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

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

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.1.15 ◽

2019 ◽

pp. 96-100

Author(s):

Thi Ngoc Suong Le ◽

Pham Chi Tran ◽

Van Huy Tran

Keyword(s):

Acute Pancreatitis ◽

Positive Predictive Value ◽

Roc Curve ◽

Predictive Value ◽

Prognostic Value ◽

Acute Inflammation ◽

Clinical Symptoms ◽

Mortality Rates ◽

Multiple Organ ◽

Central Hospital

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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Screening for aneurysms of the abdominal aorta using a simple screening device

The Ultrasound Journal ◽

10.1186/s13089-020-00192-5 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

J. W. Brakel ◽

T. A. Berendsen ◽

P. M. C. Callenbach ◽

J. van der Burgh ◽

R. J. Hissink ◽

...

Keyword(s):

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Abdominal Aorta ◽

Predictive Value ◽

Cost Effective ◽

Abdominal Ultrasound ◽

Predictive Values ◽

Bladder Scan ◽

Health Council ◽

Screening Device

Abstract Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

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Study of the sensitivity and specificity of smell and taste disorders as a predictive factor of SARS-CoV-2 infection among primary care healthcare professionals

BJGP Open ◽

10.3399/bjgpo.2021.0141 ◽

2022 ◽

pp. BJGPO.2021.0141

Author(s):

Anna Ruiz-Comellas ◽

Pere Roura Poch ◽

Glòria Sauch Valmaña ◽

Víctor Guadalupe-Fernández ◽

Jacobo Mendioroz Peña ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Clinical Symptoms ◽

Strong Predictor ◽

Area Under The Curve ◽

Low Grade ◽

Predictive Values ◽

Standard Value ◽

Taste Disorders ◽

Smell Disorders ◽

Taste And Smell

Backgroundamong the manifestations of COVID-19 are Taste and Smell Disorders (TSDs).AimThe aim of the study is to evaluate the sensitivity and specificity of TSDs and other associated symptoms to estimate predictive values for determining SARS-CoV-2 infection.Design and settingRetrospective observational study.Methodsa study of the sensitivity and specificity of TSDs has been carried out using the Polymerase Chain Reaction (PCR) test for the diagnosis of SARS-CoV-2 as the Gold Standard value. Logistic regressions adjusted for age and sex were performed to identify additional symptoms that might be associated with COVID-19.Resultsthe results are based on 226 healthcare workers with clinical symptoms suggestive of COVID-19, 116 with positive PCR and 111 with negative PCR. TSDs had an OR of 12.43 (CI 0.95 6.33–26.19), sensitivity 60.34% and specificity 89.09%. In the logistic regression model, the association of TSD, fever or low-grade fever, shivering, dyspnoea, arthralgia and myalgia obtained an area under the curve of 85.7% (CI 0.95: 80.7 % - 90.7 %), sensitivity 82.8 %, specificity 80% and positive predictive values 81.4% and negative 81.5%.ConclusionsTSDs are a strong predictor of COVID-19. The association of TSD, fever, low-grade fever or shivering, dyspnoea, arthralgia and myalgia correctly predicts 85.7% of the results of the COVID-19 test.

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Mentorship on malaria microscopy diagnostic service in Ethiopia: Baseline competency of microscopists and performance of health facilities

10.21203/rs.3.rs-87991/v2 ◽

2021 ◽

Author(s):

Bokretsion Gidey ◽

Desalegn Nega ◽

Adugna Abera ◽

Abnet Abebe ◽

Sindew Mekasha ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

False Negative ◽

Malaria Diagnosis ◽

Health Facilities ◽

Malaria Parasites ◽

Cross Sectional ◽

Predictive Values ◽

Microscopic Diagnosis ◽

Malaria Microscopy

Abstract Background: In Ethiopia, malaria cases are declining as a result of proven interventions and in 2017, the country launched a malaria elimination strategy in targeted settings. Accurate malaria diagnosis and prompt treatment are the key components of the strategy to prevent morbidity and stop the continuation of transmission. However, the quality of microscopic diagnosis in general is deteriorating as malaria burden declines. Therefore, this study was carried out to evaluate the competency of microscopists and the performance of health facilities on malaria microscopic diagnosis.Methods: A cross-sectional study was conducted from August 1st to September 30th, 2019 in nine regional states and one city administration. A standard checklist was used for on-site evaluation, archived patient slides were re-checked, and proficiency of microscopists was tested using WHO certified slides from the national slide bank at the Ethiopian Public Health Institute (EPHI). The strength of agreement, the sensitivity, the specificity, and the positive and negative predictive values were calculated.Results: In this study, 102 health facilities (84 health centers and 18 hospitals) were included; from which, 202 laboratory professionals participated. In slide re-checking, moderate agreement (Agreement: 76.0%; Kappa: 0.41) was observed between experts and microscopists on malaria detection in all health facilities. The sensitivity and specificity of routine slide reading and the re-checking results were 78.1% and 80.7%, respectively. Likewise, positive predictive value of 65.1% and negative predictive value of 88.8% were scored in the routine diagnosis. By panel testing, a substantial overall agreement (A: 91.8%; K: 0.79) was observed between microscopists and experts in detecting malaria parasites. The sensitivity and specificity in the detection of malaria parasites was 92.7% and 89.1%, respectively. Furthermore, in identifying species, a slight agreement (A: 57%; K: 0.18) was observed between microscopists and experts. Conclusion: The study found significant false positive and false negative results in routine microscopy on slide re-checking of Plasmodium parasites. Moreover, reduced grade in parasite species identification was reported on the panel tests. Therefore, implementing comprehensive malaria microscopy mentorship, in-service training, and supportive supervision are the key strategies to improve the overall performance of health facilities in malaria microscopy.

