Circulating microRNA-208 family as early diagnostic biomarkers for acute myocardial infarction: A meta-analysis

Objective:Many recent studies have demonstrated that serum miRNA-208 (miR-208) could be a powerful biomarker in the early diagnosis of acute myocardial infarction (AMI). However, the result of previous studies was not accurate due to the small sample sizes and controversial issues. Therefore, this study was performed to investigate the relationship between the expression levels of miR-208 and AMI.Materials and methods:According to the inclusion and exclusion criteria, a preliminary literature search was performed. The study was based on articles published in PubMed, Embase, Cochrane databases before September 30, 2019. Two staff members extracted data from the included articles for meta-analysis. These data were analyzed for sensitivity, specificity, diagnostic odds ratio, and summary receiver operator curve (SROC) analyses.Results:This study included 13 pieces of literature, which contains 1703 patients with AMI and 1589 controls. The main results of our meta-analysis were as follows: The pool sensitivity and specificity of miR-208 for diagnosing AMI was 83% and 97%. The area under the SROC curve (AUC) was 93%. Mir-208 had a highly effective diagnostic capacity to distinguish AMI from chest pain patients with an AUC of 93%.Conclusions:The results showed that circulating miR-208 was a reliable biomarker both for diagnosting ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). MiR-208 was sufficient to distinguish AMI patients with chest pain from healthy controls.     

Diagnostic value of microRNA-25 in patients with non-small cell lung cancer in Chinese population: A systematic review and meta-analysis

Objective:Previous studies have shown that microRNA-25 (miR-25) plays a key role in the occurrence and development of non-small cell lung cancer (NSCLC). Many studies have shown that there is a significant increment of miR-25 in circulating blood of patients with NSCLC. The meta-analysis aims to explore diagnostic value of miR-25 in NSCLC in Chinese population.Methods:PubMed, Web of science, Excerpta Medica Database, China national knowledge infrastructure and China Wanfang database were searched to collect studies upon correlation between miR-25 and diagnosis of the patients with NSCLC until April 2020. Combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under receiver operating characteristic curve were calculated by Stata 15.0 software. Literature assessment was conducted according to quality assessment of diagnostic accuracy studies, and documents with scores above or equal to 11 were included in this meta-analysis.Results:Six studies were included, including 480 cases with NSCLC and 451 healthy controls. The combined sensitivity (0.75, 95% confidence interval [CI]: 0.69∼0.80), specificity (0.81, 95% CI: 0.76∼0.86), positive likelihood ratio (4.04, 95% CI: 3.14∼5.20), negative likelihood ratio (0.31, 95% CI: 0.25∼0.37), diagnostic odds ratio (13.09, 95% CI: 9.37∼18.29) and area under curve (0.85, 95% CI: 0.82∼0.88) indicated that miR-25 had desirable diagnostic accuracy for NSCLC.Conclusion:MiR-25 can be applied in diagnosis of NSCLC and has potential of becoming a biomarker for detection of patients with early NSCLC in Chinese population.     

Diagnostic value of circulating microRNA-208a in differentiation of preserved from reduced ejection fraction heart failure

BackgroundThere is no satisfactory answer on the specific biomarker that might be used in differentiating heart failure with reduced EF (HFrEF), allowing for inadequacy of N-terminal prohormone brain natriuretic peptide (NT-proBNP).ObjectivesWe aim to evaluate the value of microRNA-208a in diagnosing HFrEF patients.MethodsWe included 120 HF patients and 60 healthy volunteers. Diagnostic values of NT-proBNP and miR-208a for HF patients versus controls and HFrEF versus HFpEF were described by area under curve (AUC), sensitivity and specificity.ResultsHFrEF patients had significantly higher miR-208a level (p<0.001). As for diagnosing HFrEF patients, additional use of miR-208a and NT-proBNP yielded a significantly higher AUC than NT-proBNP alone (0.83, 95% CI 0.76–0.90 vs. 0.73, 95% CI 0.64–0.82) and the sensitivity and specificity were raised to 68.0% and 90.2%.ConclusionUse of miR-208a in combination with NT-proBNP may allow a more reliable method in diagnosing HFrEF patients.     

