scholarly journals Predictive value of cerebrospinal fluid lactate for the diagnosis and treatment efficacy of post-neurosurgery bacterial meningitis

2019 ◽  
Author(s):  
Yufang Wang ◽  
Jingchao Li ◽  
Mingli Yao ◽  
Lingyan Wang ◽  
Bin Ouyang
Keyword(s):  
Cerebrospinal Fluid ◽  
Linear Regression ◽  
Bacterial Meningitis ◽  
Roc Curve ◽  
Predictive Value ◽  
Treatment Efficacy ◽  
Curve Analysis ◽  
Diagnosis And Treatment ◽  
Roc Curve Analysis ◽  
Csf Lactate

Abstract Background: Post-neurosurgical bacterial meningitis (PNBM) is a severe complication with high morbidity and mortality. Rapid and accurate diagnosis of PNBM is difficult. Therefore, it is necessary to find more reliable markers to assist the diagnosis. This study aims to evaluate the predictive value of cerebrospinal fluid (CSF) lactate for PNBM diagnosis and treatment efficacy.Methods: Total 105 cases were enrolled in patients with clinically suspected PNBM who underwent neurosurgeries during October 2015 to December 2016. CSF lactate as well as CSF routine and biochemistry test was measured. Receivers operating characteristic (ROC) curve analysis was used to evaluate the diagnostie power of CSF lactate for PNBM. To assess the predictive value of CSF lactate for treatment efficacy, a linear regression was used and tendency diagrams of CSF lactate and glucose for each patient were drawn.Results: Fifty-four of 105 patients were diagnosed with PNBM. CSF lactate level was significantly higher in PNBM than in non-PNBM patients (p < 0.001). The ROC curve analysis showed a great diagnostic power of CSF lactate for PNBM, and the cut-off value was 4.15 mmol/L (AUC = 0.92, sensitivity, 92.6%; specificity, 74.5%). The combination of CSF lactate and glucose showed better diagnostic efficacy (AUC = 0.97, sensitivity, 94.4%; specificity, 90.2%). The linear regression showed thatΔCSF lactate inversely correlated with ΔCSF glucose and directly correlated with ΔCSF leucocyte (both p < 0.001). The tendency diagrams showed CSF lactate a better predictor for PNBM treatment efficacy than CSF glucose.Conclusion: Our study showed CSF lactate had an excellent discriminatory power in distinguishing between PNBM and non-PNBM. The combination of CSF lactate and glucose had a better diagnostic accuracy than other CSF parameters alone. CSF lactate was a reliable predictor of treatment efficacy in PNBM patients.

scholarly journals Combine preoperative estimation of serum thyroglobulin and ACR-thyroid imaging reporting and data system scoring could accurately define malignant thyroid nodules

2020 ◽  
Vol 8 (1) ◽  
pp. 32
Author(s):  
Waseem A. Shoda
Keyword(s):  
Roc Curve ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Curve Analysis ◽  
Data System ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Serum Thyroglobulin ◽  
Thyroid Imaging ◽  
Significant Difference

Background: Evaluation of diagnostic ability of preoperative estimation of serum thyroglobulin (TG) to detect malignant thyroid nodules (TN) in comparison to the American College of Radiology, Thyroid imaging reporting and data system (ACR-TIRADS), fine needle aspiration cytology (FNAC) and intraoperative frozen section (IO-FS).Methods: 34 patients with ACR-TIRADS 2-4 TN were evaluated preoperatively for identification of malignancy and all underwent total thyroidectomy with bilateral neck block dissection if indicated. Results of preoperative investigations were statistically analyzed using the Receiver operating characteristics (ROC) curve analysis as predictors for malignancy in comparison to postoperative paraffin sections.Results: Preoperative serum TG levels had 100% sensitivity and negative predictive value, while ACR-TIRADS scoring had 100% specificity and positive predictive value with accuracy rates of 95.35% and 97.67% for TG and TIRADS, respectively. ROC curve analysis defined preoperative ACR-TIRADS class and serum TG as highly diagnostic than FNAC for defining malignancy with non-significant difference between areas under curve for TIRADS and TG. For cases had intermediate risk of malignancy on TIRADS, IO-FS had missed 3, FNAC missed 4, while serum TG levels were very high in the 13 cases and were defined by ROC curve as the only significant predictor for malignancy.Conclusions: Preoperative estimation of serum TG showed higher diagnostic validity than FNAC, high predictability of cancer and ability to verify the intermediate findings on TIRADS. Combined preoperative TIRADS and TG estimation could accurately discriminate malignant TN with high accuracy and spare the need for preoperative FNAC or IO-FS. 

