Glaucoma Diagnostic Performance of Macular Ganglion Cell Complex Thickness Using Regular and Long Axial Length Normative Databases

Abstract The risks of misdiagnosing a healthy individual as glaucomatous or vice versa may be high in a population with a large majority of highly myopic individuals, due to considerable morphologic variability in high myopic fundus. This study aims to compare the diagnostic ability of the regular and long axial length databases in the RS-3000 Advance SD-OCT (Nidek) device to correctly diagnose glaucoma with high myopia. Patients with high myopia (axial length ≥ 26.0 mm) in Chang Gung Memorial Hospital, Taiwan between 2015 and 2020 were included. Glaucoma was diagnosed based on glaucomatous discs, visual field defects and corresponding retinal nerve fiber layer defects. The sensitivity, specificity, diagnostic accuracy and likelihood ratios of diagnosing glaucoma via mGCC thickness in both superior/inferior and GChart mapping using the regular and long axial length normative databases. The specificity and diagnostic accuracy of mGCC thickness for distinguishing glaucomatous eyes from nonglaucomatous eyes among highly myopic eyes were significantly improved using the long axial length database (p=0.046). There were also significant proportion changes in S/I mapping as well as GChart mapping (37.3% and 48.0%, respectively; p<0.01) from abnormal to normal in the myopic normal eye group when using the long axial length normative database. The study revealed that clinicians could utilize a long axial length database to effectively decrease the number of false-positive diagnoses or to correctly identify highly myopic normal eyes misdiagnosed as glaucomatous eyes.

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Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Language Speech and Hearing Services in Schools ◽

10.1044/2020_lshss-20-00043 ◽

2020 ◽

pp. 1-15

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider ◽

William Harrison

Keyword(s):

Diagnostic Accuracy ◽

Psychometric Properties ◽

Language Impairment ◽

Reference Data ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Criterion Validity ◽

Likelihood Ratios ◽

Generation Task ◽

Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

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Differentiating School-Aged Children With and Without Language Impairment Using Tense and Grammaticality Measures From a Narrative Task

Journal of Speech Language and Hearing Research ◽

10.1044/2015_jslhr-l-15-0066 ◽

2016 ◽

Vol 59 (2) ◽

pp. 317-329 ◽

Cited By ~ 21

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider

Keyword(s):

Language Development ◽

Diagnostic Accuracy ◽

Language Impairment ◽

Likelihood Ratios ◽

Verb Morphology ◽

Story Generation ◽

School Aged Children ◽

Sensitive Tool ◽

Good Diagnostic Accuracy ◽

Sensitivity Specificity

Purpose To determine the diagnostic accuracy of the finite verb morphology composite (FVMC), number of errors per C-unit (Errors/CU), and percent grammatical C-units (PGCUs) in differentiating school-aged children with language impairment (LI) and those with typical language development (TL). Method Participants were 61 six-year-olds (50 TL, 11 LI) and 67 eight-year-olds (50 TL, 17 LI). Narrative samples were collected using a story-generation format. FVMC, Errors/CU, and PGCUs were computed from the samples. Results All of the three measures showed acceptable to good diagnostic accuracy at age 6, but only PGCUs showed acceptable diagnostic accuracy at age 8 when sensitivity, specificity, and likelihood ratios were considered. Conclusion FVMC, Errors/CU, and PGCUs can all be used in combination with other tools to identify school-aged children with LI. However, FVMC and Errors/CU may be an appropriate diagnostic tool up to age 6. PGCUs, in contrast, may be a sensitive tool for identifying children with LI at least up to age 8 years.

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Effects of SMILE Surgery on Intraocular Pressure, Central Corneal Thickness, Axial Length, Peripapillary Retinal Nerve Fiber Layer, and Macular Ganglion Cell Complex Thickness

Journal of Ophthalmology ◽

10.1155/2020/4934196 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Zhanlin Zhao ◽

Sylvain Michée ◽

Jean-François Faure ◽

Christophe Baudouin ◽

Antoine Labbé

Keyword(s):

