VALUE OF COMBINATION OF HAP SCORE AND BISAP SCORE IN PREDICTING SEVERITY IN PATIENTS OF ACUTE PANCREATITIS

Acute pancreatitis (AP) is an acute inflammation of the pancreas, usually occurs suddenly with a variety of clinical symptoms, complications of multiple organ failure and high mortality rates. Objectives: To determine the value of combination of HAP score and BISAP score in predicting the severity of acute pancreatitis of the Atlanta 2012 Classification. Patients and Methods: 75 patients of acute pancreatitis hospitalized at Hue Central Hospital between March 2017 and July 2018; HAP and BISHAP score is calculated within the first 24 hours. The severity of AP was classified by the revised Atlanta criteria 2012. Results: When combining the HAP and BISAP scores in predicting the severity of acute pancreatitis, the area under the ROC curve was 0,923 with sensitivity value was 66.7%, specificity value was 97.1%; positive predictive value was 66.7%, negative predictive value was 97.1%. Conclusion: The combination of HAP and BISAP scores increased the sensitivity, predictive value, and prognostic value in predicting the severity of acute pancreatitis of the revised Atlanta 2012 classification in compare to each single scores. Key words: HAPscore, BiSAP score, acute pancreatitis, predicting severity

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Peripheral Blood Leukocytes and Serum Nested Polymerase Chain Reaction Are Complementary Methods for Monitoring Active Cytomegalovirus Infection in Transplant Patients

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2013/214631 ◽

2013 ◽

Vol 24 (3) ◽

pp. e69-e74 ◽

Cited By ~ 1

Author(s):

PD Andrade ◽

MT Fioravanti ◽

EBV Anjos ◽

C De Oliveira ◽

DM Albuquerque ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Positive Predictive Value ◽

Predictive Value ◽

Cytomegalovirus Infection ◽

Clinical Symptoms ◽

Peripheral Blood Leukocytes ◽

Active Infection ◽

Chain Reaction ◽

Blood Leukocytes ◽

Polymerase Chain

BACKGROUND: Human cytomegalovirus is an important cause of morbidity and mortality in immunocompromised patients. Qualitative polymerase chain reaction (PCR) has proven to be a sensitive and effective technique in defining active cytomegalovirus infection, in addition to having low cost and being a useful test for situations in which there is no need for quantification. Real-time PCR has the advantage of quantification; however, the high cost of this methodology makes it impractical for routine use.OBJECTIVE: To apply a nested PCR assay to serum (sPCR) and to evaluate its efficiency to diagnose active cytomegalovirus infection compared with PCR of peripheral blood leukocytes (L-PCR).METHODS: Samples of 37 patients were prospectively evaluated. An internal control was created and applied to sPCR to exclude false-negative results.RESULTS: In total, 21 patients (57%) developed active cytomegalovirus infection. After analyzing the two methods for the diagnosis of active infection, higher sensitivity and negative predictive value of the L-PCR versus sPCR (100% versus 62%), and higher specificity and positive predictive value of sPCR versus L-PCR (81% versus 50% and 72%, respectively) were observed. Discordant results were observed in 11 patients who were L-PCR-positive but sPCR-negative for active cytomegalovirus infection, five of whom developed clinical symptoms of cytomegalovirus. Clinical symptoms were observed in 14 patients, 12 of whom were diagnosed with active infection by nested L-PCR (P=0.007) and seven by nested sPCR (P=0.02). Higher specificity and a positive predictive value for sPCR were observed.CONCLUSION: Nested L-PCR and sPCR were considered to be complementary methods for the diagnosis and management of symptomatic cytomegalovirus infection.

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Early Prediction of Multiple Organ Dysfunction in the Pediatric Intensive Care Unit

Frontiers in Pediatrics ◽

10.3389/fped.2021.711104 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sanjukta N. Bose ◽

Joseph L. Greenstein ◽

James C. Fackler ◽

Sridevi V. Sarma ◽

Raimond L. Winslow ◽

...

