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 value of the soluble triggering receptor expressed on myeloid cells‐1 in lower respiratory tract infections: A meta‐analysis

The soluble triggering receptor expressed on myeloid cells‐1 (sTREM‐1) is a promising diagnostic marker for many types of infections. A bivariate meta‐analysis was performed to evaluate its diagnostic value for lower respiratory tract infections (LRTI). We searched PubMed, Cochrane Library and Web of Science (from January 1966 to August 2013) for all trials assessing diagnostic value of sTREM‐1 for LRTI. The pooled sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), diagnostic odds ratio (DOR), the area under summary receiver operator characteristic (SROC) curve and the Q* were calculated. Thirteen studies with 1138 patients were included in our meta‐analysis. The pooled sensitivity and specificity of sTREM‐1 for diagnosis of LRTI was 0.84 and 0.77. The PLR, NLR and DOR were 3.6, 0.21 and 17. The area under SROC curve was 0.88 and the Q* was 0.82. The univariate meta‐regression analysis demonstrated that the assay method for sTREM‐1 significantly affected sensitivity for LRTI. The Q* of sTREM‐1 for diagnosis of community‐acquired LRTI was 0.82, and the area under SROC curve was 0.88. The Q* of sTREM‐1 in diagnosis of hospital‐acquired LRTI was 0.83, and the area under SROC curve was 0.90. The Q* of sTREM‐1 for distinguishing culture‐positive LRTI from culture‐negative diseases was 0.79, and the area under SROC curve was 0.86. Current evidence suggests that sTREM‐1 is an accurate marker of LRTI. The overall diagnostic value of sTREM‐1 for LRTI, community‐acquired LRTI and hospital‐acquired LRTI is similar.     

超声内镜引导下细针穿刺活检对胰腺实性占位定性诊断价值的Meta分析

目的:系统评价超声内镜引导下细针穿刺活检(EUS-FNA)在胰腺实性占位定性诊断中的价值.方法:计算机检索MEDLINE、Cochrane Library、中国生物医学文献数据库、万方数据库、中国学术期刊全文等数据库,检索时间均为建库至2011-10.全面查找有关EUS-FNA诊断胰腺实性占位的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息),根据QUADAS质量评价标准纳入文献的质量.采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型.对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC).结果:共检索出相关文献280篇,按照文献纳入标准,最终纳入18篇文献(均为英文文献).EUS-FNA对胰腺实性占位定性诊断价值分别为:汇总敏感度为0.90[95%CI(0.89-0.92)],汇总特异度为0.95[95%CI(0.93-0.97)],汇总阳性似然比为13.56[95%CI(8.31-22.15)],汇总阴性似然比为0.12[95%CI(0.10-0.15)],汇总诊断优势比为143.62[95%CI(93.98-219.46)],SROC曲线下面积AUC为0.9711,Q*=0.9215.另外,本研究还对有无病理医生在场指导进行了亚组分析,发现有病理医生在场的AUC为0.9757,Q*=0.9295.且汇总诊断优势比173.37[95%CI(98.09-306.44)],明显较无病理医生在场的113.64[95%CI(60.22-214.46)]高.结论:经SROC曲线证实,EUS-FNA活检在胰腺实性占位定性诊断中具有较高的灵敏度和特异度,尤其是有病理医生在场指导的情况下,可作为临床上胰腺实性占位定性诊断的重要检查手段.     

Cyst carcinoembryonic antigen in differentiating pancreatic cysts: A meta-analysis

Background

Using carcinoembryonic antigen in discriminating between benign and malignant disease remains controversial.

Aims

We aim to evaluate the diagnostic accuracy of cyst fluid carcinoembryonic antigen in predicting malignant pancreatic cystic lesions.

Methods

We performed a literature search of MEDLINE and EMBASE. We included studies that compared the diagnostic accuracy of carcinoembryonic antigen with histology. Pooled estimates of diagnostic precision were calculated using random-effects models.

