scholarly journals Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

2021 ◽  
Vol 10 (17) ◽  
pp. 3869
Author(s):  
Myrto Bolanaki ◽  
Martin Möckel ◽  
Johannes Winning ◽  
Michael Bauer ◽  
Konrad Reinhart ◽  
...  
Keyword(s):  
Predictive Value ◽  
Early Identification ◽  
Patient Population ◽  
Diagnostic Performance ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Emergency Admission ◽  
Failure Assessment ◽  
Study Population ◽  
Qsofa Score

Infectious biomarkers such as procalcitonin (PCT) can help overcome the lack of sensitivity of the quick Sequential Organ Failure Assessment (qSOFA) score for early identification of sepsis in emergency departments (EDs) and thus might be beneficial as point-of-care biomarkers in EDs. Our primary aim was to investigate the diagnostic performance of PCT for the early identification of septic patients and patients likely to develop sepsis within 96 h of admission to an ED among a prospectively selected patient population with elevated qSOFA scores. In a large multi-centre prospective cohort study, we included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission. Of the study population 27.3% (n = 202) were diagnosed with sepsis within the first 96 h. The area under the curve for PCT for the identification of septic patients in EDs was 0.86 (95% confidence interval (CI): 0.83–0.89). The resultant sensitivity for PCT at a cut-off of 0.5 µg/l was 63.4% (95% CI: 56.3–70.0). Furthermore, specificity was 89.2% (95% CI: 86.3–91.7), the positive predictive value was 68.8% (95% CI: 62.9–74.2), and the negative predictive value was 86.7% (95% CI: 84.4–88.7). The early measurement of PCT in a patient population with elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients.

scholarly journals Predictive value of qSOFA score for death in emergency department resuscitation room among adult trauma patients:a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Huang ◽  
Peng Yang ◽  
Feng Xu ◽  
Du Chen
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Study Endpoint ◽  
Trauma Patients ◽  
Roc Curve Analysis ◽  
Resuscitation Room ◽  
Failure Assessment ◽  
Qsofa Score

Abstract Background To explore the predictive value of the quick Sequential Organ Failure Assessment (qSOFA) score for death in the emergency department (ED) resuscitation room among adult trauma patients. Methods During the period November 1, 2016 to November 30, 2019, data was retrospectively collected of adult trauma patients triaged to the ED resuscitation room in the First Affiliated Hospital of Soochow University. Death occurring in the ED resuscitation room was the study endpoint. Univariate and multivariate analyses were performed to explore the association between qSOFA score and death. Receiver operating characteristic (ROC) curve analysis was also performed for death. Results A total of 1739 trauma victims were admitted, including 1695 survivors and 44 non-survivors. The death proportion raised with qSOFA score: 0.60% for qSOFA = 0, 3.28% for qSOFA = 1, 12.06% for qSOFA = 2, and 15.38% for qSOFA = 3, p < 0.001. Subgroup of qSOFA = 0 was used as a reference. In univariate analysis, crude OR for death with qSOFA = 1 was 5.65 [95% CI 2.25 to 14.24, p < 0.001], qSOFA = 2 was 22.85 [95% CI 8.84 to 59.04, p < 0.001], and qSOFA = 3 was 30.30 [95% CI 5.50 to 167.05, p < 0.001]. In multivariate analysis, with an adjusted OR (aOR) of 2.87 (95% CI 0.84 to 9.87, p = 0.094) for qSOFA = 1, aOR 6.80 (95% CI 1.79 to 25.90, p = 0.005) for qSOFA = 2, and aOR 24.42 (95% CI 3.67 to 162.27, p = 0.001) for qSOFA = 3. The Area Under the Curve (AUC) for predicting death in the ED resuscitation room among trauma patients was 0.78 [95% CI, 0.72–0.85]. Conclusions The qSOFA score can assess the severity of emergency trauma patients and has good predictive value for death in the ED resuscitation room.