急性心肌梗死患者循环miR-208b-3p诊断价值的研究

目的：探讨急性心肌梗死患者循环miR-208b-3p与正常健康人的表达是否具有差异,及其在不同亚组中的诊断价值探索。方法：收集140例急性心肌梗死(acute myocardial infarction, AMI)患者入院即刻血浆样本和19例健康人(healthy controls, HC)血浆样本,特异茎环反转录实时定量PCR(qRT-PCR)检测样本miR-208b-3p的表达水平,并与超敏肌钙蛋白I(hs-TnI)和肌酸激酶-同工酶(CK-MB)进行对比分析;qRT-PCR检测ST段抬高性型心肌梗死(ST segment elevation myocardial infarction, STEMI)和非ST段抬高性心肌梗死(non-ST segment elevation myocardial infarction, NSTEMI)患者血浆miR-208b-3p表达水平,ROC曲线评估诊断价值。结果：AMI组和HC组血浆miR-208b-3p的表达量分别为43.86±7.50和2.05±0.62,差异具有统计学意义(P < 0.05);miR-208b-3p与CK-MB呈明显正相关(r = 0.546,P < 0.001),miR-208b-3p、CK-MB和hs-TnI ROC曲线下面积(AUC)分别是0.874(P < 0.001)、0.976(P < 0.001)和0.971(P < 0.001);STEMI亚组和NSTEMI亚组血浆miR-208b-3p表达量分别为55.04±10.44和21.01±7.13,差异具有统计学意义(P < 0.05),AUC分别为0.935(P < 0.001)和0.749(P < 0.01)。结论：循环miR-208b-3p可作为AMI患者的早期诊断标准,但不优于hs-TnI和CK-MB;循环miR-208b-3p对于STEMI亚组的诊断敏感性和特异性高于NSTEMI亚组。     

Expression of microRNA-208 is Associated With Adverse Clinical Outcomes in Human Dilated Cardiomyopathy

BackgroundRecently, microRNA-208 (miR-208) encoded by the α-myosin heavy chain (MHC) gene, has been shown to be involved in pathological cardiac growth, fibrosis, and up-regulation of β-MHC expression. A recent study has also reported 2 additional myosin-expressed miRNAs (miR-208b and miR-499). The aim of this study was to determine whether miR-208, miR-208b, and miR-499 are expressed with MHC mRNA in human dilated cardiomyopathy (DCM), and whether these levels are related to left ventricular (LV) function and to clinical outcomes.Methods and ResultsEndomyocardial biopsy tissues were obtained from 82 patients with DCM and 21 subjects without LV dysfunction as controls. Levels of miR-208, miR-208b, and miR-499 were higher in DCM patients than in controls. Levels of α-MHC mRNA were lower in patients with DCM than in controls, whereas β-MHC mRNA levels were higher in patients with DCM compared with controls. Levels of miR-208 were correlated with β-MHC mRNA levels and myocardial collagen volume, whereas levels of miR-208b and miR-499 showed no correlation. After a mean follow-up of 517 days, an increase in miR-208 levels was shown to be a strong predictor of clinical outcomes (RR 3.4, 95% CI 1.1–11.2).ConclusionsThis study suggests that myocardial expression of miR-208 is associated with MHC mRNA expression and with poor clinical outcomes in patients with DCM. We conclude that miR-208 may therefore be involved in the progression of human DCM.     