Keyword(s):

High Risk ◽

Random Forest ◽

Positive Predictive Value ◽

Organ Dysfunction ◽

Predictive Value ◽

Prediction Models ◽

Pediatric Intensive Care ◽

Multiple Organ ◽

High Risk Group ◽

Early Prediction

Objective: The objective of the study is to build models for early prediction of risk for developing multiple organ dysfunction (MOD) in pediatric intensive care unit (PICU) patients.Design: The design of the study is a retrospective observational cohort study.Setting: The setting of the study is at a single academic PICU at the Johns Hopkins Hospital, Baltimore, MD.Patients: The patients included in the study were <18 years of age admitted to the PICU between July 2014 and October 2015.Measurements and main results: Organ dysfunction labels were generated every minute from preceding 24-h time windows using the International Pediatric Sepsis Consensus Conference (IPSCC) and Proulx et al. MOD criteria. Early MOD prediction models were built using four machine learning methods: random forest, XGBoost, GLMBoost, and Lasso-GLM. An optimal threshold learned from training data was used to detect high-risk alert events (HRAs). The early prediction models from all methods achieved an area under the receiver operating characteristics curve ≥0.91 for both IPSCC and Proulx criteria. The best performance in terms of maximum F1-score was achieved with random forest (sensitivity: 0.72, positive predictive value: 0.70, F1-score: 0.71) and XGBoost (sensitivity: 0.8, positive predictive value: 0.81, F1-score: 0.81) for IPSCC and Proulx criteria, respectively. The median early warning time was 22.7 h for random forest and 37 h for XGBoost models for IPSCC and Proulx criteria, respectively. Applying spectral clustering on risk-score trajectories over 24 h following early warning provided a high-risk group with ≥0.93 positive predictive value.Conclusions: Early predictions from risk-based patient monitoring could provide more than 22 h of lead time for MOD onset, with ≥0.93 positive predictive value for a high-risk group identified pre-MOD.

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Positive predictive value of acute and chronic pancreatitis diagnoses in the Danish National Patient Registry: A validation study

Scandinavian Journal of Public Health ◽

10.1177/1403494818773535 ◽

2018 ◽

Vol 48 (1) ◽

pp. 14-19 ◽

Cited By ~ 6

Author(s):

Jakob Kirkegård ◽

Marie R. Mortensen ◽

Ida R. Johannsen ◽

Frank V. Mortensen ◽

Deirdre Cronin-Fenton

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Positive Predictive Value ◽

Predictive Value ◽

Medical Records ◽

Patient Registry ◽

National Patient Registry ◽

Danish National Patient Registry ◽

National Patient ◽

Acute And Chronic Pancreatitis

Aims: To examine the validity of the diagnoses of acute and chronic pancreatitis registered in the Danish National Patient Registry. Methods: We identified all patients in the Danish National Patient Registry admitted to two Danish hospitals with acute or chronic pancreatitis from 1996 to 2013. From this population, we randomly sampled 100 patients with acute pancreatitis and 100 patients with chronic pancreatitis. For each cohort, we computed the positive predictive values and associated 95% confidence intervals (CIs) for the discharge diagnosis of acute or chronic pancreatitis using medical records as the gold standard. Results: We identified 2617 patients with acute pancreatitis and 1284 patients with chronic pancreatitis discharged from either of the two hospitals during the study period. Of these, 776 (19.9%) had a diagnosis of both acute and chronic pancreatitis and are thus present in both cohorts. From the 200 sampled patients, a total of 138 (69.0%) medical records were available for review. The positive predictive value for a diagnosis of acute pancreatitis in the Danish National Patient Registry was 97.3% (95% CI 90.5–99.2%) and for chronic pancreatitis 83.1% (95% CI 72.2–90.3%). Conclusions: The validity of diagnoses of acute and chronic pancreatitis registered in the Danish National Patient Registry since 1996 is generally high.

