scholarly journals A new tool for sepsis screening in the Emergency Department

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luisa Agnello ◽  
Alessandro Iacona ◽  
Bruna Lo Sasso ◽  
Concetta Scazzone ◽  
Michele Pantuso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Systemic Inflammatory Response Syndrome ◽  
Diagnostic Accuracy ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Index Value ◽  
Sepsis Screening ◽  
Substantial Change

Abstract Objectives In this study, we developed and evaluated the diagnostic accuracy of the Sepsis Index for early sepsis screening in the Emergency Department (ED). Methods Sepsis Index is based on the combination of monocyte distribution width (MDW) and mean monocyte volume (MMV). Sepsis Index≥1 was selected to define sepsis. We tested its diagnostic accuracy in an ED population stratified in four groups: controls, Systemic Inflammatory Response Syndrome (SIRS), infection, and sepsis, according to Sepsis-2 criteria. Results Patients with sepsis displayed higher median Sepsis Index value than patients without sepsis. At the receiver operating characterictis (ROC) curve analysis for the prediction of sepsis, the area under the curve (AUC) of MDW and Sepsis Index were similar: 0.966 (95%CI 0.947–0.984), and 0.964 (95%CI 0.942–0.985), respectively. Sepsis Index showed increased specificity than MDW (94.7 vs. 90.6%), without any decrease in sensitivity (92.0%). Additionally, LR+ increased from 9.8 (MDW) to 17.4 (Sepsis Index), without any substantial change in LR− (respectively 0.09 vs. 0.08). Finally, PPV increased from 0.286 (MDW) to 0.420 (Sepsis Index). Conclusions Sepsis Index improves the diagnostic accuracy of MDW alone for sepsis screening.

scholarly journals Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1292
Author(s):  
Luisa Agnello ◽  
Alessandro Iacona ◽  
Salvatore Maestri ◽  
Bruna Lo Sasso ◽  
Rosaria Vincenza Giglio ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Early Detection ◽  
Diagnostic Accuracy ◽  
Positive Likelihood Ratio ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Independent Validation ◽  
Sepsis Screening

(1) Background: The early detection of sepsis is still challenging, and there is an urgent need for biomarkers that could identify patients at a high risk of developing it. We recently developed an index, namely the Sepsis Index (SI), based on the combination of two CBC parameters: monocyte distribution width (MDW) and mean monocyte volume (MMV). In this study, we sought to independently validate the performance of SI as a tool for the early detection of patients at a high risk of sepsis in the Emergency Department (ED). (2) Methods: We enrolled all consecutive patients attending the ED with a request of the CBC. MDW and MMV were measured on samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser. SI was calculated based on the MDW and MMV. (3) Results: We enrolled a total of 703 patients stratified into four subgroups according to the Sepsis-2 criteria: control (498), infection (105), SIRS (52) and sepsis (48). The sepsis subgroup displayed the highest MDW (median 27.5, IQR 24.6–32.9) and SI (median 1.15, IQR 1.05–1.29) values. The ROC curve analysis for the prediction of sepsis showed a good and comparable diagnostic accuracy of the MDW and SI. However, the SI displayed an increased specificity, positive predictive value and positive likelihood ratio in comparison to MDW alone. (4) Conclusions: SI improves the diagnostic accuracy of MDW for sepsis screening.

Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department

2020 ◽  
Vol 58 (11) ◽  
pp. 1951-1957 ◽  
Author(s):  
Luisa Agnello ◽  
Giulia Bivona ◽  
Matteo Vidali ◽  
Concetta Scazzone ◽  
Rosaria Vincenza Giglio ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Early Identification ◽  
Screening Tool ◽  
Complete Blood Count ◽  
Sepsis Group ◽  
Control Group ◽  
Roc Curve Analysis ◽  
Distribution Width ◽  
Patients At Risk