Clinical role of miR-421 as a novel biomarker in diagnosis of gastric cancer patients: A meta-analysis

Background:Gastric cancer (GC) has been identified as one of the most common malignancies. It was found that microRNAs can be used as potential biomarkers for GC diagnosis. The aim of this study was to estimate the diagnostic value of 4 potential microRNAs in GC.Methods:PubMed, Embase, Cochrane Library, and Web of Science were used to search published studies. The quality of the studies was scored with the Quality Assessment of Diagnostic Accuracy Studies. The pooled sensitivity and specificity, diagnostic odds ratio (DOR) and area under the curve (AUC) were calculated. The heterogeneity was evaluated using Cochrane Q statistics and the inconsistency index.Results:A total of 22 studies reporting the diagnostic value of miR-21 (n = 9), miR-106 (n = 10), miR-421 (n = 5) and miR-223 (n = 3) were included. Quality Assessment of Diagnostic Accuracy Studies scores showed the high quality of the selected 22 articles. The random effects model was adopted by evaluating the heterogeneity between articles. The DOR, AUC, and Q value of miRNA-21 were 12.37 (95% confidence interval [CI]: 5.36–28.54), 0.86 and 0.79, respectively. The DOR, AUC and Q value of miRNA-106 were 12.98 [95% CI: 7.14–23.61], 0.85 and 0.78, respectively. The DOR, AUC and Q value of miRNA-421 were 27.86 [95% CI: 6.04–128.48], 0.92 and 0.86, respectively. The DOR, AUC and Q value of miRNA-223 were 18.50 [95% CI: 7.80–43.86], 0.87 and 0.80, respectively. These results indicate that miRNA-421 has the highest diagnostic accuracy, followed by miR-223, miRNA-21, and miRNA-106 among the 4 microRNAs in GC.Conclusions:miR-21, miR-106, miR-421, and miR-223 have good diagnostic efficacy, especially miR-421, could be used as auxiliary diagnostic indicator for GC.     

Secretin-stimulated magnetic resonance imaging/magnetic resonance cholangiopancreatography for the detection of chronic pancreatitis: A meta-analysis

ObjectiveTo evaluate the diagnostic accuracy of secretin-stimulated magnetic resonance imaging/magnetic resonance cholangiopancreatography (S-MRI/MRCP) as noninvasive modalities in detecting chronic pancreatitis (CP).MethodsA systematic literature search in the PubMed, EMBASE, Web of Science, Cochrane, and Chinese Biomedical Literature Databases to identify relevant original studies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (version 2). Study data were independently extracted to calculate sensitivity and specificity, as well as areas under summary receiver operating characteristic curves (AUCs), and to test for heterogeneity and the threshold effect.ResultsThe sample comprised 11 studies including 180 patients with CP and 340 patients without CP. Pooled sensitivity and specificity were 0.72 (95% confidence interval [CI] 0.65–0.78) and 0.87 (95% CI 0.83–0.90), respectively. Pooled positive and negative likelihood ratios were 4.99 (95% CI 2.59–9.61) and 0.32 (95% CI 0.19–0.54), respectively. The diagnostic odds ratio was 23.31 (95% CI 7.50–72.44). The AUC and Q¹ index were 0.8631 and 0.7937, respectively. Publication bias was absent (P = 0.64).ConclusionsS-MRI/MRCP had low sensitivity and moderately high specificity for the detection of CP. Large-scale, quality-controlled, prospective studies are needed to verify the diagnostic accuracy of these modalities.     

Poor increase on HAV vaccination coverage among people living with HIV after an immunization-based intervention