Results

Eight studies (504 patients) were included. The carcinoembryonic antigen cutoff level for determining a malignant cyst ranged from 109.9 to 6000 ng/mL. Pooled estimates of carcinoembryonic antigen in malignant cysts prediction were poor: pooled sensitivity of 63%, pooled specificity of 63%. The positive likelihood ratio was 1.89 and the negative likelihood ratio was 0.62. The diagnostic odds ratio was 3.84. The area under the summary receiver–operating characteristic curve was 0.70. In subgroup analysis of patients with mucinous cysts (mucinous cystic neoplasm and intraductal papillary mucinous neoplasm; 5 studies, 227 patients), pooled sensitivity was 65%, pooled specificity 66% and diagnostic odds ratio 4.74 respectively.

Conclusion

This meta-analysis suggests that the accuracy of carcinoembryonic antigen in differentiating “between benign and malignant” pancreatic cysts was poor. The decision to perform surgical resection for pancreatic cystic lesions should not be based solely on carcinoembryonic antigen level.     

Endobronchial ultrasound‐guided transbronchial needle biopsy for the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies: A meta‐analysis and systematic review

Intrathoracic lymph node metastases in patients with extrathoracic malignancies are a common clinical manifestation. Several studies evaluating intrathoracic lymph node metastases in patients with extrathoracic malignancy by using the endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) have been reported. The objective of this meta‐analysis is to investigate the diagnostic value of EBUS‐TBNA for diagnosing intrathoracic lymph node metastases in patients with extrathoracic malignancies. We systematically searched Cochrane Library, Medline and Embase for relevant studies published prior to May 2013. Studies specifically designed to evaluate the diagnostic accuracy of EBUS‐TBNA for intrathoracic lymph node metastases in patients with an extrathoracic malignancy were selected. Diagnostic accuracy meta‐analysis was conducted by pooling estimates of sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR) and diagnostic odds ratios (DOR) derived from a summary receiver operating characteristic (SROC) analysis of the original studies. Six studies were included, which provided a dataset of 533 patients. EBUS‐TBNA pooled estimates had 0.85 sensitivity (95% confidence interval (CI): 0.80–0.89), 0.99 specificity (95% CI: 0.95–1.00), PLR 28.63 (95% CI: 11.51–71.22) and NLR 0.16 (95% CI: 0.12–0.21). The overall DOR was 179.77 (95% CI: 66.29–487.50). The area under the SROC curve and the diagnostic accuracy were 0.9247 and 0.8588, respectively. Evidence gathered from studies of moderate quality reveals a high degree of diagnostic accuracy of EBUS‐TBNA for diagnosing intrathoracic lymph node metastases in patients with extrathoracic malignancies.     

Association between Ras association domain family 1A promoter methylation and hepatocellular carcinoma: A meta-analysis

AIM:To assess diagnostic accuracy of Ras association domain family 1A(RASSF1A)promoter methylation in body fluids(serum,plasma and whole blood)for hepatocellular carcinoma(HCC).METHODS:Relative information about study characteristics and incidence of RASSF1A methylation was collected.Quality of all included studies was evaluated by Quality Assessment of Diagnostic Accuracy Studies-2.Sensitivity and specificity were pooled using a randomeffect model,and a summary receiver operating characteristic curve was used to demonstrate the overall diagnostic performance.Positive likelihood ratio(PLR),negative likelihood ratio(NLR),and diagnostic odds ratio(DOR)with 95%CI were also calculated.Meta-regression was applied to analyze observed heterogeneity,and Deeks’test was performed to detect publication bias.RESULTS:After a systematic literature review,seven studies with a total of 302 cases of HCC and 250 cases of chronic liver diseases were included in the analysis.The pooled sensitivity and specificity were 0.70(95%CI:0.49-0.85)and 0.72(95%CI:0.54-0.85),respectively.The PLR was 2.51(95%CI:1.64-3.86),NLR was 0.41(95%CI:0.25-0.68),and DOR was 6.13(95%CI:3.17-11.84).Theχ2values of sensitivity,specificity,PLR,NLR and DOR were 59.41(P<0.001),50.50(P<0.001),17.40(P=0.010),31.24(P<0.001)and80.51(P<0.001),respectively.The area under the curve was 0.77(95%CI:0.73-0.81).Three factors were analyzed by univariate meta-regression and none was significant to interpret the observed heterogeneity(P>0.05).No significant publication bias was detected by Deeks’test(P=0.346).CONCLUSION:We showed the potential diagnostic value of RASSF1A methylation in body fluids in HCC patients and it may improve diagnostic accuracy combined with theα-fetoprotein test.     