AbstractObjectivesThe diagnosis of sepsis in the Emergency Department (ED) is challenging and a reliable biomarker is needed. The current study aimed to evaluate the diagnostic accuracy of monocyte distribution width (MDW) for the early identification of sepsis in the ED.MethodsWe performed a large observational study including consecutive adult patients (≥18 years of age) presenting to the ED between September and November 2019, with an order for complete blood count (CBC) evaluation. A total of 2,215 patients were enrolled and classified based on Sepsis-2 criteria as the control group (1,855), infection group (172), Systemic Inflammatory Response Syndrome (SIRS) group (100), and sepsis group (88).ResultsMDW levels were higher in patients with sepsis than in all other groups (p<0.001). ROC curve analysis showed an optimal diagnostic accuracy of MDW for sepsis prediction at a cut-off point of 23.5, with an AUC of 0.964, sensitivity and specificity of 0.920 and 0.929, respectively.ConclusionsOur findings encourage further investigation to validate the use of MDW as a screening tool for the early identification of patients at risk of sepsis in the ED.

scholarly journals The neurophysiological lesson from the Italian CIDP database

2021 ◽  
Author(s):  
Emanuele Spina ◽  
◽  
Pietro Emiliano Doneddu ◽  
Giuseppe Liberatore ◽  
Dario Cocito ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Odds Ratio ◽  
Motor Nerve ◽  
Lower Number ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Electrophysiological Data ◽  
Electrophysiological Examination ◽  
Temporal Dispersion

Abstract Introduction Electrophysiological diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) may be challenging. Thus, with the aim ofproviding some practical advice in electrophysiological approach to a patient with suspected CIDP, we analyzed electrophysiological data from 499 patients enrolled inthe Italian CIDP Database. Methods We calculated the rate of each demyelinating feature, the rate of demyelinating features per nerve, the diagnostic rate for upper andlower limb nerves, and, using a ROC curve analysis, the diagnostic accuracy of each couple of nerves and each demyelinating feature, for every CIDP subtype.Moreover, we compared the electrophysiological data of definite and probable CIDP patients with those of possible and not-fulfilling CIDP patients, and by a logisticregression analysis, we estimated the odds ratio (OR) to make an electrophysiological diagnosis of definite or probable CIDP. Results The ulnar nerve had the highestrate of demyelinating features and, when tested bilaterally, had the highest diagnostic accuracy except for DADS in which peroneal nerves were the most informative.In possible and not-fulfilling CIDP patients, a lower number of nerves and proximal temporal dispersion (TD) measurements had been performed compared to definiteand probable CIDP patients. Importantly, OR for each tested motor nerve and each TD measurement was 1.59 and 1.33, respectively. Conclusion Our findingsdemonstrated that the diagnosis of CIDP may be missed due to inadequate or incomplete electrophysiological examination or interpretation. At the same time, thesedata taken together could be useful to draw a thoughtful electrophysiological approach to patients suspected of CIDP.

scholarly journals Mortality risk prediction in lupus patients complicated with invasive infection in the emergency department: LUPHAS score

2019 ◽  
Vol 11 ◽  
pp. 1759720X1988555 ◽  
Author(s):  
Wanlong Wu ◽  
Jun Ma ◽  
Yuhong Zhou ◽  
Chao Tang ◽  
Feng Zhao ◽  
...  
Keyword(s):  
Emergency Department ◽  
Prediction Model ◽  
Risk Score ◽  
Roc Curve ◽  
Curve Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Invasive Infection ◽  
Roc Curve Analysis ◽  
All Cause Mortality ◽  
Qsofa Score