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Performance of the New Automated Latex Immunoturbidometric Assay in the Diagnosis of Heparin Induced Thrombocytopenia: A Single Institution Experience

Blood ◽

10.1182/blood-2019-127312 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4689-4689

Author(s):

Sriman Swarup ◽

Somedeb Ball ◽

Nimesh Adhikari ◽

Anita Sultan ◽

Khatrina Swarup ◽

...

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Serotonin Release ◽

Small Sample ◽

Second Phase ◽

Heparin Induced Thrombocytopenia ◽

Study Population ◽

Release Assay

Introduction: Heparin induced thrombocytopenia (HIT) is a severe prothrombotic condition, usually triggered by exposure to heparin products. It is characterized by platelet activation induced by the formation of antibodies to the platelet factor 4 (PF4)/ heparin polyanion complexes. Diagnostic algorithm includes clinical scoring (4T score) alongside serological test for detection of these antibodies (HIT-Ab), while serotonin release assay (SRA) remains the gold- standard for confirmation. The automated latex immunoturbidometric assay (LIA) has recently been FDA approved as a screening tool for HIT and is a potential alternative to the conventional particle immunofiltration assay (PIFA) for time-sensitive detection of HIT-Ab to guide treatment considerations. We recently introduced LIA in our institution. In this study, we present our experience with LIA in comparison to PIFA in the diagnosis of HIT. Methods: We retrospectively reviewed the charts of all the patients on whom a PIFA was ordered between March 2017 and March 2018 in our hospital. We collected information on the results of the PIFA and SRA (if available). We replaced PIFA with LIA for HIT screening. Then, we introduced a structured protocol for diagnosis of HIT in our institution by incorporating 4T scoring alongside LIA order in the electronic medical record (EMR), in December 2018. We reviewed the EMR of all the patients on whom HIT-Ab test (LIA) was ordered between January and June of 2019, and collected similar information as before. All the data were compiled in a single master excel sheet for calculation of performance characteristics (sensitivity, specificity, positive and negative predictive values) for both PIFA and LIA. A patient was considered to have the diagnosis of HIT if the result of SRA was available and positive. Results: In the first phase, a total of 31 orders for SRA was noted against 170 PIFA orders. Five patients had a positive SRA, of whom two were PIFA negative. Half the patients with a negative SRA result were positive for PIFA. Hence, the sensitivity and specificity of PIFA test for our study population were noted to be 60% and 50%, respectively. PIFA had a positive predictive value (PPV) of mere 18.75% for the diagnosis of HIT, whereas the negative predictive value (NPV) was found to be 86.66%. Introduction of structured protocol for HIT diagnosis substantially reduced the number of inappropriate SRA orders in the second phase. On review of data for six months with the new HIT-Ab test LIA, SRA was ordered in only eight patients, to go with 69 orders for the LIA. The result of LIA was positive in all three patients with a positive SRA, whereas it was false positive in four instances. Only one patient was negative for both LIA and SRA during this period. LIA was found to be 100% sensitive and 20% specific for the diagnosis of HIT in our sample. PPV and NPV for LIA were 42.85% and 100%, respectively. Conclusion: The sensitivity and specificity of LIA were found to be 100% and 20%, respectively, in our study population, which is different from the earlier report (Warkentin et al. 2017). The small sample size is a limitation of our study. Higher PPV and NPV for LIA, with its quick turnaround time, make it a useful alternative for the time-sensitive determination of post-test probability for HIT in patients. [HIT- Ab- Heparin Induced Thrombocytopenia Antibody, PIFA- Particle Immunofiltration Assay, LIA- Latex Immunoturbidometric Assay, SRA- Serotonin Release Assay, +ve- Positive, -ve - Negative, PPV- Positive Predictive Value, NPV- Negative Predictive Value] Disclosures No relevant conflicts of interest to declare.