Diagnostic accuracy of glycated hemoglobin compared with oral glucose tolerance test for diagnosing diabetes mellitus in Chinese adults: A meta-analysis

Aims

A meta-analysis was conducted to evaluate the diagnostic value of glycated hemoglobin (HbA1c) ≥6.5% (48 mmol/mol) for diabetes in Chinese adults.

Methods

Oral glucose tolerance test (OGTT) was selected as the reference standard. PubMed, EMBASE, CNKI, Wanfang Data, and VIP were searched to obtain all diagnostic tests with HbA1c ≥6.5% (48 mmol/mol) for diabetes in Chinese adults published between January 2003 and October 2013. The qualities of the included studies were assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-DiSc software was used to conduct a comprehensive quantitative assessment, and summary receiver operating characteristic (sROC) curves were obtained.

Results

A total of 9 studies with 25,932 subjects were included. Pooled sensitivity was 0.518, pooled specificity 0.956, pooled positive likelihood ratio 19.007 and pooled negative likelihood ratio was 0.477. Pooled diagnostic odds ratio was 40.631. AUC_sROC was 0.929.

Conclusion

Compared with OGTT, using HbA1c ≥6.5% (48 mmol/mol) to diagnose diabetes in Chinese adults exhibited high specificity and low sensitivity and would have failed to diagnose 48.7% of newly diagnosed diabetes. The diagnostic HbA1c value could be reduced to improve sensitivity. Long-term prospective studies are required to establish an appropriate HbA1c value as a diagnostic criterion for diabetes in China.     

Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients

Objective

Peripheral artery disease (PAD) and diabetes mellitus are significant risk factors for all-cause death or cardiovascular death. PAD occurs more frequently in diabetic than in non-diabetic patients. However, the association of ankle-brachial index (ABI), especially borderline ABI, with clinical outcomes has not been fully elucidated in diabetic patients. This study aimed to investigate the association of ABI with mortality and the incidence of PAD in Japanese diabetic patients.

Methods

This observational study included 3981 diabetic patients (61.0 ± 11.8 years of age, 59.4% men), registered in the Kyushu Prevention Study for Atherosclerosis. Patients were divided into 3 groups according to the value of ABI at baseline: ABI ≤0.90 (abnormal ABI:354 patients), 0.91 ≤ ABI ≤ 0.99 (borderline ABI:333 patients), and 1.00 ≤ ABI ≤ 1.40 (normal ABI:3294 patients).

Results

Cumulative incidence of all-cause death was significantly higher in patients with abnormal and borderline ABI than in those with normal ABI (34.4% vs. 13.5%, P < 0.0001 and 26.1% vs. 13.5%, P < 0.0001, respectively). In multivariate analysis, the risks for all-cause death in patients with abnormal ABI (HR:2.16; 95%CI:1.46–3.14; P = 0.0002) and borderline ABI (HR:1.78; 95%CI:1.14–2.70; P = 0.01) were significantly higher than in those with normal ABI. The incidence of PAD was remarkably higher in patients with borderline ABI than in those with normal ABI (32.2% vs.9.6%, P < 0.0001). After adjustment, the risk for PAD was significantly higher in patients with borderline ABI than in those with normal ABI (HR:3.10; 95%CI:1.90–4.95; P < 0.0001).

