a cross-sectional approach and was carried out at the Departmentof Clinical Pathology and Microbiology of Dr. Moewardi Hospital in Surakarta from May until August 2019. The inclusioncriteria were patients with acute leukemia who were willing to participate in this study, while exclusion criteria were patientswith liver disease. There were 61 samples consisting of 30 male and 31 female patients with ages ranging from 1 to 70 years.Fifty-four patients (88.5%) were diagnosed with Acute Lymphoblastic Leukemia (ALL) and 30 (49.18%) were in themaintenance phase. The risk factors found in those patients were neutropenia 50-1500 μL (23.8%), use of intravenous line(22%), and corticosteroid therapy for more than one week (20.9%). The median of CRP in the group of patients with positiveculture results was 11.20 mg/L (11.20-26.23 mg/L) and negative culture results in 0.38 mg/L (0.01-18.63 mg/L). The cut-offvalue of CRP using the Receiver Operating Curve (ROC) was 9.54 mg/L (area under curve 0.996 and p. 0.026), with a sensitivityof 100%, specificity of 93.2%, Positive Predictive Value (PPV) of 33.3%, Negative Predictive Value (PPV) of 100%, PositiveLikelihood Ratio (PLR) of 1.08, Negative Likelihood Ratio (NLR) of 0 and accuracy of 93.4%. C-reactive protein can be used asa screening marker for fungal infections in patients with acute leukemia.

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Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Canadian Urological Association Journal ◽

10.5489/cuaj.3242 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 387 ◽

Cited By ~ 3

Author(s):

Nathan C Wong ◽

Rahul K Bansal ◽

Armando J Lorenzo ◽

Jorge DeMaria ◽

Luis H Braga

Keyword(s):

Primary Care ◽

Physical Examination ◽

Likelihood Ratio ◽

Predictive Value ◽

Undescended Testis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Primary Care Providers ◽

Care Providers ◽

Hospital Patients

Introduction: Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists.Methods: We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed.Results: Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes.Conclusion: Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.

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Predictive Value of Interim PET/CT in DLBCL Treated with R-CHOP: Meta-Analysis

BioMed Research International ◽

10.1155/2015/648572 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Na Sun ◽

Jinhua Zhao ◽

Wenli Qiao ◽

Taisong Wang

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Meta Analysis ◽

Prognostic Significance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Chop Chemotherapy ◽

Interim Pet ◽

Pet Ct ◽

Fdg Pet Ct

Objective.We conducted a meta-analysis to evaluate the predictive value of interim18F-FDG PET/CT in patients with DLBCL treated with R-CHOP chemotherapy.Methods.We searched for articles published in PubMed, ScienceDirect, Wiley, Scopus, and Ovid database from inception to March 2014. Articles related to interim PET/CT in patients with DLBCL treated with R-CHOP chemotherapy were selected. PFS with or without OS was chosen as the endpoint to evaluate the prognostic significance of interim PET/CT.Results.Six studies with a total of 605 cases were included. The sensitivity of interim PET/CT ranged from 21.2% to 89.7%, and the pooled sensitivity was 52.4%. The specificity of interim PET/CT ranged from 37.4% to 90.7%, and the pooled specificity was 67.8%. The pooled positive likelihood ratio and negative likelihood ratio were 1.780 and 0.706, respectively. The explained AUC was 0.6978 and theQ*was 0.6519.Conclusions.The sensitivity and specificity of interim PET/CT in predicting the outcome of DLBCL patients treated with R-CHOP chemotherapy were not satisfactory (52.4% and 67.8%, resp.). To improve this, some more work should be done to unify the response criteria and some more research to assess the prognostic value of interim PET/CT with semiquantitative analysis.

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Classification of Thyroid Nodules with Stacked Denoising Sparse Autoencoder

International Journal of Endocrinology ◽

10.1155/2020/9015713 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Zexin Li ◽

Kaiji Yang ◽

Lili Zhang ◽

Chiju Wei ◽

Peixuan Yang ◽

...

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Discriminative Ability ◽

Sparse Autoencoder ◽

Immune Related Genes

Purpose. Several commercial tests have been used for the classification of indeterminate thyroid nodules in cytology. However, the geographic inconvenience and high cost confine their widespread use. This study aims to develop a classifier for conveniently clinical utility. Methods. Gene expression data of thyroid nodule tissues were collected from three public databases. Immune-related genes were used to construct the classifier with stacked denoising sparse autoencoder. Results. The classifier performed well in discriminating malignant and benign thyroid nodules, with an area under the curve of 0.785 [0.638–0.931], accuracy of 92.9% [92.7–93.0%], sensitivity of 98.6% [95.9–101.3%], specificity of 58.3% [30.4–86.2%], positive likelihood ratio of 2.367 [1.211–4.625], and negative likelihood ratio of 0.024 [0.003–0.177]. In the cancer prevalence range of 20–40% for indeterminate thyroid nodules in cytology, the range of negative predictive value of this classifier was 37–61%, and the range of positive predictive value was 98–99%. Conclusion. The classifier developed in this study has the superb discriminative ability for thyroid nodules. However, it needs validation in cytologically indeterminate thyroid nodules before clinical use.

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VALIDITY OF C- REACTIVE PROTEIN IN DIAGNOSIS OF NEONATAL SEPSIS.

10.36106/ijsr/1506241 ◽

2020 ◽

pp. 1-4

Author(s):

Ghongade P. G. ◽

Khaire P. B.

Keyword(s):

Birth Weight ◽

Neonatal Sepsis ◽

Predictive Value ◽

Screening Test ◽

Treatment Strategies ◽

High Sensitivity ◽

C Reactive Protein ◽

Suspected Sepsis ◽

Adequate Treatment ◽

Reactive Protein

Background: Neonatal sepsis with its high incidence &grave prognosis, in spite of adequate treatment with modern antibiotics, has been a challenge for all times. Optimal diagnosis and treatment strategies are difficult to define. It is essential to diagnose early with laboratory investigation like serial CRP; so that a feasible, rapid and a relatively economic method to diagnose neonatal sepsis at earliest can be instituted even at basic health care level. hence a study was planned to find out the role of CRP against blood culture in early detection of neonatal sepsis. Aim & Objective: To evaluate Validity of C-Reactive Protein as a screening test in neonatal sepsis. Material and Method: This prospective study was carried out inpaediatric dept of medical college. 100 neonates (≤ 28 days) with suspected neonatal sepsis having a birth weight of ≥ 1000 grams admitted during a period from January 2020 to March 2020 were screened primarily with C-Reactive Protein. Serial level of CRPon the day of admission,2nd ,4th ,6th ,8th& 10th day was compared with the serial blood cultureon the day of admission,8th,15th& 21st day to establish the validity of CRP as a screening test.Data analysis carried out by Percentages, Chi Square test, Sensitivity, Specificity, Positive predictive value, Negative predictive value. Results: Amongst 100neonate 76% were early neonates,65% were low birth weight,CRP was having high sensitivity & specificity(78.57%,76.74% respectively). ROC analysis showed AUC 0.8 with p<0.001.Conclusion: CRP is a good screening test & establishes its validity in diagnosing suspected sepsis.

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