Intraocular Pressure ◽

Ganglion Cell ◽

Nerve Fiber ◽

Axial Length ◽

Central Corneal Thickness ◽

Corneal Thickness ◽

Ganglion Cell Complex ◽

Fiber Layer ◽

Rnfl Thickness ◽

The Mean

Purpose. To evaluate the change in intraocular pressure (IOP), central corneal thickness (CCT), axial length, peripapillary retinal nerve fiber layer (RNFL) thickness, and macular ganglion cell complex (GCC) thickness after small incision lenticule extraction (SMILE) surgery. Methods. This prospective observational study was conducted in Espace Nouvelle Vision, Ophthalmological Clinic, Paris, France. Fifty eyes of 25 patients were enrolled in this study and underwent SMILE surgeries. IOP, central corneal thickness (CCT), axial length (AL), peripapillary RNFL thickness, and macular GCC thickness were measured before and at 3 months after SMILE. Results. The mean preoperative spherical equivalent was −3.15 ± 1.50 diopters (D), and the mean postoperative value was 0.15 ± 0.28 D. After SMILE surgery, IOP decreased from 15.03 ± 2.79 mmHg to 11.02 ± 2.73 mmHg and 10.02 ± 2.21 mmHg at 1 and 3 months, respectively ( P < 0.01 for both comparisons). The mean decrease in measured IOP as a function of ablation depth was 0.065 ± 0.031 mmHg/μm. CCT decreased from 545.98 ± 26.61 μm to 478.40 ± 30.26 μm after SMILE surgery ( P < 0.01 ). AL decreased from 24.80 ± 0.84 mm to 24.70 ± 0.83 mm ( P < 0.01 ). There was no statistically significant change in mean peripapillary RNFL or mean GCC thickness after SMILE surgery. Conclusions. SMILE surgery modified IOP measurement, CCT, and AL but did not change peripapillary RNFL and macular GCC thicknesses. The postoperative drop in measured IOP might be explained by the decreased CCT. An accurate re-evaluation of AL should be performed before cataract surgery among post-SMILE patients.

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Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department

BMJ Open ◽

10.1136/bmjopen-2021-048795 ◽

2021 ◽

Vol 11 (9) ◽

pp. e048795

Author(s):

Bram Kok ◽

Frederik Schuit ◽

Arthur Lieveld ◽

Kaoutar Azijli ◽

Prabath WB Nanayakkara ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Diagnostic Accuracy ◽

Prospective Observational Study ◽

Lung Ultrasound ◽

Final Diagnosis ◽

Likelihood Ratios ◽

Reverse Transcription Pcr ◽

Registration Number ◽

Sensitivity Specificity

BackgroundBedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy.DesignA multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED.Setting/patientsAdult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR.MeasurementsWe assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard.ResultsBetween 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16.ConclusionIdentifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement.Trial registration numberNL8497.

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Macula structural and vascular differences in glaucoma eyes with and without high axial myopia

10.1101/2021.09.02.21263045 ◽

2021 ◽

Author(s):

Jasmin Rezapour ◽

Christopher Bowd ◽

Jade Dohleman ◽

Akram Belghith ◽

James A. Proudfoot ◽

...

Keyword(s):

Ganglion Cell ◽

Axial Length ◽

Plexiform Layer ◽

Positive Association ◽

Mean Deviation ◽

Ganglion Cell Complex ◽

Inner Plexiform Layer ◽

Fiber Layer ◽

Cross Sectional ◽

Axial Myopia

AbstractAimsTo assess the thickness of various retinal layers, and the superficial vessel density (sVD) in the macula of glaucomatous eyes and their associations with axial length (AL) and visual field mean deviation (VFMD) to identify parameters useful for glaucoma management in myopic eyes.Methods248 glaucoma patients (401 eyes) participating in the Diagnostic Innovations in Glaucoma Study observational cohort representing 3 axial myopia groups (non-myopia: n=146 eyes; mild myopia: n=208 eyes; high myopia (AL>26 mm): n=47 eyes) who completed macular OCT and OCT-Angiography imaging were included. The cross-sectional associations of AL and VFMD with the thickness of the ganglion cell inner plexiform layer (GCIPL), macular retinal nerve fiber layer (mRNFL), ganglion cell complex (GCC), sVD and macular choroidal thickness (mCT) were evaluated.ResultsThinner Global GCIPL and GCC were significantly associated with worse VFMD (R2=35.1%; and R2=33.4%; respectively p<0.001), but not with AL (all p>0.350). Thicker mRNFL showed a weak association with increasing AL (R2=3.4%; p=0.001) and a positive association with VFMD (global R2=20.5%; p<0.001). Lower sVD was weakly associated with increasing AL (R2=2.3%; p=0.016) and more strongly associated with more severe glaucoma VFMD (R2=31.8%; p<0.001). Thinner mCT was associated with increasing AL (R2=17.3% p<0.001) and not associated with VFMD (P=0.262). mRNFL was thickest while mCT was thinnest in all sectors of high myopic eyes.ConclusionsGCIPL and GCC thinned with increasing severity of glaucoma but were not significantly associated with axial length. GCIPL and GCC thickness may be useful clinical parameters to identify glaucoma in myopic eyes.

