Multivariable prediction model for predicting deaths in severe dengue cases

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.

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Multivariable prediction model for predicting deaths in severe dengue cases

10.21203/rs.2.9960/v1 ◽

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 ◽

Laboratory Data ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Serum Lactate ◽

Mortality Prediction ◽

Severe Dengue

Abstract Background Many predictive models have been developed to predict an outbreak, identify and stratify dengue but none in predicting mortality 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 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 was 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, BMI, respiratory rate, platelet count, AST, serum bicarbonate, serum lactate and serum albumin. The AUROC 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 mortality 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 and found that a large majority of patients developed severe dengue during febrile phase.

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A lung ultrasound score for early triage of elderly patients with acute dyspnea

CJEM ◽

10.1017/cem.2018.483 ◽

2019 ◽

Vol 21 (3) ◽

pp. 399-405 ◽

Cited By ~ 6

Author(s):

Thibaut Markarian ◽

Laurent Zieleskiewicz ◽

Gilles Perrin ◽

Pierre-Géraud Claret ◽

Anderson Loundou ◽

...

Keyword(s):

Elderly Patients ◽

Likelihood Ratio ◽

Predictive Value ◽

Lung Ultrasound ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Care Group ◽

Acute Dyspnea ◽

Ultrasound Score

ABSTRACTObjectivesLung ultrasound has value in diagnosing dyspnea. The main objective of this study was to evaluate the accuracy of a modified lung ultrasound (MLUS) score to predict the severity of acute dyspnea in elderly patients.MethodsThis was an observational single-centre study including patients over age 64 admitted to the emergency department for acute dyspnea with hypoxia. Participants had an early lung ultrasound performed by a dedicated emergency physician, followed by the usual care by a team blinded to the lung ultrasound results. Patients were allocated by disposition to either a critical care (CC) group (patients who needed admission to the intensive care unit [ICU] and/or who died within 48 h) or a standard care group.ResultsAmong 137 patients analysed (mean age 79 ± 13 years, 74 [54%] women), 43 (31%) were categorized into the CC group. The time taken to obtain the MLUS was 30 ± 22 min. The area under the receiver operating characteristic curve of the MLUS for predicting the CC group was 0.97 (0.92–0.99; p < 0.01) with a cut-off set strictly above 17 for 93% sensitivity (81–99), 99% specificity (94–100), a positive predictive value of 98% (87–100), a negative predictive value of 97% (91–99), a positive likelihood ratio of 86, a negative likelihood ratio of 0.07, and a diagnostic accuracy of 97% (93–99). In a multivariate analysis, the MLUS was the only independent associated factor for the CC group.ConclusionAn early lung ultrasound score can predict the need for ICU admission and/or death within 48 hours in elderly dyspneic patients.

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Ultrasound elastography: a novel tool for the differential diagnosis of pleural effusion

European Respiratory Journal ◽

10.1183/13993003.02018-2018 ◽

2019 ◽

Vol 54 (2) ◽

pp. 1802018 ◽

Cited By ~ 5

Author(s):

Bin Jiang ◽

Xue-lian Li ◽

Yan Yin ◽

Qin Zhang ◽

Tong Zang ◽

...

Keyword(s):

Pleural Effusion ◽

Likelihood Ratio ◽

Predictive Value ◽

Malignant Disease ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Ultrasound Elastography ◽

The Mean ◽

Validation Set

IntroductionTraditional thoracic ultrasound (TUS) is often the initial tool used to help diagnose malignant pleural effusion (MPE). Ultrasound elastography, a relatively new technique, has been used to differentiate malignant disease from benign disease by evaluating tissue “stiffness”. However, no studies evaluating the efficacy of ultrasound elastography for diagnosing MPE are available. We assessed the value of ultrasound elsatography for diagnosing MPE prospectively.MethodsAll 244 enrolled patients were divided into a development set and a validation set in chronological order. The cut-off elasticity index was established using a receiver operating characteristic curve constructed from the continuous data of the patients in the development set. The diagnostic performance of ultrasound elastography was compared with that of TUS in the validation set.ResultsIn the development set, the mean elasticity index (47.25 kPa) was the optimal cut-off. In the validation set, pleural ultrasound elastography had a sensitivity of 83.64%, a specificity of 90.67%, a positive predictive value of 86.79%, a negative predictive value of 88.31%, a positive likelihood ratio of 8.96 and a negative likelihood ratio of 0.18 for diagnosing MPE. The sensitivity of ultrasound elastography was significantly higher (p=0.006) than that of TUS (60%).ConclusionPleural ultrasound elastography is a better technique than TUS for differentiating MPE from benign pleural disease.

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

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009869 ◽

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.

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Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis

International Journal of Reproductive BioMedicine ◽

10.18502/ijrm.v13i6.7281 ◽

2020 ◽

Author(s):

Zahra Hadizadeh-Talasaz ◽

Ali Taghipour ◽

Seyede Houra Mousavi-Vahed ◽

Robab Latifnejad Roudsari

Keyword(s):

Systematic Review ◽

Likelihood Ratio ◽

Plasma Protein ◽

Predictive Value ◽

Meta Analysis ◽

Protein A ◽

Fetal Loss ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Forest Plot

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein- A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44- 5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required. Key words: Pregnancy-associated plasma protein-A, Fetal loss, Pregnancy, Systematic review.

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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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