ObjectivesTo assess HAV serologic and vaccination status among people who live with HIV (PLWH), and to evaluate the impact of a vaccination-based strategy on HAV-negative patients in Seville, Spain.MethodsStudy with two time-overlapping phases: (i) cross-sectional study of HAV immunity prevalence among PLWH followed at a Spanish hospital between August 2019 and March 2020. (ii) Patients seronegative for HAV, reliably unvaccinated were included in a before-and-after quasi-experimental study, with an intervention focused on HAV vaccination according to national recommendations in force.ResultsSix hundred and fifty-six patients were included, of which 111 [17%, 95% confidence interval (95% CI) 14–20%] were seronegative for HAV. Of these, 48 [43% (95% CI, 34–53%)] individuals were MSM. The absence of HAV immunity was attributed in 69 [62% (95% CI, 52–71%)] patients to non-referral to vaccination, followed by lack of achievement of a correct vaccination scheme [n = 26; 23% (95% CI, 16–32%)]. After the program implementation, 96 [15% (95% CI, 12–18%)] individuals were seronegative (17% vs. 15%, p = 0.256), of whom 42 [41% (95% CI, 32–51%)] were MSM. The absence of immunity after the intervention was mainly attributed to: adherence failure in 23 [24.0% (95% CI, 15.8–33.7%)] patients, on-course immunization scheme in 34 [33% (95% CI, 24–43%)] individuals and pending appointment at the vaccine delivery unit in 20 [20.8% (95% CI, 13.2–30.3%)] patients.ConclusionsA sizeable proportion of PLWH remains susceptible for HAV infection in future outbreaks. A program based on referral to the vaccine delivery unit yields poor results, largely due to program adherence failures. New strategies are needed to increase HAV vaccination coverage.     

Endoscopic ultrasound guided fine needle aspiration for the diagnosis of intra-abdominal lymphadenopathy: a systematic review and meta-analysis

Abstract

Background: It is difficult to diagnose the cause of abdominal lymphadenopathy without determining the primary lesions. With the advent of curved ultrasound endoscopy, EUS-FNA can sample lymph nodes safely, accurately and conveniently. Due to the lack of formal quantitative and comprehensive literature review to determine the diagnostic value of EUS-FNA in the diagnosis of enlarged intra-abdominal lymph nodes of unknown origin, we conducted this study to systematically evaluate the diagnostic accuracy of EUS-FNA in the enlarged intra-abdominal lymph nodes.

Methods: We performed a systematic review and meta-analysis to evaluate the accuracy of EUS-FNA for the diagnosis of intra-abdominal lymphadenopathy. We searched PubMed, Embase, and Cochrane Library to collect related studies and diagnostic performance data. We used a random-effects model to estimate the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR). Heterogeneity was assessed by subgroup and meta-regression analysis.

Results: Twelve eligible studies involved 774 patients were identified. The pooled sensitivity and specificity of all studies is 94% (95% CI: 91% to 96%) and 98% (95% CI: 96% to 99%), respectively. The pooled positive and negative likelihood ratios are 17.44 (95% CI, 6.50 to 46.79) and 0.09 (95% CI: 0.06 to 0.14). The pooled DOR is 277.82 (95% CI, 97.65 to 790.46).

Conclusions: EUS-FNA is a safe and feasible technique with high sensitivity and specificity for the diagnosis of abdominal lymph node enlargement. Considering the limitations and heterogeneity, high-quality studies are needed to further explore the diagnostic value of EUS-FNA.     

Accuracy and clinical effect of out-of-hospital electrocardiography in the diagnosis of acute cardiac ischemia: a meta-analysis