Conclusions

Borderline ABI in diabetic patients was associated with significantly higher risks for mortality and PAD compared with normal ABI.     

SDC2基因甲基化对结直肠癌诊断价值的Meta分析

目的通过Meta分析方法评价多配体蛋白聚糖2(Syndecan-2,SDC2)基因甲基化作为生物标志物诊断结直肠癌(colorectal cancer,CRC)的价值。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science、CBM、万方、知网、维普数据库,查找建库至2020年9月1日有关SDC2基因甲基化与CRC的研究,按照纳入及排除标准严格筛选文献,提取信息并依据QUADAS-2准则对文献进行质量评价。检验阈值效应及非阈值效应,计算合并灵敏度(sensitivity,Sen)、特异度(specificity,Spe)、阳性似然比(positive likelihood ratio,PLR)、阴性似然比(negative likelihood ratio,NLR)、诊断比值比(diagnostic odds ratio,DOR),绘制综合受试者工作特征曲线(summary receiver operating characteristic curve,SROC)并计算曲线下面积(area under curve,AUC)。采用亚组分析、敏感性分析探讨研究异质性。Deek’s漏斗图用以评价纳入文献偏倚大小。结果共纳入符合标准的文献11篇,包括1419例CRC患者和1363名健康对照者。SDC2甲基化诊断CRC的Sen_合并=0.77(95%CI:0.65~0.86),Spe_合并=0.94(95%CI:0.92~0.96),PLR_合并=14.17(95%CI:9.14~21.99),NLR_合并=0.24(95%CI:0.16~0.38),DOR_合并=58.28(95%CI:28.25~120.20),AUC=0.95(95%CI:0.93~0.97)。亚组分析结果显示,粪便SDC2甲基化对CRC的诊断价值(DOR_合并=84.23,95%CI:55.72~127.35)明显高于血液组(DOR_合并=33.27,95%CI:8.05~137.56)。亚洲地区SDC2甲基化对CRC的诊断价值(DOR_合并=76.44,95%CI:56.03~104.30)明显高于非亚洲地区(DOR_合并=16.50,95%CI:2.97~91.52)。Deek’s漏斗图提示,本研究不存在显著发表偏倚(P=0.840)。结论SDC2基因甲基化对CRC具有极高的诊断价值。     

Diagnostic value of computed tomography‐based pulmonary artery to aorta ratio measurement in chronic obstructive pulmonary disease with pulmonary hypertension: A systematic review and meta‐analysis

ObjectiveWe conducted a meta‐analysis to systematic assess the diagnostic value of computed tomography (CT)‐based pulmonary artery to aorta (PA:A) ratio measurement in COPD with pulmonary hypertension (COPD‐PH).MethodsPublished studies referring to diagnostic accuracy of PA:A ratio for COPD‐PH were screened out from PubMed, Embase, Web of science, China National Knowledge databases (CNKI), Wan fang databases, and VIP databases. We used bivariate random‐effects model to estimate pooled sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR, respectively), and diagnostic odds ratios (DOR). Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were also calculated to summarize the aggregate diagnostic performance.ResultsNine eligible studies were included and the pooled SEN was 69% (95% CI: 59 ~ 78), SPE was 85% (95% CI: 77 ~ 90), PLR was 4.5 (95% CI: 2.8 ~ 7.5), and NLR was 0.36 (95% CI: 0.26 ~ 0.51), respectively. DOR reached 13.00 (95% CI: 6.00 ~ 28.00), and value of AUC was 0.84 (95% CI: 0.81 ~ 0.87). Subgroup analysis indicated that when the value of PA:A ratio was equal or greater than one (PA/A ≥ 1), the combined SEN, SPE, AUC, and DOR was 69%, 89%, 0.90, and 19.65, respectively.ConclusionsPA:A ratio is helpful for appraisal of COPD‐PH, and PA/A ≥ 1 possessed prominent diagnostic accuracy.     