scholarly journals P204 Re-established CRP cut-off in UC; it may be a better predictor of mucosal remission

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S240-S240
Author(s):  
O K Bakkaloglu ◽  
T Eskazan ◽  
S Bozcan ◽  
S Yıldırım ◽  
E A Kurt ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Positive Predictive Value ◽  
Roc Curve ◽  
Predictive Value ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Predictive Values ◽  
Mucosal Disease ◽  
Mayo Score ◽  
Montreal Classification

Abstract Background Although faecal calprotectin can predict mucosal remission in ulcerative colitis, the CRP level in this context is insufficient and frequently stay under the current cut off level. While some patients with active mucosal disease have normal CRP levels most patients in mucosal remission have much lower CRP levels. The aim of this study is to define CRP cut off levels in the prediction of mucosal remission, considering both extensiveness and severity, in ulcerative colitis. Methods We retrospectively reviewed colonoscopy reports of ulcerative colitis patients (who are not on any steroid treatment at that time) which were performed between December 2016 and March 2019 and also their CRP levels which were obtained at the same week of the colonoscopy examination. We excluded the data of patients with any other possible cause of inflammation or infection at the time of laboratory assessment. Degree of mucosal disease at colonoscopy was evaluated according to endoscopic Mayo score. Mucosal remission was defined as endoscopic Mayo score 0 or 1. The extent of mucosal inflammation was classified according to Montreal classification. The CRP level with optimal sensitivity and specificity for mucosal remission prediction was assessed by ROC curve analysis and positive and negative predictive values were also calculated. Results A total of 331 colonoscopy reports of 260 patients (122 m, 138 f) were involved in this study. There were no significant differences between ages of patients when compared with ex, and Montreal classification and we did not find any correlation between age and CRP levels. Sensitivity, specificity, positive predictive value and negative predictive values for 5 mg/l, 3 mg /l and 2 mg/l are summarised in Table 1. CRP levels which predict Mayo 0 disease, mucosal remission (Mayo 0–1) and Mayo 3 disease are shown in Table 2. At the ROC curve analysis, we found that CRP level of approximately 2.9 mg/l can predict mucosal remission with a 77% sensitivity and % 80 specificity in all examinations without grouping into a separate segmental disease. For subgroups with Montreal E1, E2 and E3 ROC curve analysis suggested 1,8 mg/l (sn. 84%, sp. 90%), 2,7 mg/l (sn. 75%, sp. 75%) and 3 mg/l (sn. 80%, sp. 80%) CRP levels can be used for prediction of mucosal remission respectively (Table 3). It is important to emphasise that 30% of all patients with Mayo 3 colonoscopy and further 23% of patients with Montreal E3–Mayo 3 activity have CRP levels below the regular cut-off value of 5 mg/l. Conclusion CRP cut-off level of approximately 2.9 mg/l can predict mucosal remission in ulcerative colitis better than standard cut-off of 5 mg/l which has a low positive predictive value and specificity even at extended and active mucosal disease.

scholarly journals Predictive value of plasma parameters in the risk of postpartum ketosis in dairy cows

2017 ◽  
Vol 61 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Yu Cao ◽  
Jiang Zhang ◽  
Wei Yang ◽  
Cheng Xia ◽  
Hong-You Zhang ◽  
...  
Keyword(s):  
Dairy Cows ◽  
Roc Curve ◽  
Predictive Value ◽  
Curve Analysis ◽  
Paraoxonase 1 ◽  
Roc Curve Analysis ◽  
Plasma Parameters ◽  
Holstein Friesian ◽  
Plasma Activity ◽  
Friesian Cows

AbstractIntroduction:The predictive value of selected parameters in the risk of ketosis and fatty liver in dairy cows was determined.Material and Methods:In total, 21 control and 17 ketotic Holstein Friesian cows with a β-hydroxybutyrate (BHBA) concentration of 1.20 mmol/L as a cut-off point were selected. The risk prediction thresholds for ketosis were determined by receiver operating characteristic (ROC) curve analysis.Results:In the ketosis group, paraoxonase-1 (PON-1) activity and concentration of PON-1 and glucose (GLU) were decreased, and aminotransferase (AST) activity as well as BHBA and non-esterified fatty acid (NEFA) contents were increased. The plasma activity and concentration of PON-1 were significantly positively correlated with the level of plasma GLU. The plasma activity and concentration of PON-1 were significantly negatively correlated with the levels of AST and BHBA. According to ROC curve analysis, warning indexes of ketosis were: plasma PON-1 concentration of 46.79 nmol/L, GLU concentration of 3.04 mmol/L, AST concentration of 100 U/L, and NEFA concentration of 0.82 mmol/L.Conclusion:This study showed that the levels of PON-1, GLU, AST, and NEFA could be used as indicators to predict the risk of ketosis in dairy cows.