scholarly journals Predictive value of qSOFA score for death in emergency department resuscitation room among adult trauma patients：a retrospective study

2021 ◽  
Author(s):  
Wenjuan Huang ◽  
Peng Yang ◽  
Feng Xu ◽  
Du Chen
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Study Endpoint ◽  
Trauma Patients ◽  
Roc Curve Analysis ◽  
Resuscitation Room ◽  
Failure Assessment ◽  
Qsofa Score

Abstract Background To explore the predictive value of quick Sequential Organ Failure Assessment (qSOFA) score for death in emergency department (ED) resuscitation room among adult trauma patients.Methods During the period November 1, 2016 to November 30, 2019, we retrospectively collected data of adult trauma patients triaged to ED resuscitation room of the First Affiliated Hospital of Soochow University. Take death occurred in ED resuscitation room as the study endpoint. Univariate and multivariate analyses were performed to explore the association between qSOFA score and death. Receiver operating characteristic (ROC) curve analysis was also performed for death.Results A total of 1739 trauma victims were admitted, including 1695 survivors and 44 non-survivors. The death proportion raised with qSOFA score: 0.60% for qSOFA=0, 3.28% for qSOFA༝1, 12.06% for qSOFA༝2, and 15.38% for qSOFA༝3, p < 0.001. Subgroup of qSOFA = 0 was used as a reference. In univariate analysis, crude OR for death with qSOFA = 1 was 5.65 [95% CI 2.25 to 14.24, p < 0.001], qSOFA = 2 was 22.85 [95% CI 8.84 to 59.04, p < 0.001], and qSOFA = 3 was 30.30 [95% CI 5.50 to 167.05, p < 0.001]. In multivariate analysis, with an adjusted OR (aOR) of 2.87 (95% CI 0.84 to 9.87, p༝0.094) for qSOFA༝1, aOR 6.80 (95% CI 1.79 to 25.90, p = 0.005) for qSOFA༝2, and aOR 24.42 (95% CI 3.67 to 162.27, p = 0.001) for qSOFA༝3. The Area Under the Curve (AUC) for predicting death in ED resuscitation room among trauma patients was 0.78 [95% CI, 0.72–0.85].Conclusions qSOFA score can assess the severity of emergency trauma patients and has good predictive value for death in ED resuscitation room.

Use of a New Monoclonal Antibody-Based Enzyme Immunoassay for Soluble Fibrin to Exclude Pulmonary Embolism

2000 ◽  
Vol 84 (09) ◽  
pp. 474-477 ◽  
Author(s):  
Bernd-Jan Sanson ◽  
Wouter de Monyé ◽  
Jeroen Lijmer ◽  
Menno Huisman ◽  
Harry Büller ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Study Cohort ◽  
Suspected Pulmonary Embolism ◽  
Soluble Fibrin

SummaryWe prospectively evaluated the diagnostic performance of a new soluble fibrin assay in 303 consecutive patients with suspected pulmonary embolism and examined potentially useful cut-off levels at which this disease can be safely excluded. In addition, the diagnostic accuracy was calculated in the subgroups of in- and outpatients. The ROC curve of the assay in the total study cohort had an area under the curve of 0.69. The cut-off level associated with a sensitivity and negative predictive value of 100% was 20 ng/ml, but the specificity was only 4%. The cut-off level with a sensitivity of 90% was 30 ng/ml, which corresponded with a specificity and negative predictive value of 27% and 86%, respectively. The diagnostic performance was comparable in the subgroups of in- and outpatients. We conclude that the soluble fibrin assay has a low diagnostic accuracy and seems unsuitable as a screening test for the exclusion of pulmonary embolism.