STUDY OBJECTIVE: We sought to evaluate quantitatively the evidence on the diagnostic performance of out-of-hospital ECG for the diagnosis of acute cardiac ischemia (ACI) and acute myocardial infarction (AMI) and the clinical effect of out-of-hospital thrombolysis. METHODS: We conducted a systematic review and meta-analysis of the English-language literature published between 1966 and December 1998 on the diagnostic accuracy of out-of-hospital ECG and the clinical effect of out-of-hospital thrombolysis. Both prospective and retrospective studies qualified for the assessment of diagnostic performance. For clinical effect, data from prospective nonrandomized studies were synthesized separately from data from randomized trials. Diagnostic performance was assessed by using estimates of test sensitivity, specificity, and diagnostic odds ratios and was summarized by using summary receiver-operating characteristic curves. Measures of clinical effect included time savings, early ventricular function, early mortality, and long-term survival. RESULTS: Diagnostic accuracy was evaluated in 11 studies with a total of 7,508 patients. Data were available for ACI in 5 studies and for AMI in 8 studies. For ACI, the random-effects pooled sensitivity was 76% (95% CI, 54% to 89%), the specificity was 88% (95% CI, 67% to 96%), and the diagnostic odds ratio was 23 (95% CI, 6.3 to 85). The respective figures for AMI were sensitivity of 68% (95% CI, 59% to 76%), specificity of 97% (95% CI, 89% to 92%), and diagnostic odds ratio of 104 (95% CI, 48 to 224). Both in nonrandomized (n=4, total 1,531 patients) and randomized (n=9, total 6,643 patients) studies, out-of-hospital thrombolysis shortened the time from onset of symptoms to thrombolytic treatment by 40 to 60 minutes. Data on short-term ejection fraction were sparse. Hospital mortality was reduced by 16% (95% CI, 2% to 27%) among randomized trials, and a similar estimate of effect was seen in nonrandomized studies. There was no clear effect on long-term mortality, but data were sparse. CONCLUSION: Out-of-hospital ECG has excellent diagnostic performance for AMI and very good performance for ACI. Out-of-hospital thrombolysis achieves time savings and improves short-term mortality, but the effect on long-term mortality is unknown.     

Diagnostic accuracy of blood biomarkers and non-invasive scores for the diagnosis of NAFLD and NASH: Systematic review and meta-analysis

Introduction and objectivesFatty liver disease is an important public health problem. Early diagnosis is critical to lower its rate of progression to irreversible/terminal stages. This study aimed to evaluate the accuracy of non-invasive prediction scores for fatty liver disease (NAFLD and NASH) diagnosis in adults.Materials and methodsA search was conducted in 10 databases, a qualitative synthesis of 45 studies, and quantitative analysis of the six most common scores. There were 23 risk scores found for NAFLD diagnosis and 32 for NASH diagnosis. The most used were Fatty Liver Index (FLI), aspartate aminotransferase (AST) to Platelet Ratio Index, Fibrosis-4 Index (FIB-4), AST/alanine aminotransferase (ALT) ratio, BARD score, and NAFLD fibrosis score (NFS).ResultsThe results from the meta-analysis for FLI: Area under the curve (AUC) of 0.76 (95% Confidence Interval [CI] 0.73, 0.80), sensitivity 0.67 (CI 95% 0.62, 0.72) and specificity 0.78 (CI 95% 0.74, 0.83). The AST to Platelet Ratio Index: AUC 0.83 (CI 95% 0.80, 0.86), sensitivity 0.45 (95% CI 0.29, 0.62), and specificity of 0.89 (95% CI 0.83, 0.92). The NFS: AUC of 0.82 (CI 95% 0.78, 0.85), sensitivity 0.30 (CI 95% 0.27, 0.33) and specificity 0.96 (CI 95% 0.95,0.96).ConclusionsThe FLI for NAFLD and AST to Platelet Ratio Index for NASH were the risk scores with the highest prognostic value in the included studies. Further research is needed for the application of new diagnostic risk scores for NAFLD and NASH.     

Effectiveness of contrast-enhanced ultrasound for the diagnosis of acute pancreatitis: A systematic review and meta-analysis