EUS和MRCP对胆总管结石诊断准确性试验的Meta分析

目的通过Cochrane协作网推荐的头对头比较的诊断准确性试验(DTA)的Meta分析方法,系统评价和比较超声内镜(EUS)和磁共振胰胆管成像(MRCP)对胆总管结石的诊断价值。方法检索Ovid Medline、PubMed、EmBase、Cochrane Library、Clinical Trials和ISI Web of Knowledge数据库中建库至2019年1月有关EUS和MRCP对胆总管结石诊断价值的文献。公认的参考标准为经内镜逆行胰胆管造影(ERCP)、术中胆管造影(IOC)或阴性病例临床随访>3个月。使用QUADAS-2工具评价纳入研究的质量。采用RevMan 5.2、STATA 12和Meta-DiSc 1.4软件进行Meta分析,合并诊断效应量,绘制森林图和SROC曲线并计算曲线下面积(AUC),比较EUS和MRCP对胆总管结石的诊断效能。结果共纳入32项研究中的5项,累计病例272例。纳入的研究均未表现出高偏倚风险。随机效应模型合并统计显示,EUS诊断胆总管结石的灵敏度为0.97,特异度为0.90,阳性似然比为7.54,阴性似然比为0.07,诊断比值比(DOR)为162.55。MRCP诊断胆总管结石的灵敏度为0.87,特异度为0.92,阳性似然比为8.99,阴性似然比为0.19,DOR为79.02。EUS的合并DOR明显高于MRCP(P=0.008),进一步分析表明,这主要是由于EUS的灵敏度显著高于MRCP(P=0.006)。两种方式的特异度差异无统计学意义(P=0.42)。SROC曲线显示,EUS和MRCP的AUC分别为0.9771和0.9523,Q*统计量分别为0.9320和0.8936,但差异无统计学意义(P>0.05)。结论EUS和MRCP对胆总管结石均能提供良好的诊断准确性,但EUS具有更高的诊断准确性和灵敏度,且具有相当的特异度。在适当的情况下,EUS应被纳入胆总管结石疑似患者的诊断方式中。     

The accuracy of the physical examination for the detection of lower extremity peripheral arterial disease

BACKGROUND:

Peripheral arterial disease (PAD) is a major risk factor for adverse cardiovascular events. There has been a definite push for wider use of the ankle-brachial index (ABI) as a simple screening tool for PAD. Perhaps this has occurred to the detriment of a thorough physical examination.

OBJECTIVE:

To assess the accuracy of the physical examination to detect clinically significant PAD compared with the ABI.

METHODS:

PADfile, the PAD module of CARDIOfile (the Kingston Heart Clinic’s cardiology database [Kingston, Ontario]), was searched for all patients who underwent peripheral arterial testing. Of 1619 patients, 1236 had all of the necessary data entered. Patients’ lower limbs were divided into two groups: those with a normal ABI between 0.91 and 1.30, and those with an abnormal ABI of 0.90 or lower. Peripheral pulses were graded as either absent or present. Absent was graded as 0/3, present but reduced (1/3), normal (2/3) or bounding (3/3). Femoral bruits were graded as either present (1) or absent (0). Using the ABI as the gold standard, the sensitivity, specificity, negative predictive value (NPV), positive predictive value and overall accuracy were calculated for the dorsalis pedis pulse, the posterior tibial pulse, both pedal pulses, the presence or absence of a femoral bruit and, finally, for a combination of both pedal pulses and the presence or absence of a femoral bruit.

RESULTS:

In 1236 patients who underwent PAD testing and who underwent a complete peripheral vascular physical examination (all dorsalis pedis and posterior tibial pulses palpated and auscultation for a femoral bruit), the sensitivity, specificity, NPV, positive predictive value and accuracy for PAD were 58.2%, 98.3%, 94.9%, 81.1% and 93.8%, respectively.