Classical (adiponectin, leptin, resistin) and new (chemerin, vaspin, omentin) adipocytokines in patients with prediabetes

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Antoaneta Gateva ◽  
Yavor Assyov ◽  
Adelina Tsakova ◽  
Zdravko Kamenov
Keyword(s):  
Insulin Resistance ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Serum Adiponectin ◽  
Endocrine Organ ◽  
Serum Leptin ◽  
Discriminating Power ◽  
Study Population ◽  
Obese Subjects

Abstract Background In the last decade, there has been an increased interest toward fat tissue as an endocrine organ that secretes many cytokines and bioactive mediators that play a role in insulin sensitivity, inflammation, coagulation and the pathogenesis of atherosclerosis. The aim of this study was to investigate classical (adiponectin, leptin, resistin) and new (chemerin, vaspin, omentin) adipocytokine levels in subjects with prediabetes [impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT)] and obese subjects with normoglycemia. Methods In this study, 80 patients with a mean age of 50.4 ± 10.6 years were recruited, divided into two groups with similar age and body mass index (BMI) – with obesity and normoglycemia (n = 41) and with obesity and prediabetes (n = 39). Results Serum adiponectin levels were significantly higher in subjects with normoglycemia compared to patients with prediabetes. Adiponectin has a good discriminating power to distinguish between patients with and without insulin resistance in our study population [area under the curve (AUC) = 0.728, p = 0.002]. Other adipocytokine levels were not significantly different between the two groups. The patients with metabolic syndrome (MetS) had significantly lower levels of leptin compared to those without MetS (33.03 ± 14.94 vs. 40.24 ± 12.23 ng/mL) and this difference persisted after adjustment for weight and BMI. Receiver operating characteristic (ROC) analysis showed that low serum leptin can predict the presence of MetS (p = 0.03), AUC = 0.645. Conclusion Serum adiponectin is statistically higher in patients with normoglycemia compared to those with prediabetes and has a predictive value for distinguishing between patients with and without insulin resistance in the studied population. Serum leptin has a good predictive value for distinguishing between patients with and without MetS in the studied population.

scholarly journals Evaluation of the Dynamiker Cryptococcal Antigen Lateral Flow Assay for the Diagnosis of HIV-Associated Cryptococcosis

2020 ◽  
Author(s):  
Richard Kwizera ◽  
Denis Omali ◽  
Kiiza Tadeo ◽  
John Kasibante ◽  
Morris K. Rutakingirwa ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Performance ◽  
Point Of Care ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Sub Saharan Africa ◽  
Serum Samples ◽  
Cryptococcal Antigen ◽  
Asymptomatic Patients ◽  
Sub Saharan

Background: Cryptococcal meningitis is a leading cause of meningitis in sub-Saharan Africa. Given the need for rapid point of care testing, we evaluated the diagnostic performance of the Dynamiker cryptococcal antigen (CrAg) lateral flow assay (LFA). Methods: We assessed the diagnostic performance of the Dynamiker CrAg-LFA compared to the IMMY CrAg-LFA as the reference standard. We tested 150 serum, 115 plasma, 100 cerebrospinal fluid (CSF) samples from HIV patients with symptomatic meningitis and 113 serum samples from patients with suspected asymptomatic cryptococcal antigenemia. Results: Compared to the IMMY CrAg-LFA, sensitivity of Dynamiker CrAg-LFA was 98% in serum, 100% in plasma, 100% in CSF from symptomatic patients and 96% in serum from asymptomatic patients. Specificity was 66% in serum, 61% in plasma, 91% in CSF from symptomatic patients, and 86% in serum from asymptomatic patients. The positive predictive value was 85% in serum, 82% in plasma, 96% in CSF from symptomatic patients, and 69% in serum from asymptomatic patients. The negative predictive value was 94% in serum, 100% in plasma, 100% in CSF from symptomatic patients, and 99% in serum from asymptomatic patients. The inter-assay reproducibility was 100% across the four sample types with no observed discordant results when Dynamiker CrAg-LFA was tested in duplicate. However, a high number of false positives were observed on serum of symptomatic patients (11%), serum of asymptomatic patients (11%) and plasma of symptomatic patients (14%). Conclusion: The Dynamiker CrAg-LFA had excellent sensitivity but poor specificity, particularly when tested on serum and plasma.