Abstract 12875: Serum Neutrophil Gelatinase-associated Lipocalin Has a Predictive Value for the Neurological Outcome of Post Cardiac Arrest Victims

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tadashi Kaneko ◽  
Motoki Fujita ◽  
Yasuaki Ogino ◽  
Hiroki Irie ◽  
Shinsuke Iwashita ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Roc Curve ◽  
Predictive Value ◽  
Neurological Outcome ◽  
Neuron Specific Enolase ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Significant Difference ◽  
Neutrophil Gelatinase

Introduction: Neutrophil gelatinase-associated lopocalin (NGAL) is well known as the biomarker of acute kidney injury. Currently, serum NGAL is reported as the biomarker which is associated with mortality and multiple organ dysfunction syndrome in septic patients. In this study, we measured serum NGAL in post cardiac arrest syndrome (PCAS) patients to investigate the predictive value of neurological outcome. Hypothesis: Serum NGAL is associated with favorable neurological outcome of PCAS patients. Methods: 43 cases of PCAS patients were measured serum NGAL on day 1 and 2, and serum neuron specific enolase (NSE) was also measured on day 2. Patients were divided into two group (group G: CPC 1-2 and group P: CPC 3-5, CPC: cerebral performance categories). Serum NGAL and NSE were compared between group G and P. Receiver operation characteristic (ROC) curve analysis were performed of both NGAL and NSE. Results: Group G (n = 20) and P (n = 23) were analyzed. Serum NGAL showed significant difference in day 2 (G: 282±116 ng/mL v.s. P: 299±87 ng/mL in day1: P = 0.609, G: 185±124 ng/mL v.s. P: 353±110 ng/mL in day 2: P<0.001). The ROC curve analysis showed area under the curve of NGAL in day 2 was 0.871, and the area of NSE in day2 showed 0.918. Conclusions: Serum NGAL in PCAS patients had the predictive value for neurological outcome which is comparable to serum NSE. (This study was supported by grants from Japanese Ministry of Health, Labour and Welfare: No. 25462824)

scholarly journals Predictive Value of Cerebrospinal Fluid Lactate Level for the Diagnosis of Bacterial Meningitis following Cranial Surgery

2021 ◽  
Vol 18 (4) ◽  
pp. 12-18
Author(s):  
Ashok Kharel ◽  
Gopal Sedain ◽  
Sushil krishna Shilpakar ◽  
Mohan Raj Sharma
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Aseptic Meningitis ◽  
Predictive Value ◽  
Lactate Level ◽  
Clinical Suspicion ◽  
Receiver Operating Curve ◽  
Prospective Clinical Study ◽  
Cranial Surgery ◽  
Csf Lactate

Background:To distinguish post-neurosurgical bacterial meningitis (PNBM) from aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker. Objective:To determine the value of cerebrospinal fluid (CSF) lactate level for the identification of bacterial meningitis following cranial surgery. Methods:Between January 2016 and December 2016, a prospective clinical study was done in Department of Neurosurgery, in which all patients with clinical suspicion of PNBM were enrolled. Patients with clinical suspicion of bacterial meningitis BM were categorized, according to preset criteria, into 3 groups: (1) proven BM; (2) presumed BM, and (3) nonbacterial meningeal syndrome. CSF markers were plotted in a receiver operating curve (ROC) to evaluate their diagnostic accuracy. Results:The study included 70 patients. We obtained 65 CSF samples from patients with clinical suspicion of BM by CSF analysis. 20 corresponded to proven BM, 7 to probable BM and 38 to excluded BM. Mean lactate in CSF was: 8.4 ±3.0 mmol /l for proven BM, 4.8 ± 0.99 mmol /l for probable BM and 2.08 ± 0.822 mmol/l for excluded BM (P < .001). Conclusion: CSF lactate level has good predictive value to distinguish BM from aseptic meningitis with sensitivity of 90% and specificity: 87% at cut-off value: 4.0 mmol/l.

scholarly journals The Plasma Level of Leukemia Stem Cell Specific Antigens - CLL1 and TIM3 Are Predictive of Overall Survival in Acute Myeloid Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1407-1407
Author(s):  
Chin-Hin Ng ◽  
Ma Thin Mar Win ◽  
Elaine Seah ◽  
Wee-Joo J Chng
Keyword(s):  
Overall Survival ◽  
Complete Remission ◽  
Roc Curve ◽  
Predictive Value ◽  
Function Analysis ◽  
Survival Function ◽  
Survival Outcome ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Cox Regression Analysis