CONCLUSIONS:

The clinical examination of the peripheral arterial foot pulses and the auscultation for a femoral bruit had a high degree of accuracy (93.8%) for the detection or exclusion of PAD compared with the ABI using the cut-off of 0.90 or lower. If both peripheral foot pulses are present in both lower limbs and there are no femoral bruits, the specificity and NPV of 98.3% and 94.9%, respectively, make the measurement of the ABI seem redundant. The emphasis in PAD detection should be redirected toward encouraging a thorough physical examination.     

Sensitivity and specificity of the ankle--brachial index to diagnose peripheral artery disease: a structured review

The ankle-brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral artery disease (PAD). However, it has shown variable accuracy for identification of significant stenosis. The authors performed a structured review of the sensitivity and specificity of ABI ≤ 0.90 for the diagnosis of PAD. MEDLINE, EMBASE, Cochrane databases, Science Citation Index database, and Biological Abstracts database were searched for studies of the sensitivity and specificity of using ABI ≤ 0.90 for the diagnosis of PAD. Eight studies comprising 2043 patients (or limbs) met the inclusion criteria. The result indicated that, although strict inclusion criteria on studies were formulated, different reference standards were found in these studies, and methods of ABI determination and characteristics of populations varied greatly. A high level of specificity (83.3-99.0%) and accuracy (72.1-89.2%) was reported for an ABI ≤ 0.90 in detecting ≥ 50% stenosis, but there were different levels of sensitivity (15-79%). Sensitivity was low, especially in elderly individuals and patients with diabetes. In conclusion, the test of ABI ≤ 0.90 can be a simple and useful tool to identify PAD with serious stenosis, and may be substituted for other non-invasive tests in clinical practice.     

Regular arrangement of collecting venules under endoscopy for predicting a Helicobacter pylori-negative stomach: A systematic review and meta-analysis

Background and aimsThe regular arrangement of collecting venules (RAC) refers to the appearance of multiple regular tiny veins in the body of the stomach and is considered to be very effective for identifying gastric mucosa with non-Helicobacter pylori infection. This meta-analysis was conducted to systematically evaluate the value of the sign in predicting a Helicobacter pylori-negative stomach and the relevant factors that may affect the performance of this prediction.MethodsTwo biomedical databases (PubMed and EMBASE) were systematically searched through April 20, 2020. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the SROC curve (AUC) were calculated.ResultsFourteen articles with 4070 patients were included. The pooled sensitivity, specificity, PLR, NLR, DOR and AUC for the RAC in predicting non-Hp infection were 0.80 (0.67–0.89), 0.97 (0.93–0.98), 24.8 (12.2–50.8), 0.21 (0.12–0.36), 120 (47–301) and 0.97 (0.19–1.00), respectively.ConclusionsThe RAC is a valuable endoscopic feature for the prediction of patients without Hp infection.     

Prevalence and treatment patterns of lower extremity peripheral arterial disease among patients at risk in ambulatory health settings

Background

Lower extremity peripheral arterial disease (PAD) is underdiagnosed and undertreated in Canada, although data are limited. We sought to measure PAD prevalence and treatment patterns in ambulatory settings.

Methods

Five trained undergraduate pharmacy students screened subjects > 50 years of age in 10 community pharmacies and 4 physician offices in northern and central Alberta. We assessed cardiovascular risk factors, cardiovascular disease (CVD), and use of evidence-based therapies; administered the Edinburgh Claudication Questionnaire; and measured the ankle-brachial index (ABI). Patients with definite claudication but ABI > 0.90, or patients with ABI > 1.30 were referred to the study vascular medicine physician for further assessment. PAD was defined as an ABI ≤ 0.90 at the initial community screening or an exercise ABI of ≤ 0.90 and 20% lower than the resting ABI, or toe-brachial index of ≤ 0.70.