scholarly journals Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection

2019 ◽  
Vol 8 (6) ◽  
pp. 833 ◽  
Author(s):  
Bo-Sun Shim ◽  
Young-Hoon Yoon ◽  
Jung-Youn Kim ◽  
Young-Duck Cho ◽  
Sung-Jun Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Whole Blood ◽  
Predictive Value ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
C Reactive Protein ◽  
Suspected Infection ◽  
Reactive Protein ◽  
Failure Assessment ◽  
Emergency Department Patients

We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups—those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.

scholarly journals Qualitative analysis of contrast-enhanced ultrasound in the diagnosis of small, TR3–5 benign and malignant thyroid nodules measuring ≤1 cm

2020 ◽  
Vol 93 (1111) ◽  
pp. 20190923
Author(s):  
Xin Li ◽  
Feng Gao ◽  
Fan Li ◽  
Xiao-xia Han ◽  
Si-hui Shao ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Qualitative Analysis ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Area Under The Curve ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Sensitivity Specificity

Objective: To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3–5 benign and malignant thyroid nodules (≤1 cm). Methods: From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ2 test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules. Results: The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (p＜0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (p＞0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663–0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871–0.961). Conclusion: CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS. Advances in knowledge: The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.

Diagnostic performance of renal ultrasonography in detecting chronic kidney disease of various severity

2020 ◽  
Vol 14 (5) ◽  
pp. 195-202
Author(s):  
Iroshani Kodikara ◽  
Dhanusha T. K. Gamage ◽  
Ganananda Nanayakkara ◽  
Isurani Ilayperuma
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Area Under The Curve ◽  
Receiver Operating Curve ◽  
Receiver Operating Curve Analysis ◽  
Complementary Role ◽  
Diagnostic Role ◽  
Estimated Glomerular Filtration Rates

AbstractBackgroundAssociation between early diagnosis of chronic kidney disease (CKD) and low morbidity and mortality rate has been proven. Thus, tools for early CKD diagnosis are vital. Ultrasonography has been widely used to diagnose and monitor the progression of CKD.ObjectivesTo determine the performance of selected renal ultrasonographic parameters for the diagnosis of early CKD.MethodsIn a cohort of patients diagnosed with CKD (n = 100), diagnostic performance of ultrasonographically measured renal length (RL), renal cortical thickness (RCT), and parenchymal thickness (PT) was determined using receiver operating curve analysis; correlation of each parameter with the associated comorbidities and serum creatinine (Scr) levels was also determined. Severity of CKD was graded with estimated glomerular filtration rates (eGFR).ResultsOf all patient participants, 85 had severity grades 2 or 3. Mean (standard deviation) Scr was 1.88 (0.60) mg/dL; eGFR was 43.3 (11.85) mL/min/1.73 m2. RL was 9.01 (0.83) cm, PT was 1.32 (0.22) cm, and RCT was 6.0 (0.10) mm. PT and RCT were positively correlated with eGFR (P = 0.01 and 0.002, respectively). Early CKD was better predicted by PT (area under the curve (AUC) 0.735; 82% sensitivity; 30% specificity; 68% positive predictive value (PPV)) and RCT (AUC 0.741; 82% sensitivity; 48% specificity; 51% PPV); severe CKD was better predicted by RL (AUC 0.809; 67% sensitivity; 26% specificity, 45% PPV; 13% negative predictive value).ConclusionIndex ultrasonic parameters show a diagnostic role in different stages of CKD. The index ultrasound and biochemical parameters showed a complementary role in predicting renal dysfunction.