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Diagnostic Value of Autoantibodies in Lung Cancer: a Systematic Review and Meta-Analysis

Cellular Physiology and Biochemistry ◽

10.1159/000495935 ◽

2018 ◽

Vol 51 (6) ◽

pp. 2631-2646 ◽

Cited By ~ 7

Author(s):

Jiangyue Qin ◽

Ni Zeng ◽

Ting Yang ◽

Chun Wan ◽

Lei Chen ◽

...

Keyword(s):

Lung Cancer ◽

Diagnostic Accuracy ◽

Test Performance ◽

Meta Analysis ◽

Cyclin B1 ◽

Diagnostic Value ◽

Likelihood Ratios ◽

Summary Receiver Operating Characteristic ◽

Mixed Effect ◽

Sensitivity Specificity

Background/Aims: Recently, many studies have demonstrated that various tumor-associated autoantibodies have been detected in early stages of lung cancer. Therefore, we conducted a meta-analysis to comprehensively evaluate available evidence on the diagnostic value of autoantibodies against tumor-associated antigens in lung cancer. Methods: We systematically searched PubMed, Scopus, Web of Science and other databases through 23 March 2018. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. We used the bivariate mixed-effect models to calculate pooled values of sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratios and associated 95% confidence intervals. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. Deek’s funnel plot was used to detect publication bias. Results: Review of 468 candidate articles identified fifty-three articles with a total of 11,515 patients for qualitative review and meta-analysis. Pooled sensitivity, specificity and area under the SROC curve were as follows for tumor-associated autoantibodies against the following proteins: p53, 0.19, 0.98, 0.82; NY-ESO-1, 0.17, 0.98, 0.90; Survivin, 0.19, 0.99, 0.96; c-myc, 0.14, 0.98, 0.45; Cyclin B1, 0.18, 0.98, 0.91; GBU4-5, 0.07, 0.98, 0.91; CAGE, 0.14, 0.98, 0.90; p16, 0.08, 0.97, 0.91; SOX2, 0.14, 0.99, 0.93; and HuD, 0.17, 0.99, 0.82. Conclusion: Each tumor-associated autoantibody on its own showed excellent diagnostic specificity for lung cancer but inadequate sensitivity. Our results suggest that combinations or panels of tumor-associated autoantibodies may provide better sensitivity for diagnosing lung cancer, and the diagnostic accuracy of tumor-associated autoantibodies should be validated in more studies.

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Evaluation of a cryptococcal antigen lateral flow assay test for rapid detection of cryptococcal infection in HIV-negative patients in Ibadan, Nigeria

African Journal of Clinical and Experimental Microbiology ◽

10.4314/ajcem.v22i1.12 ◽

2021 ◽

Vol 22 (1) ◽

pp. 93-96

Author(s):

S.A. Fayemiwo ◽

O.B. Makanjuola ◽

J. Nwaokenye ◽

M.O. Owolabi

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Lateral Flow ◽

Lateral Flow Assay ◽

Likelihood Ratios ◽

Cryptococcal Antigen ◽

Cryptococcal Infection ◽

Test Kit ◽

Sensitivity Specificity ◽

Hiv Negative

Background: A number of studies have been conducted in Nigeria on the prevalence of cryptococcal infections mostly on HIV-infected patients using culture, India ink and/or latex agglutination tests. These tests are either laborious, time-consuming and expensive or have low sensitivity, thus limiting their use. Cryptococcal antigen lateral flow assays (LFA) were introduced in the last decade as rapid user-friendly tests for diagnosis. In this study, we sought to determine the diagnostic accuracy of an LFA kit for the detection of cryptococcal antigen in the serum of HIV-negative patients with or without cerebrovascular accident (CVA) or stroke in University College Hospital, Ibadan, Nigeria.Methodology: The diagnostic accuracy of Dynamiker CrAg LFA was tested against BiosynexR CryptoPS on serum samples of 100 HIV-negative patients with and without stroke. Samples were tested and results interpreted in accordance with the manufacturer’s instructions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios of the Dynamiker CrAg LFA were calculated by comparing with the BiosynexR CryptoPS as ‘gold standard’.Results: Overall, a total of 98 valid patient sample results were analysed; 17 samples (17.3%) were positive with Dynamiker CrAg LFA cryptococcal antigen and 16 samples (16.3%) were positive with BiosynexR CryptoPS. The sensitivity, specificity, PPV and NPV of Dynamiker CrAg LFA compared to the BiosynexR CryptoPS were 100%, 98.8%, 94.1% and 100% respectively, while the positive and negative likelihood ratios were 82 and 0 respectively.Conclusion: In comparison to the BiosynexR CryptoPS, the Dynamiker CrAg LFA is a highly sensitive and specific test for the detection of cryptococcal antigen in serum. The test kit should be considered as a screening device for cryptococcal infection both in outreach and clinical settings, especially in antiretroviral therapy (ART) centres. Keywords: Cryptococcus; evaluation; lateral flow assay; HIV-negative; stroke