Results

We recruited 361 patients (65.1 ± 9.5 years old, 55% female, 85% white) between July 1 and November 30, 2008. Sixteen subjects had PAD (prevalence 4.4%; 95% confidence interval [CI], 2.3-6.5), and all were previously unaware that they had PAD. Nine patients (2.5%) had PAD only, 7 (1.9%) had both PAD and CVD, 87 (24%) had CVD only, and 259 (72%) had neither PAD nor CVD. Use of antiplatelet agents (44%), angiotensin blockade (56%), or statins (44%) was low in patients with newly diagnosed PAD and without other CVD.

Conclusions

About 1 in 20 ambulatory persons > 50 years of age screened had PAD. All cases of PAD that we found were previously undiagnosed, and there was a large treatment gap for those without concomitant CVD.     

CT-Base Pulmonary Artery Measurementin the Detection of Pulmonary Hypertension: A Meta-Analysis and Systematic Review

To summarize the performance of CT-based main pulmonary artery diameter or pulmonary artery to aorta ratio (PA:A ratio) measurement in detection of pulmonary hypertension by a systematic review and meta-analysis.A comprehensive literature search was performed to identify studies determining diagnostic accuracy of main pulmonary artery diameter or PA:A ratio measurement for pulmonary hypertension. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of the included studies. A bivariate random-effects model was used to pool sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall diagnostic performance.This meta-analysis included 20 publications involving 2134 subjects. Summary estimates for main pulmonary artery diameter measurement in the diagnosis of pulmonary hypertension were as follows: sensitivity, 0.79 (95% CI 0.72–0.84); specificity, 0.83 (95% CI 0.75–0.89); PLR, 4.68 (95% CI 3.13–6.99); NLR, 0.26 (95% CI 0.20–0.33); DOR, 18.13 (95% CI 10.87–30.24); and AUC 0.87. The corresponding summary performance estimates for using the PA:A ratio were as follows: sensitivity, 0.74 (95% CI 0.66–0.80); specificity, 0.81 (95% CI 0.74–0.86); PLR, 3.83 (95% CI, 2.70–5.43); NLR, 0.33 (95% CI 0.24–0.44); DOR, 11.77 (95% CI 6.60–21.00); and AUC 0.84.Both main pulmonary artery diameter and PA:A ratio are helpful for diagnosing pulmonary hypertension. Nevertheless, the results of pulmonary artery measurement should be interpreted in parallel with the results of traditional tests such as echocardiography.     

Insights into the potential use of microRNAs as a novel class of biomarkers in esophageal cancer

MicroRNAs (abbreviated miRNAs) have been demonstrated to be involved in tumorigenesis and cancer development and proposed as promising biomarkers in cancer diagnosis. Numerous studies have observed the aberrant expression of miRNAs in esophageal cancer. However, there are some discrepant results. Thus, we conducted this meta‐analysis to identify the overall accuracy of miRNAs in the diagnosis of esophageal cancer. A comprehensive literature search was conducted in PubMed and other databases using combinations of key words. The summary receiver operator characteristic curves were plotted to assess the overall diagnostic performance of miRNAs. Chi‐squared and I² tests were used to assess the heterogeneity between studies. Additionally, we conducted subgroup and sensitivity analyses to analyze the potential sources of heterogeneity. In total, 33 studies from 12 articles were available in this meta‐analysis. The pooled sensitivity, specificity, positive and negative likelihood ratio (PLR, NLR) diagnostic odds ratio, and area under the curve were 0.80, 0.80, 4.0, 0.25, 16, and 0.87, respectively. Subgroup analyses based on the sample types (saliva‐, serum‐ and plasma‐based) showed no differences in the diagnostic accuracy of each subgroup. An independent meta‐analysis of eight articles was conducted to evaluate the diagnostic accuracy of miRNAs in patients with esophageal squamous cell carcinoma, with a pooled sensitivity of 0.77, specificity of 0.83, PLR of 4.4, NLR of 0.27, diagnostic odds ratio of 16, and area under the curve of 0.87. In conclusion, this meta‐analysis demonstrates the feasibility of using miRNAs as non‐invasive biomarkers to discriminate esophageal cancer from healthy controls. However, further high‐quality studies on more clearly defined esophageal cancer patient are needed to confirm our conclusion.     