scholarly journals Accurate Point-of-Care Detection of Ruptured Fetal Membranes: Improved Diagnostic Performance Characteristics with a Monoclonal/Polyclonal Immunoassay

2016 ◽  
Vol 10 ◽  
pp. CMRH.S38386 ◽  
Author(s):  
Linda C. Rogers ◽  
Laurie Scott ◽  
Jon E. Block
Keyword(s):  
Predictive Value ◽  
Laboratory Tests ◽  
Diagnostic Performance ◽  
Point Of Care ◽  
Performance Characteristics ◽  
Perinatal Morbidity ◽  
Test Sensitivity ◽  
Vaginal Secretions ◽  
Sensitivity Specificity ◽  
Point Of Care Detection

Objective Accurate and timely diagnosis of rupture of membranes (ROM) is imperative to allow for gestational age-specific interventions. This study compared the diagnostic performance characteristics between two methods used for the detection of ROM as measured in the same patient. Methods Vaginal secretions were evaluated using the conventional fern test as well as a point-of-care monoclonal/polyclonal immunoassay test (ROM Plus®) in 75 pregnant patients who presented to labor and delivery with complaints of leaking amniotic fluid. Both tests were compared to analytical confirmation of ROM using three external laboratory tests. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results Diagnostic performance characteristics uniformly favored ROM detection using the immunoassay test compared to the fern test: sensitivity (100% vs. 77.8%), specificity (94.8% vs. 79.3%), PPV (75% vs. 36.8%), NPV (100% vs. 95.8%), and accuracy (95.5% vs. 79.1%). Conclusions The point-of-care immunoassay test provides improved diagnostic accuracy for the detection of ROM compared to fern testing. It has the potential of improving patient management decisions, thereby minimizing serious complications and perinatal morbidity.

scholarly journals Diagnostic Evaluation of a High-Sensitivity Troponin I Point-of-Care Assay

2019 ◽  
Vol 65 (12) ◽  
pp. 1592-1601 ◽  
Author(s):  
Nils A Sörensen ◽  
Johannes T Neumann ◽  
Francisco Ojeda ◽  
Evangelos Giannitsis ◽  
Eberhard Spanuth ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Troponin I ◽  
Point Of Care ◽  
Diagnostic Algorithm ◽  
High Sensitivity ◽  
Data Set ◽  
High Sensitivity Troponin ◽  
Point Of Care Assay

Abstract BACKGROUND Increasing numbers of patients are presenting worldwide to emergency departments with suspected myocardial infarction. The use of point-of-care troponin assays might enable faster decision-making in this high-risk population and reduce the burden on emergency facilities. Here, we evaluate the diagnostic performance of a point-of-care high-sensitivity troponin I assay. METHODS We conducted a prospective cohort study including patients presenting to the emergency department with suspected myocardial infarction from July 2013 to July 2016. A diagnostic algorithm for a high-sensitivity troponin I point-of-care assay was developed in a derivation data set with 669 patients and validated in an additional 610 patients. RESULTS The derived 0/1 h algorithm for the point-of-care assay consisted of an admission troponin I &lt;4 ng/L and a δ from 0 h to 1 h &lt;3 ng/L for rule out and an admission troponin I ≥90 ng/L or a δ from 0 h to 1 h ≥20 ng/L for rule in of non-ST-elevation myocardial infarction. Application to the validation cohort showed a negative predictive value of 99.7% (95% CI, 98.1%–100.0%) and 48.0% of patients ruled out, whereas 14.6% were ruled in with a positive predictive value of 86.5% (95% CI, 77.6%–92.8%). The diagnostic performance of the point-of-care high-sensitivity assay was highly comparable to guideline-recommended use of a laboratory-based high-sensitivity troponin assay. CONCLUSIONS The clinical application of a 0/1 h diagnostic algorithm based on a high-sensitivity troponin I point-of-care assay is safe, and diagnostic performance is comparable to a laboratory-based high-sensitivity troponin I assay.

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