Background: Infection remains a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). This study aimed to establish a clinical prediction model for the 3-month all-cause mortality of invasive infection events in patients with SLE in the emergency department. Methods: SLE patients complicated with invasive infection admitted into the emergency department were included in this study. Patient’s demographic, clinical, and laboratory characteristics on admission were retrospectively collected as baseline data and compared between the deceased and the survivors. Independent predictors were identified by multivariable logistic regression analysis. A prediction model for all-cause mortality was established and evaluated by receiver operating characteristic (ROC) curve analysis. Results: A total of 130 eligible patients were collected with a cumulative 38.5% 3-month mortality. Lymphocyte count <800/ul, urea >7.6mmol/l, maximum prednisone dose in the past ⩾60 mg/d, quick Sequential Organ Failure Assessment (qSOFA) score, and age at baseline were independent predictors for all-cause mortality (LUPHAS). In contrast, a history of hydroxychloroquine use was protective. In a combined, odds ratio-weighted LUPHAS scoring system (score 3–22), patients were categorized to three groups: low-risk (score 3–9), medium-risk (score 10–15), and high-risk (score 16–22), with mortalities of 4.9% (2/41), 45.9% (28/61), and 78.3% (18/23) respectively. ROC curve analysis indicated that a LUPHAS score could effectively predict all-cause mortality [area under the curve (AUC) = 0.86, CI 95% 0.79–0.92]. In addition, LUPHAS score performed better than the qSOFA score alone (AUC = 0.69, CI 95% 0.59–0.78), or CURB-65 score (AUC = 0.69, CI 95% 0.59–0.80) in the subgroup of lung infections ( n = 108). Conclusions: Based on a large emergency cohort of lupus patients complicated with invasive infection, the LUPHAS score was established to predict the short-term all-cause mortality, which could be a promising applicable tool for risk stratification in clinical practice.

Monocyte distribution width (MDW): a useful biomarker to improve sepsis management in Emergency Department

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Donatella Poz ◽  
Danila Crobu ◽  
Elena Sukhacheva ◽  
Marco Bruno Luigi Rocchi ◽  
Maria Chiara Anelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Area Under The Curve ◽  
Sepsis Group ◽  
Differential Analysis ◽  
Clinical Value ◽  
Sepsis Management ◽  
Distribution Width ◽  
Standard Clinical Practice

Abstract Objectives Sepsis is a time-dependent and life-threating condition. Despite several biomarkers are available, none of them is completely reliable for the diagnosis. This study aimed to evaluate the diagnostic utility of monocyte distribution width (MDW) to early detect sepsis in adult patients admitted in the Emergency Department (ED) with a five part differential analysis as part of the standard clinical practice. Methods A prospective cohort study was conducted on 985 patients aged from 18 to 96 and included in the study between November 2019 and December 2019. Enrolled subjects were classified into four groups based on sepsis-2 diagnostic criteria: control, Systemic Inflammatory Response Syndrome (SIRS), infection and sepsis. The hematology analyzer DxH 900 (Beckman Coulter Inc.) provides the new reportable parameter MDW, included in the leukocyte 5 part differential analysis, cleared by Food and Drug administration (FDA) and European Community In-Vitro-Diagnostic Medical Device (CE IVD) marked as early sepsis indicator (ESId). Results MDW was able to differentiate the sepsis group from all other groups with Area Under the Curve (AUC) of 0.849, sensitivity of 87.3% and specificity of 71.7% at cut-off of 20.1. MDW in combination with white blood cell (WBC) improves the performance for sepsis detection with a sensitivity increased up to 96.8% when at least one of the two biomarkers are abnormal, and a specificity increased up to 94.6% when both biomarkers are abnormal. Conclusions MDW can predict sepsis increasing the clinical value of Leukocyte 5 Part Differential analysis and supporting the clinical decision making in sepsis management at the admission to the ED.

scholarly journals Is There a Role for Prostate Tumour Overexpressed-1 in the Diagnosis of HGPIN and of Prostatic Adenocarcinoma? A Comparison with α-Methylacyl CoA Racemase

2012 ◽  
Vol 25 (1) ◽  
pp. 67-74 ◽  
Author(s):  
M. Scarpelli ◽  
R. Mazzucchelli ◽  
F. Barbisan ◽  
A. Santinelli ◽  
A. Lopez-Beltran ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Differential Display ◽  
Roc Curve ◽  
Intraepithelial Neoplasia ◽  
Prostatic Intraepithelial Neoplasia ◽  
Curve Analysis ◽  
High Grade ◽  
Roc Curve Analysis ◽  
Prostate Tumour