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Diagnostic Laboratory Tests for COVID-19 in US: Methodology and Performance

10.21203/rs.3.rs-43374/v1 ◽

2020 ◽

Author(s):

Mrigendra M. Bastola ◽

Craig Locatis ◽

Paul Fontelo

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Small Sample ◽

Published Data ◽

Test Accuracy ◽

Rt Pcr ◽

Likelihood Ratios ◽

Predictive Values

Abstract Background: COVID-19 is a global pandemic caused by a new coronavirus strain. Innovative tests have been developed to diagnose and characterize the spread of COVID-19. Only a few studies have reported the diagnostic value of currently available tests. The diagnostic performance of the tests is a major concern after the recent resurgence in COVID-19. Methods: Published papers and FDA data on the currently available tests were used for analysis. Likelihood ratios, and predictive values of tests were computed. Only FDA approved tests were included. RT-PCR performance among different specimen types were also explored.Main results: All the published reports on the COVID-19 tests reported RT-PCR as the validation tool for their results. Not all available COVID-19 tests reported their sensitivity and specificity. Among the publications which reported, the positive likelihood ratio ranged between 0.15 to 0.88 and tests had high negative likelihood ratio (0.99). Conclusion: Although most recent publications showed high positive and negative likelihood ratios and high predictive values, the publications on test accuracy and validity have limited scope primarily due to their small sample size and insufficiencies in methodology and published data. Although most lab tests reported high sensitivity and specificity, false omission and false discovery rates were found notable in several COVID-19 lab tests. These results suggest need for caution on test results’ interpretation. Practitioners also need to integrate evidence that is evolving rapidly.

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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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Predicting Disease in Transition Dairy Cattle Based on Behaviors Measured Before Calving

Animals ◽

10.3390/ani10060928 ◽

2020 ◽

Vol 10 (6) ◽

pp. 928

Author(s):

Mohammad W. Sahar ◽

Annabelle Beaver ◽

Marina A. G. von Keyserlingk ◽

Daniel M. Weary

Keyword(s):

Dairy Cattle ◽

Sensitivity And Specificity ◽

Roc Curve ◽

Predictive Value ◽

Predictive Ability ◽

Training Dataset ◽

Test Dataset ◽

Increased Risk ◽

High Prevalence ◽

Random Method

Dairy cattle are particularly susceptible to metritis, hyperketonemia (HYK), and mastitis in the weeks after calving. These high-prevalence transition diseases adversely affect animal welfare, milk production, and profitability. Our aim was to use prepartum behavior to predict which cows have an increased risk of developing these conditions after calving. The behavior of 213 multiparous and 105 primiparous Holsteins was recorded for approximately three weeks before calving by an electronic feeding system. Cows were also monitored for signs of metritis, HYK, and mastitis in the weeks after calving. The data were split using a stratified random method: we used 70% of our data (hereafter referred to as the “training” dataset) to develop the model and the remaining 30% of data (i.e., the “test” dataset) to assess the model’s predictive ability. Separate models were developed for primiparous and multiparous animals. The area under the receiver operating characteristic (ROC) curve using the test dataset for multiparous cows was 0.83, sensitivity and specificity were 73% and 80%, positive predictive value (PPV) was 73%, and negative predictive value (NPV) was 80%. The area under the ROC curve using the test dataset for primiparous cows was 0.86, sensitivity and specificity were 71% and 84%, PPV was 77%, and NPV was 80%. We conclude that prepartum behavior can be used to predict cows at risk of metritis, HYK, and mastitis after calving.

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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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Limited predictive value of an acute test with subcutaneous octreotide for long-term IGF-I normalization with Sandostatin LAR in acromegaly

Acta Endocrinologica ◽

10.1530/eje.1.01935 ◽

2005 ◽

Vol 153 (1) ◽

pp. 67-71 ◽

Cited By ~ 27

Author(s):

Wouter W de Herder ◽

H Rob Taal ◽

Piet Uitterlinden ◽

Richard A Feelders ◽

Joop A M J L Janssen ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Clinical Decision Making ◽

Subcutaneous Administration ◽

Clinical Decision ◽

Term Treatment ◽

Predictive Values ◽

Long Term Treatment ◽

Igf I

Objectives: To study whether the growth hormone (GH) response after the subcutaneous administration 50 μg of octreotide (acute octreotide test) has any predictive value for long-term IGF-I normalization with Sandostatin LAR. Design: Twenty four therapy-naive patients with active acromegaly were studied. Results: >75% GH decrease in the acute octreotide test predicted long-term IGF-I normalization with Sandostatin LAR in 8/11 (73%) of patients. 3/13 (23%) patients with <75% GH decrease in the acute octreotide test were long-term biochemically controlled with Sandostatin LAR. Using the >75% GH reduction criterion, the sensitivity and specificity of this test for predicting long-term normalization of serum IGF-I with Sandostatin LAR treatment were 73% and 77%, respectively (positive and negative predictive values: 73% and 77%, respectively). 6/8 (75%) patients with GH suppression to levels <1.1 μg/l and 9/16 (56%) patients with GH suppression to levels <2 μg/l in the acute octreotide test showed normalization of serum IGF-I with long-term Sandostatin LAR treatment. The sensitivity and specificity of GH suppression <1.1 μg/l for predicting of the long-term normalization of serum IGF-I with Sandostatin LAR therapy were 55% and 85%, respectively (positive and negative predictive values: 75% and 69%, respectively). The sensitivity and specificity of GH suppression <2 μg/l for predicting of the long-term normalization of serum IGF-I with Sandostatin LAR therapy were 82% and 46%, respectively (positive and negative predictive values: 56% and 75%, respectively). Conclusion: The acute octreotide is not recommended for clinical decision making with regard to long-term treatment using the long-acting somatostatin analog Sandostatin LAR in acromegaly.

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