ObjectiveTo systematically determine the diagnostic value of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis.MethodsRelevant studies were identified by searching the database up to December 2016. Patient clinical characteristics and diagnostic sensitivity and specificity were extracted. The summary receiver operating characteristic (ROC) curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in the diagnosis and evaluation of acute pancreatitis.ResultsFrom 27 citations, seven were included in the meta-analysis, with a total of 421 cases. We detected the heterogeneity of the studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.92 (95% CI: 0.88, 0.95), the specificity was 0.84 (95% CI: 0.78, 0.90), the positive likelihood ratio was 5.38 (95% CI: 3.21, 9.00), the negative likelihood ratio was 0.13 (95% CI: 0.05, 0.36), and the diagnostic odds ratio was 49.37 (95% CI: 14.69, 165.94). The area under the ROC curve was 0.9273 (95% CI: 0.8916, 0.9790).ConclusionsCEUS is a reliable, non-invasive imaging modality with no radiation exposure and a high sensitivity and specificity for the assessment of severity of acute pancreatitis. Nonetheless, it should be applied cautiously, and large-scale, well-designed trials are necessary to assess its clinical value.     

Diagnostic value of sepsis biomarkers in hematopoietic stem cell transplant recipients in a condition of high prevalence of gram-negative pathogens

Objective/backgroundA decision about the need for antimicrobial therapy in a patient with febrile neutropenia after hematopoietic stem cell transplantation (HSCT) is often complicated because of the low frequency of culture isolation and reduced clinical manifestation of infection. Usefulness and choice of sepsis biomarkers to distinguish bloodstream infection (BSI) from other causes of febrile episode is still argued in HSCT recipients in modern epidemiological situations characterized by the emergence of highly resistant gram-negative microorganisms. In this study a comparative analysis of diagnostic values of presepsin, procalcitonin (PCT), and C-reactive protein (CRP) was performed as sepsis biomarkers in adult patients after HSCT in a condition of high prevalence of gram-negative pathogens.MethodsA prospective observational clinical study was performed at the Center of Hematology and Bone Marrow Transplantation in Minsk, Republic of Belarus. The biomarkers (presepsin, PCT, and CRP) were assessed in a 4-hour period after the onset of febrile neutropenia episode in adult patients after HSCT. Microbiologically-confirmed BSI caused by a gram-negative pathogen was set as a primary outcome.ResultsClinical and laboratory data were analyzed in 52 neutropenic patients after HSCT aged 18–79 years. Out of the biomarkers assessed, the best diagnostic value was shown in presepsin (area under the curve [AUC]: 0.889, 95% confidence interval [CI]: 0.644–0.987, p < .0001) with 75% sensitivity and 100% specificity, then in PCT (AUC: 0.741, 95% CI: 0.573–0.869, p = .0037) with 62% sensitivity and 88% specificity. The optimal cut-off value for CRP was set as 165 mg/L, while it had an average diagnostic value (AUC: 0.707, 95% CI: 0.564–0.825, p = .0049) with low sensitivity (40%) and should not be routinely recommended as a biomarker in adult patients with suspected BSI after HSCT.ConclusionPresepsin may be recommended in adult patients with suspected gram-negative BSI after HSCT as a possible additional supplementary test with a cut-off value of 218 pg/mL. PCT is inferior to presepsin in terms of sensitivity and specificity, but still shows a good quality of diagnostic value with an optimal cut-off value of 1.5 ng/mL. CRP showed an average diagnostic value with low sensitivity (40%) and should not be routinely recommended as a biomarker in adult patients with suspected BSI after HSCT in a condition of high prevalence of gram-negative pathogens.     

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting

ObjectiveTyphoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children.MethodsPatients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness.ResultsBlood culture was positive in only 27.3% of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90% (95% CI = 74.4–96.5), 100% (95% CI = 90.1–100), 100% (95% CI = 87.5–100), and 92.1% (95% CI = 79.2–97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7% (95% CI = 70.3–94.7), 85.7% (95% CI = 70.6–93.7), 83.9% (95% CI = 67.4–92.9), 88.2% (95% CI = 73.4–95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3% (95% CI = 19.8–36.3), 64.6% (95% CI = 55.3–72.9), 89.1% (95% CI = 81.9–93.7), 80.9% (95% CI = 72.6–87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2% (95% CI = 69.4–94.5)] followed by Diazo [79% (95% CI = 61.6–90.2)], Widal [41.4% (95% CI = 25.5–59.3)] and blood culture [31% (95% CI = 17.3–49.2)].ConclusionBoth Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.     

Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: A meta-analysis

Background and objectiveEUS-FNA of pancreatic lesion has been put into clinical use widely in many centers. The present meta-analysis was conducted to study the diagnostic role of EUS-FNA in pancreatic cancer.MethodsA comprehensive review of study on the precision of EUS-FNA in the diagnosis of pancreatic cancer. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). A summary receiver-operating characteristic (SROC) was constructed to summarize the overall test performance.ResultsThirty-one articles were eligible for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS-FNA in the diagnosis of pancreatic cancer were 0.89 (95% CI: 0.88–0.90), 0.96 (95% CI: 0.95–0.97), 16.88 (95% CI: 10.63–26.79), 0.13 (95%CI: 0.10–0.16) and 150.80 (95%CI: 95.94–237.03) respectively. In subgroup meta-analysis of the prospective studies, the pooled sensitivity, specificity, PLR, NLR and DOR were 0.91 (95% CI: 0.90–0.93), 0.94 (95% CI: 0.91–0.96), 11.19 (95% CI: 6.36–19.69), 0.10 (95% CI: 0.07–0.15) and 125.22 (62.37–251.41). The area under the curve (AUC) was 0.97, indicating a good performance of overall accuracy.ConclusionEUS-FNA has the high sensitivity and specificity in differentiating pancreatic cancer. Moreover, it is also a safe diagnostic modality with little complications.     

Diagnostic accuracy of electronic surveillance tool for catheter-associated urinary tract infections in tertiary care hospitals: A meta-analysis

Background:Automated systems have been developed to reduce labor-intensive manual recordings during nosocomial infection surveillance. The diagnostic accuracies of these systems have differed in various settings.Methods:We designed this meta-analysis to evaluate the diagnostic accuracy of an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs) in tertiary care hospitals. We systematically searched databases such as Medline, Scopus, Cochrane library and Embase (from inception until November 2019) for relevant studies. We assessed the quality of trials using the diagnostic accuracy studies-2 tool, and performed a meta-analysis to obtain a pooled sensitivity and specificity for electronic surveillance. We included 6 studies with 16,492 patients in the analysis.Results:We found a pooled sensitivity of electronic diagnostic surveillance for CAUTIs of 97.5% (95% confidence interval [CI], 67.6–99.9%) and a pooled specificity of 92.6% (95% CI, 55.2–99.2%). The diagnostic odds ratio was 494 (95% CI, 89–2747). The positive likelihood ratio was 13.1 (95% CI, 1.63–105.8) and the negative likelihood ratio 0.02 (95% CI, 0.001–0.40). A bivariate box plot indicated the possibility of heterogeneity between the included studies.Conclusion:Our review suggests that electronic surveillance is useful for diagnosing CAUTIs among hospitalized patients in tertiary care hospitals due to its high sensitivity and specificity.     

Diagnostic Utility of Cardiac Biomarkers in Discriminating Takotsubo Cardiomyopathy From Acute Myocardial Infarction

BackgroundTakotsubo cardiomyopathy (TC) mimics acute myocardial infarction (AMI). We postulated that ventricular dysfunction in TC in the absence of significant myocardial necrosis would produce higher B-type natriuretic peptide (BNP)/troponin T (TnT) and BNP/creatine kinase MB fraction (CKMB) ratios than in AMI.Methods and ResultsWe studied 58 consecutive TC (age 65.8 ± 82.9) and 97 AMI patients (age 59.8 ± 83.4). The ratios of BNP/TnT and BNP/CKMB were calculated with the use of first simultaneously drawn laboratory values. Receiver operating characteristic curves were used to distinguish TC from AMI with 95% specificity based on cardiac biomarker ratios. Median BNP/TnT and BNP/CKMB ratios were, respectively, 1,292 [interquartile range 443.4–2,657.9] and 28.44 [13.7–94.8] in the TC group and 226.9 [69.91–426.32] and 3.63 [1.07–10.02] in the AMI group (P < .001). TC can be distinguished from AMI with 95% specificity with the use of BNP/TnT ratio ≥1,272 (sensitivity 52%) and BNP/CKMB ratio ≥29.9 (sensitivity 50%).ConclusionsThe value of BNP is significantly higher in TC than in AMI. Early BNP/TnT and BNP/CKMB ratios help to differentiate TC from AMI with greater accuracy than BNP alone.     