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A Neural Network Based Retinal Nerve Fiber Layer Profile Compensation for Glaucoma Diagnosis in Myopia (Preprint)

10.2196/preprints.22664 ◽

2020 ◽

Author(s):

Lei Li ◽

Haogang Zhu ◽

Zhenyu Zhang ◽

Liang Zhao ◽

Liang Xu ◽

...

Keyword(s):

Neural Network ◽

Nerve Fiber ◽

Retinal Nerve Fiber Layer ◽

Axial Length ◽

High Myopia ◽

Fiber Layer ◽

Nerve Fiber Layer ◽

Biometric Parameters ◽

Glaucoma Diagnosis ◽

Retinal Nerve Fiber

BACKGROUND Myopia, especially high myopia is a major risk factor for the presence of glaucoma. Due to the axial elongation-associated changes in the optic nerve and retina in high myopia, traditional methods like optic disc evaluation and visual field were not able to correctly differentiate the glaucomatous lesions. It has been a clinical emphasis and challenge to detect glaucoma in highly myopic eyes. Previous studies have shown that the distribution of retinal nerve fiber layer (RNFL) depended on axial length and other morphologic parameters. It was assumed that a neural network can transform the RNFL profile and make it thus comparable in eyes with varied axial length, thus improve the diagnosis of glaucoma with special emphasis on myopic and highly myopic eyes. OBJECTIVE To develop a neural network for adjusting the dependence of the peripapillary RNFL thickness (RNFLT) profile on age, gender and ocular biometric parameters, and to evaluate its performance in glaucoma diagnosis, especially in high myopia. METHODS RNFLT with 768 points at the circumferential 3.4 mm scan was measured using spectral-domain OCT. A fully connected network and a radial basis function network were trained for vertical (scaling) and horizontal (shift) transformation of the RNFLT profile with adjustment for age, axial length (AL), disc-fovea angle and distance, in a test group of 2223 non-glaucomatous eyes. The performance of RNFLT compensation was evaluated in an independent group of 254 glaucoma patients and 254 non-glaucomatous participants. RESULTS By applying the RNFL compensation algorithm, the AUROC in detecting glaucoma increased from 0.70 to 0.84, from 0.75 to 0.89, from 0.77 to 0.89, and from 0.78 to 0.87, for eyes in the highest 10% (mean: 26.0±0.9mm), 20% (25.3±1.0mm), and highest 30% (24.9±1.0mm) percentile subgroup of the AL distribution, and in eyes of any AL (23.5±1.2mm), in comparing with unadjusted RNFLT, respectively. The difference between uncompensated versus compensated RNFLT values increased with longer axial length, with enlargement of 19.8%, 18.9%, 16.2% and 11.3% in the highest 10%, 20% and 30% percentile subgroups, and in all eyes, respectively. CONCLUSIONS In a population-based study sample, an algorithm-based adjustment for age, gender and ocular biometric parameters improved the diagnostic precision of the RNFLT profile for glaucoma detection in particular in myopic and highly myopic eyes.

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Diagnostic Accuracy of 64-Slice Computed Tomography Angiography in Patients with Chest Pain vs. SPECT in the Assessment of Significant Coronary Artery Disease: A Systematic Review and Meta-analysis

Health Technology Assessment in Action ◽

10.18502/htaa.v4i2.6230 ◽

2021 ◽

Author(s):

Maryam Jamali ◽

Rajabali Daroudi ◽

Masih Tajdini ◽

Ali Akbari Sari ◽

Sajad Alaei ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Odds Ratio ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