Abstract Background: Despite intensive chemotherapy, acute myeloid leukemia (AML) is still associated with significant relapse rate. This was thought to be due to a sub clone of leukemic blasts that was resistant to chemotherapy. This sub clone of resistant blasts were later identified to be leukemic stem cell (LSC). Many studies have demonstrated that high initial load of LSC at diagnosis was associated with relapse and poor overall outcome. This study aimed to use a clinically practical method - ELISA to identify plasma biomarkers that are closely related to LSC and study their predictive value in term of complete remission (CR), relapse, and overall survival. Method: Peripheral blood of 27 newly diagnosed AML patients were collected at diagnosis. Plasma component of the blood was separate from cellular component using Ficoll separation method. 9 biomarkers were shortlisted based on surface antigens of LSC that were commonly reported in literature as well as genes that were reported to be highly expressed in LSC. These are CD25, CD32, CD96, CD123, TIM3, CLL-1, HCK, FLT3 and WT1. Commercially available ELISA kits with high sensitivity and specificity to these 9 human biomarkers were sourced. All 9 biomarkers were measured on 80 normal blood donors' plasma to use as control and to establish the normal range (Mean+/-2SD). The plasma of the 27 study subjects was measured in duplicate for all 9 biomarkers. ROC curve analysis was done in relation to complete remission, relapse, and survival outcome on all 9 candidates biomarkers. Results: A total 27 newly diagnosed AML patients with curative intent were included in this analysis. Median age for this cohort was 41 years old (range: 22-70). Induction death rate 14.8% (n=4), and complete remission (CR) rate of 77.8%. A total of 8 relapsed refractory cases and 6 deaths were observed over the median follow-up of 10.2 months (range: 0.6-31.2). ROC curve analysis was carried out on all 9 candidates plasma biomarkers, CLL-1 and TIM3 came out to be of significant predictive value of survival outcome. No biomarker was found to be predictive of relapse or CR. ROC curve analysis of plasma CLL-1 level in relation to survival outcome showed an AUC of 0.77 with a plasma cut-off level of 54pg/ml giving the best discriminative result. Chi-square test using this cut off level for survival outcome showed a better survival in patients with plasma CLL-1 level of <54pg/ml (p= 0.001). This cut-off level gave a sensitivity of 83.3% and a specificity of 85.7%, with a high negative predictive value (NPV) of 94.7% but moderate positive predictive value (PPV) of 62.5%. Using this cut-off level to predict CR also showed a significant result (50% CR rate for those with plasma CLL-1 of >54 pg/ml compared to 89.5% in patients with <54pg/ml, p=0.024). Survival function analysis using this cut-off level showed a significantly prolonged survival in patients with plasma CLL-1 level of <54pg/ml with mean survival of 29.63 months (95%CI: 26.70-32.56) as compared to those with plasma CLL-1 level of >54pg/ml (Mean survival: 8.1 months, 95%CI:3.2-13.0). Cox-regression analysis on overall survival showed a significantly high Hazard Ratio of 18.3 for plasma CLL-1 level >54pg/ml (p=0.09, 95%CI:2.09-160.2), see the figure 1 below. ROC curve analysis of plasma TIM3 level in relation to survival outcome revealed an AUC of 0.73 with a plasma cut-off level of 615pg/ml to be the best discriminative cut-off. Chi-square test using this cut-off level for survival outcome showed significant better survival in patients with plasma TIM3 level of <615pg/ml (p=0.016). This cut-off level gave a sensitivity of 83.3% and a specificity of 71.43% with high NPV of 93.75% but a rather low PPV of 45.45%. Survival function analysis again confirmed a much longer mean survival in patients with plasma TIM3 level of <615pg/ml (Mean survival: 29.2 months, 95%CI:25.5-32.9) as compared to TIM3 level of >615pg/ml (Mean survival: 13.8 months, 95%CI:7.2-20.4), p=0.014. Cox-regression analysis again showed a significant Hazard Ratio of 9.2 for plasma TIM3 level of >615pg/ml (p=0.043, 95%CI:1.01-78.7), see figure 2 below. Conclusion: A raised plasma CLL-1 level of more than 54pg/ml and TIM3 level of more than 615pg/ml were predictive of survival outcome in this small cohort of AML patients who underwent curative chemotherapy. A larger cohort of AML patients would be needed to confirm this novel finding. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document