Diagnostic accuracy of interleukin-33 for tuberculous pleural effusion: A systematic review and meta-analysis

Background:The detection of interleukin 33 (IL-33) in pleural effusion may be more sensitive in diagnosing tuberculous pleural effusion (TPE). The present study aimed to assess the accuracy of pleural IL-33 for the diagnosis of TPE by means of meta-analysis and systematic review of relevant studies.Method:After retrieving the published studies, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and a summary receiver operating characteristic curve were assessed to estimate the usefulness of pleural IL-33 in diagnosing TPE using meta-analysis with a random-effects model. We also performed meta-regression and subgroup analysis.Results:A total of 639 patients from 6 studies were analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.87 (95% confidence interval [CI], 0.82–0.91), 0.76 (95% CI, 0.72–0.80), 6.54 (95% CI, 2.65–16.15), 0.17 (95% CI, 0.10–1.27), and 45.40 (95% CI, 12.83–160.70) respectively. The area under the curve was 0.94. The composition of the included population was the main cause of heterogeneity and subgroup analysis showed that pleural IL-33 had a higher specificity (0.93, 95% CI 0.87–0.96) when used for differential diagnosis between TPE and malignant pleural effusion.Conclusion:The detection of IL-33 alone in pleural effusion seems to not be an efficient diagnostic marker for TPE but may serve as a novel biomarker to differentiate between TPE and malignant pleural effusion.     

Diagnostic performance of 2 h postprandial capillary and venous glucose as a screening test for abnormal glucose tolerance

AimsTo evaluate the diagnostic performance of postprandial venous and capillary glucose to screen for abnormal glucose tolerance in primary care setting.MethodsBoth post-breakfast venous plasma and capillary blood glucose were taken simultaneously from a consecutive sample of volunteer civil service workers in Khon Kaen, Thailand between June and December 2009. The 75-g oral glucose tolerance test was performed within 3 days of the baseline visit. Both postprandial capillary and venous glucose were assessed for sensitivity, specificity, area under the receiver operating characteristic (ROC) curve and likelihood ratio using the oral glucose tolerance test (OGTT) results for the diagnosis of abnormal glucose tolerance as a gold standard.Results1102 volunteers participated, of whom 874 (79.3%) completed the full study protocol. Five-hundred and four (57.8%) of 874 participants were female. The mean age was 39.9 years (SD = 12.16) and the mean BMI was 24.3 kg/m² (SD = 6.86). The sensitivity and specificity at the optimal cut-off point for venous glucose were 68.28% (95% CI 60.04–75.75) and 67.90% (95% CI 64.38–71.28), respectively. The sensitivity and specificity at the optimal cut-off point for capillary glucose were 63.45% (95% CI 55.05–71.28) and 64.06% (95% CI 60.46–67.55), respectively. The area under the ROC curve was 0.73 (95% CI 0.68–0.78) for venous glucose and 0.69 (95% CI 0.64–0.74) for capillary glucose. The subgroup analysis involving individuals with waist circumference > 90 cm improved the area under the curve (AUC) to 0.76 (95% CI 0.68–0.83).ConclusionsPostprandial blood glucose testing had a moderate discriminating characteristic for the diagnosis of abnormal glucose tolerance. Careful consideration is needed when using it to screen for this condition in general population.