Prostate Tumour Overexpressed-1 (PTOV1) was recently identified as a novel gene and protein during a differential display screening for genes overexpressed in prostate cancer (PCa). α-Methyl-CoA racemose (AMACR) mRNA was identified as being overexpressed in PCa. PTOV1 and racemase were immunohistochemically evaluated in PCa, high-grade prostatic intraepithelial neoplasia (HGPIN), atrophy and normal-looking epithelium (NEp) in 20 radical prostatectomies (RPs) with pT2a Gleason score 6 prostate cancer with the aim of analyzing the differences in marker expression between PTOV1 and AMACR. The level of expression of PTOV1 and AMACR increased from NEp and atrophy through HGPIN, away from and adjacent to prostate cancer, to PCa. With the ROC curve analysis the overall accuracy in distinguishing PCa vs HGPIN away from and adjacent to cancer was higher for AMACR than for PTOV1. In conclusion, AMACR can be considered a more accurate marker than PTOV1 in the identification of HGPIN and of PCa. However, PTOV1 may aid in the diagnosis of PCa, at least to supplement AMACR as another positive marker of carcinoma and to potentially increase diagnostic accuracy.

scholarly journals Shear wave elastography in optic neuritis: diagnostic accuracy of the optic nerve and adjacent fat tissue values

2021 ◽  
Vol 21 (86) ◽  
pp. e194-e199
Author(s):  
Mustafa Devran Aybar ◽  
◽  
Onder Turna ◽  
Keyword(s):  
Optic Nerve ◽  
Diagnostic Accuracy ◽  
Optic Neuritis ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Curve Analysis ◽  
Fat Tissue ◽  
Roc Curve Analysis ◽  
Optic Nerves ◽  
The Mean

Introduction: In this study, we attempt to determine the diagnostic performance of shear wave elastography of the optic nerve and adjacent fat tissue in patients with optic neuritis. Methods: The study included a patient group consisting of 72 eyes of 36 patients who were diagnosed with unilateral optic neuritis, and an age-matched control group of 36 eyes of 18 healthy subjects. The patient group consisted of 25 multiple sclerosis patients and 11 recurrent isolated optic neuritis patients. The mean shear wave elastography values of the optic nerves and intraorbital fat tissue adjacent optic nerves were recorded using m/s and kPa as units. ROC curve analysis was performed, and the diagnostic accuracy of shear wave elastography values was determined. Results: The mean shear wave elastography values of the optic nerves with neuritis (2.49 ± 0.41 m/s and 17.56 ± 4.42 kPa) were significantly higher than the values of the contralateral normal optic nerves (1.71 ± 0.32 m/s and 9.02 ± 2.34 kPa) (p = 0.006 and p = 0.004, respectively) in the optic neuritis group. The mean shear wave elastography values of intraorbital fat tissue adjacent optic nerves with neuritis (1.87 ± 0.32 m/s and 9.65 ± 1.12 kPa) were significantly higher than the values of the contralateral normal side (1.47 ± 0.27 m/s and 6.78 ± 1.14 kPa) (p = 0.025 and p = 0.022, respectively) in the optic neuritis group. ROC curve analysis showed a high diagnostic accuracy for determining optic neuritis with shear wave elastography values of the optic nerves (AUC 0.955 [95% CI, 0.933–0.978] in m/s and AUC 0.967 [95% CI, 0.940–0.985] in kPa). Conclusions: Shear wave elastography may be an important alternative diagnostic tool in the diagnosis of optic neuritis.