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Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Stroke ◽

10.1161/strokeaha.120.030959 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3765-3769

Author(s):

Charles Esenwa ◽

Ji-Ae Lee ◽

Taha Nisar ◽

Anna Shmukler ◽

Inessa Goldman ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Computed Tomography Angiography ◽

Predictive Value ◽

Screening Tool ◽

Clinical Symptoms ◽

Shortness Of Breath ◽

Patient Reported

Background and Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19–specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

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The predictive value of serum neopterin for multiple organ dysfunction syndrome in severe burn patients

Pteridines ◽

10.1515/pteridines-2018-0019 ◽

2018 ◽

Vol 29 (1) ◽

pp. 196-200 ◽

Cited By ~ 1

Author(s):

Wei Xiong ◽

Jun Ouyang ◽

Hai Ci ◽

Wenping Jiang ◽

Wei Han ◽

...

Keyword(s):

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Roc Curve ◽

Predictive Value ◽

Multiple Organ ◽

Burn Patients ◽

Multiple Organ Dysfunction ◽

Severe Burn ◽

Serum Neopterin ◽

Neopterin Level

AbstractObjective To investigate the predictive value of serum neopterin for multiple organ dysfunction syndrome (MODS) in severe burn patients. Methods Seventy-six severe burn patients with burns covering a total body surface area (TBSA) above 70% were included in this study. Of the 76 patients, 29 cases developed MODS (MODS group) and the remaining 47 subjects did not (non-MODS group). From the MODS group, 12 patients died (Death group) and 17 patients survived (Survive group). The serum level of neopterin in the MODS and non-MODS groups were examined by radioimmunoassay on following 1, 3 , 7 , 14 , 21 and 28 post-burn days (PBDs). A receiver operating characteristic (ROC) curve was used to analyse the predictive value of serum neopterin for MODS and death. Results The serum neopterin level in the MODS group was significantly higher than that of non-MODS group between 3~28 PBDs (p<0.001). However, the serum neopterin levels between the MODS and non-MODS groups following 1 PBD were not statistically significant (p>0.05). The best diagnostic performance of serum neopterin for MODS occurred 14 PBDs with the prediction sensitivity and specificity of 75.86% (56.46%~89.70%) and 85.11% (71.69%~93.80%) respectively. However, serum neopterin levels had no clinical value in predicting the death of MODS patients. The area under the ROC curve (AUC) was 0.72 (0.58~0.85), 0.81 (0.71~0.92) and 0.83 (0.72~0.94) for serum neopterin as biomarker in the prediction of MODS after 3, 7 and 14 PBDs, respectively. The AUCs were 0.50 (0.27~0.73), 0.53 (0.30~0.76) and 0.56 (0.33~0.79) for serum neopterin as biomarker in prediction of death for MODS patients after 3, 7 and 14 PBDs, respectively. Conclusion The persistent and significant increase of serum neopterin level is closely related to the development of MODS in patients with severe burns. Serum neopterin is therefore a promising serological marker for MODS early diagnosis, but has little efficacy in the prediction of the likelihood of death in severe burn patients with MODS.

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Value of Examination Under Fluoroscopy for the Assessment of Sacroiliac Joint Dysfunction

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e781 ◽

2015 ◽

Vol 5;18 (5;9) ◽

pp. E781-E786

Author(s):

Burton D Beakley

Keyword(s):