A Systematic Review of the Diagnostic Accuracy of Cardiovascular Magnetic Resonance for Pulmonary Hypertension

Background

The diagnostic accuracy of cardiovascular magnetic resonance (CMR) for pulmonary hypertension (PH) compared with right heart catheterization were assessed. The purpose of this systematic review was to comprehensively evaluate the diagnostic accuracy of CMR in evaluating PH.

Methods

Published literature was obtained from PUBMED, Web of Knowledge, Cochrane library, Embase, Biosis Preview, China National Knowledge Infrastructure, and Chongqing VIP databases, and all studies were inclusive until December 2012. Studies relevant to PH and its imaging in CMR and right heart catheterization were included if correlation coefficient was elucidated clearly. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) score was used to assess the quality of studies. Sensitivity and specificity were pooled separately and compared with overall accuracy measures: diagnostic odds ratio and symmetric summary receiver operating characteristic.

Results

Sixteen studies were included in the systematic review. Of all the studies, the most widely used index was ventricular mass index (VMI) of CMR. We performed a meta-analysis for VMI among 429 patients in 5 individual studies, which showed a modest diagnostic accuracy of VMI for PH with a summary sensitivity and specificity of 84% (95% confidence interval, 79%-87%) and 82% (95% confidence interval, 73%-89%), respectively. In addition, the summary positive likelihood ratio was 4.894, indicating that VMI of CMR allows a modest ability to distinguish PH patients from healthy subjects with a cutoff point of 0.45 using functional and structural measures.

Conclusions

This systematic review and meta-analysis indicates that VMI seems to have a moderate sensitivity and specificity for detection of PH. The application values of other parameters still need further investigation.     

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure

Background

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up.

Methods

This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization.

Results

The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average.

Conclusion

NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.     

Diagnostic value of serum anti-C1q antibodies in patients with lupus nephritis: a meta-analysis

The autoantibodies against C1q (anti-C1q) have been reported in patients with systemic lupus erythematosus (SLE). In the past decade, though there were increasing studies suggesting it is relatively specific in lupus nephritis (LN), its overall diagnostic value in LN has not been evaluated. The meta-analysis was conducted to quantitatively evaluate the diagnostic accuracy of autoantibodies against C1q in patients with LN, and to provide more precise evidence of a correlation between anti-C1q antibodies and activity of LN. We searched Medline, Embase and Cochrane databases and contacted authors if necessary. A total of 25 studies including 2,502 patients with SLE and 1,317 with LN met our inclusion criteria for this meta-analysis. Among all 25 studies, 22 studies were available for comparison between SLE with and without LN, and 9 studies compared anti-C1q between patients with active and inactive LN. Summary receiver operating characteristic (SROC) curve was used to summarize comprehensive test performance. The QUADAS tool was used to assess the quality of the studies. For the diagnosis of LN, the pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of anti-C1q were 0.58 (0.56-0.61, 95% confidence interval [95% CI]), 0.75 (0.72-0.77, 95% CI), 2.60 (2.06-3.28, 95% CI), 0.51 (0.41-0.63, 95% CI), and 6.08 (3.91-9.47, 95% CI) respectively. The area under the SROC curve (AUC) was 0.7941. For comparison between active and inactive LN, the weighted sensitivity, specificity, PLR, NLR and DOR were 0.74 (0.68-0.79, 95% CI), 0.77 (0.71-0.82, 95% CI), 2.91 (1.83-4.65, 95% CI), 0.33 (0.19-0.56, 95% CI), and 10.56 (4.56-24.46, 95% CI) respectively. The AUC was 0.8378. In conclusion, this meta-analysis indicates that anti-C1q antibodies have relatively fair sensitivity and specificity in the diagnosis of LN, suggesting that the presence of anti-C1q antibodies may be a valuable adjunct for predicting LN and assessing renal activity.