Neurogranin as a Novel Biomarker in Alzheimer’s Disease

2020 ◽  
Author(s):  
Luisa Agnello ◽  
Caterina Maria Gambino ◽  
Bruna Lo Sasso ◽  
Giulia Bivona ◽  
Salvatore Milano ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Neurological Diseases ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Phosphorylated Tau ◽  
Roc Curve Analysis ◽  
Total Tau ◽  
Novel Biomarkers ◽  
Good Diagnostic Accuracy

Abstract Background In this study, we investigated the possible role of 2 novel biomarkers of synaptic damage, namely, neurogranin and α-synuclein, in Alzheimer disease (AD). Methods The study was performed in a cohort consisting of patients with AD and those without AD, including individuals with other neurological diseases. Cerebrospinal fluid (CSF) neurogranin and α-synuclein levels were measured by sensitive enzyme-linked immunosorbent assays (ELISAs). Results We found significantly increased levels of CSF neurogranin and α-synuclein in patients with AD than those without AD. Neurogranin was correlated with total tau (tTau) and phosphorylated tau (pTau), as well as with cognitive decline, in patients with AD. Receiver operating characteristic (ROC) curve analysis showed good diagnostic accuracy of neurogranin for AD at a cutoff point of 306 pg per mL with an area under the curve (AUC) of 0.872 and sensitivity and specificity of 84.2% and 78%, respectively. Conclusions Our findings support the use of CSF neurogranin as a biomarker of synapsis damage in patients with AD.

scholarly journals Red Blood Cell Distribution Width (RDW) Predicts COVID-19 Severity: A Prospective, Observational Study from the Cincinnati SARS-CoV-2 Emergency Department Cohort

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 618 ◽  
Author(s):  
Brandon Michael Henry ◽  
Justin Lee Benoit ◽  
Stefanie Benoit ◽  
Christina Pulvino ◽  
Brandon A. Berger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Severe Illness ◽  
Cell Distribution ◽  
Laboratory Assessment ◽  
Distribution Width ◽  
Red Blood Cell Distribution

Since previous evidence has demonstrated that red blood cell distribution width (RDW) may be a useful prognostic parameter in many critical illnesses and infectious diseases, we investigated the utility of RDW for monitoring patients with coronavirus disease 2019 (COVID-19). The study population consisted of 49 COVID-19 patients, including 16 (32.6%) with severe illness, 12 (24.5%) with severe acute kidney injury (AKI), and 8 (16.3%) requiring renal replacement therapy (RRT). The predictive value of blood tests, performed during emergency department evaluation, was then addressed. A progressive increase of RDW was observed with advancing COVID-19 severity. The area under the curve (AUC) of RDW was 0.73 for predicting severe illness, 0.80 for severe AKI, and 0.83 for RRT, respectively. In multivariate analysis, elevated RDW was associated with 9-fold and 16-fold increased odds of severe COVID-19 and AKI, respectively. The results of this study suggest that RDW should be part of routine laboratory assessment and monitoring of COVID-19.

Diagnostic accuracy of pancreatic enzymes evaluated by use of multivariate data analysis

1993 ◽  
Vol 39 (9) ◽  
pp. 1960-1965 ◽  
Author(s):  
S C Kazmierczak ◽  
P G Catrou ◽  
F Van Lente
Keyword(s):  
Neural Network ◽  
Network Analysis ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Enzyme Activities ◽  
Laboratory Tests ◽  
Curve Analysis ◽  
Multivariate Techniques ◽  
Neural Network Analysis ◽  
Roc Curve Analysis

Abstract We analyzed pancreatic enzyme data from 508 patients with suspected pancreatitis by neural network analysis, by an Expert multirule generation protocol, and by receiver-operator characteristic (ROC) curve analysis of a single test result. Neural network analysis showed that use of lipase provided the best means for diagnosing pancreatitis. Diagnostic accuracies achieved by using amylase only, lipase only, and amylase and lipase in combination were 76%, 82%, and 84%, respectively. Use of the Expert rule generation protocol provided a diagnostic accuracy of 92% when rules for single and multiple samplings were combined. ROC curve analysis for initial enzyme activities showed the maximal diagnostic accuracy to be 82% and 85% for amylase and lipase, respectively; use of peak enzyme activities yielded accuracies of 81% and 88%, respectively. The evaluation of laboratory test data should include analysis of the diagnostic accuracy of laboratory tests by multivariate techniques such as neural network analysis or an Expert systems approach. Multivariate analysis should allow for a more realistic assessment of the diagnosis accuracy of laboratory tests because all the available data are included in the evaluation.

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