Sensitivity Analyses ◽

Likelihood Ratios ◽

History Of ◽

Artery Disease ◽

Sensitivity Specificity

Context: This systematic review and meta-analysis intended to investigate the diagnostic accuracy of computed tomography angiography (CTA) in comparison with single-photon emission computed tomography (SPECT) for the diagnosis of coronary artery disease (CAD) in chest pain patients with no history of cardiovascular diseases (CVDs). Methods: Invasive angiography was considered as the reference test with a stenosis threshold of ≥ 50%. Cochrane, Scopus, Science Direct, PubMed, and Embase databases were comprehensively searched from the time of inception of these databases to May 15, 2018. A manual search in Google Scholar, a reference review of the obtained studies, and a review of gray literature (including those presented in conferences and congresses) regarding diagnostic performances of CTA and SPECT techniques were performed independently by two researchers. A meta-analysis was performed to determine pooling estimates of sensitivity, specificity, diagnostic odds ratio, and positive as well as negative likelihood ratios in CTA and SPECT tests. According to the 2 × 2 contingency table of each study, at 0.95 confidence interval, the diagnostic accuracy of CTA and SPECT was meta-analyzed by pooling estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratios based on DerSimonian-Laird’s random-effects model. Heterogeneity was assessed by calculating I2. Analyses were performed using MetaDiSc version 1.4 and Stata version 11. The qualities of the selected studies were assessed independently by two researchers according to the quality assessment of diagnostic accuracy studies (QUADAS) questionnaire. Sensitivity analyses were performed by the Jackknife method. Publication bias was evaluated by Deeks’ funnel plot. Results: Fourteen studies related to CTA (1206 individuals) and 15 related to SPECT (1638 individuals) were eligible for meta-analysis. The pooled sensitivity and the specificity of CTA for CAD diagnosis were 91% (95% CI, 88% - 94%) and 87% (95% CI, 84% - 98%), respectively. The pooled positive and negative likelihood ratios, the diagnostic odds ratio, and the area under the ROC curve for CTA were 7.93 (95% CI, 5.11 - 12.29), 0.1 (95% CI, 0.06 - 0.17), 95.71 (95% CI, 59.81 - 153.15), and 0.96, respectively. The pooled sensitivity and the specificity of SPECT for CAD diagnosis were 81% (95% CI, 79% - 83%) and 74% (95% CI, 71% - 78%), respectively. The pooled positive and negative likelihood ratios, the diagnostic odds ratio, and the area under the ROC curve for SPECT were 3.03 (95% CI, 2.34 - 3.91), 0.25 (95% CI, 0.21 - 0.30), 13.56 (95% CI, 10.60 - 12.34), and 0.86, respectively. According to the sensitivity analyses, the removal of any single study at a time did not change the effect size of the remaining studies. We observed symmetry in the Deeks’ funnel plot, indicating that there was ignorable publication bias for CTA and SPECT studies. Conclusions: This study demonstrated that the diagnostic accuracies of CTA and SPECT tests lie in the ‘excellent’ and the ‘very good’ ranges, respectively. CTA is stronger evidence, than SPECT, to rule out CVDs in patients with low and intermediate risks of CAD with no history of cardiovascular diseases.

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Diagnostic accuracy of serum lipase and amylase as biomarkers for acute pancreatitis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181766 ◽

2018 ◽

Vol 6 (5) ◽

pp. 1721

Author(s):

Anil Kumar ◽

Sangeeta Kapoor

Keyword(s):

Acute Pancreatitis ◽

Diagnostic Accuracy ◽

Serum Amylase ◽

Health Care Facilities ◽

Likelihood Ratios ◽

Serum Lipase ◽

Predictive Values ◽

Single Marker ◽

Study Population ◽

Sensitivity Specificity

Background: Currently, majority of clinicians ask for both amylase and lipase for diagnosis of acute pancreatitis but a large number of health care facilities in India still have facility for only amylase. Aim was to find which single marker to be used in for diagnosis of acute pancreatitis.Methods: Patients seeking care at emergency department for acute abdominal pain during the period from July 2016 to June 2017 formed the study population. The serum lipase and amylase were taken from 1725 patients. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated.Results: Sixteen patients had amylase above 3-fold elevation, while there were 26 such patients in the lipase group. The sensitivity and specificity of amylase at 3-fold above normal limit were 62.8% and 99.2% while those of lipase were 96.1% and 99.1% respectively. Both amylase and lipase had high accuracy index in the area under the ROC curve (0.990 and 0.997 respectively).Conclusions: In this study, serum lipase had better diagnostic accuracy as compared to serum amylase. In resource-constrained settings with limited lab and radiological facilities, serum lipase should be preferred over serum amylase for diagnosis of acute pancreatitis.

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