Sensitivity And Specificity ◽

Roc Curve ◽

Predictive Value ◽

Joint Pain ◽

Clinical Symptoms ◽

Small Sample ◽

Joint Disease ◽

Pain Clinic ◽

Predictive Values ◽

Si Joint

Background: Pain emanating from the sacroiliac (SI) joint can have variable radiation patterns. Single physical examination tests for SI joint pain are inconsistent with multiple tests increasing both sensitivity and specificity. Objective: To evaluate the use of fluoroscopy in the diagnosis of SI joint pain. Study Design: Prospective double blind comparison study Setting: Pain clinic and radiology setting in urban Veterans Administration (VA) in New Orleans, Louisiana. Methods: Twenty-two adult men, patients at a southeastern United States VA interventional pain clinic, presented with unilateral low back pain of more than 2 months’ duration. Patients with previous back surgery were excluded from the study. Each patient was given a Gapping test, Patrick (FABERE) test, and Gaenslen test. A second blinded physician placed each patient prone under fluoroscopic guidance, asking each patient to point to the most painful area. Pain was provoked by applying pressure with the heel of the palm in that area to determine the point of maximum tenderness. The area was marked with a radio-opaque object and was placed on the mark with a fluoroscopic imgage. A site within 1 cm of the SI joint was considered as a positive test. This was followed by a diagnostic injection under fluoroscopy with 1 mL 2% lidocaine. A positive result was considered as more than 2 hours of greater than 75% reduction in pain. Then, in 2-3 days this was followed by a therapeutic injection under fluoroscopy with 1 mL 0.5% bupivacaine and 40 mg methylprednisolone. Results: Each patient was reassessed after 6 weeks. The sensitivity and specificity in addition to the positive and negative predictive values were determined for both the conventional examinations, as well as the examination under fluoroscopy. Finally, a receiver operating characteristic (ROC) curve was constructed to evaluate test performance. The sensitivity and specificity of the fluoroscopic examination were 0.82 and 0.80 respectively; Positive predictive value and negative predictive value were 0.93 and 0.57 respectively. The area under ROC curve was 0.812 which is considered a “good” test; however the area under ROC for the conventional examination were between 0.52 -0.58 which is considered “poor to fail”. Limitations: Variation in anatomy of the SI joint, small sample size. Conclusions: Multiple structures of the SI joint complex can result in clinical symptoms of pain. These include intra-articular structures (degenerative arthritis, and inflammatory conditions) as well as extraarticular structures (ligaments, muscles, etc.). Key words: Sacroilliac joint disease, radicular pain, thigh thrust test, compression test, distraction test, Gaenslen test, Patrick test (FABER test)

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A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20180430 ◽

2018 ◽

Vol 5 (3) ◽

pp. 796

Author(s):

Vamsavardhan Pasumarthi ◽

C. P. Madhu

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Roc Curve ◽

Predictive Value ◽

Scoring System ◽

Alvarado Score ◽

Predictive Values ◽

Sensitivity Specificity ◽

Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

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The prognostic value of amplitude-integrated electroencephalography in neonates with hypoxic-ischemic encephalopathy

Vojnosanitetski pregled ◽

10.2298/vsp1206492v ◽

2012 ◽

Vol 69 (6) ◽

pp. 492-499 ◽

Cited By ~ 8

Author(s):

Brankica Vasiljevic ◽

Svjetlana Maglajlic-Djukic ◽

Miroslava Gojnic

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Gestational Age ◽

Predictive Value ◽

Prognostic Value ◽

Hypoxic Ischemic Encephalopathy ◽

Clinical Scoring ◽

Neurodevelopmental Impairment ◽

Ischemic Encephalopathy ◽

Neurodevelopment Outcome

Background/Aim. Diagnosis of perinatal hypoxic-ischemic encephalopathy (HIE) and early prediction neurological outcome is important and difficult. The aim of this study was to determine the prognostic value of amplitude integrated electroencephalography (aEEG) for abnormal neurodevelopment outcome in a neonate with HIE. Methods. A total of 90 neonates > 32 gestational age (GA) with HIE were enrolled prospectively. All neonates with HIE were categorized into three grades according to the Sarnat and Sarnat clinical scoring system (mild HIE, moderate HIE and severe HIE). aEEG traces were recorded with a cerebral function monitor (CFM) during the first 72 h of life. The neurodevelopment outcome was assessed at 12 months of age of corrected gestational age. Results. The pattern of aEEG correlated with the severity of HIE (p < 0.0001) and subsequent neurodevelopment outcome (p < 0.001). We found that aEEG background patterns exhibited superior prediction of abnormal outcomes at 12 months of age (sensitivity of 91.7% and specificity of 94.3%, positive predictive value of 78.6% and negative predictive value of 98.1%) when compared to aEEG seizure (sensitivity of 94% and specificity of 48%, positive predictive value of 57% and a negative predictive value of 92%). Electroclinical dissociation seizure was detected in 28% of the neonates with HIE. Conclusions. Our results confirm that aEEG is simple and accurate bedside diagnostic method for assessing extension of hypoxic-ischemic brain damage and early identification of neonates with perinatal HIE who are at high risk of neurodevelopmental impairment.

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.333 ◽

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.

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