Korean Addenbrooke's Cognitive Examination Revised (K‐ACER) for differential diagnosis of Alzheimer's disease and subcortical ischemic vascular dementia

Aim: Sensitive, specific neuropsychological screening tests, such as the Addenbrooke's Cognitive Examination Revised (ACE‐R), are essential for dementia diagnosis. We aimed to validate the use of the Korean version of ACE‐R (K‐ACER) to differentiate Alzheimer's disease (AD) from subcortical ischemic vascular dementia (SIVD). Methods: Standard tests for dementia screening were applied to 156 subjects (84 controls, 30 AD, 42 SIVD), and total and sub‐domain scores on the K‐ACER, as well as the sub‐domain ratio (VLOM), were compared. Results: The reliability of the K‐ACER was very good (α‐coefficient 0.84), and cut‐off score for dementia was determined (cut‐off value 78, sensitivity 0.93, specificity 0.95). The likelihood ratio for dementia was calculated as between 78 and 82. At a cut‐off of 78, the likelihood of dementia was 18.6:1. Although a comparison of K‐ACER scores between AD and SIVD patients revealed significant differences in verbal fluency, language domain and VLOM ratio, sensitivity and specificity for differential diagnosis between AD and SVID proved less accurate. Conclusion: The K‐ACER is a rapid, sensitive and specific dementia screening test. Though sub‐domains of items may be useful for differentiating between AD and SIVD, sensitivity and specificity is less accurate than dementia screening itself. Geriatr Gerontol Int 2010; 10: 295–301.     

Utility of the Addenbrooke's Cognitive Examination – Revised for the diagnosis of dementia syndromes

Aim: To evaluate the utility of the Addenbrooke's Cognitive Examination – Revised (ACE‐R) as a screening tool for dementia. Method: Prospective audit of 122 patients (82 with dementia, 40 with no dementia) referred to a Sydney cognition clinic. Results: An ACE‐R cut‐off score of 84/100 provided an optimal balance of sensitivity, specificity and positive predictive value (0.85, 0.80 and 0.90, respectively) in identifying patients with dementia. In our sample, the ACE‐R was a superior dementia screening tool to the Mini‐Mental State Examination in patients with higher levels of education (≥10 years of formal schooling), but not in patients with lower levels of education. Patients misclassified by the instrument had evidence of high levels of education, focal executive dysfunction, medical comorbidities, significant vascular disease and polypharmacology. Conclusions: The ACE‐R is a useful screening tool for detecting the presence of dementia in a cognition clinic setting. Caution may be warranted in some patient populations.     

Diagnostic Accuracy of the Chinese Version of the Trail‐Making Test for Screening Cognitive Impairment

Background/Objectives

The Trail‐Making Test (TMT), which is commonly used to measure executive function, consists of two components (TMT‐A and TMTB). There is a lack of normative TMT data for Chinese elderly adults. This study aimed to evaluate the validity of the TMT in screening for cognitive impairment.

Design

2,294 Chinese‐speaking adults aged 50 to 85: 1,026 with normal cognition (NC), 462 with mild cognitive impairment (MCI), 108 with Alzheimer's disease (AD), 113 with vascular mild cognitive impairment (VaMCI), 121 with vascular dementia (VaD), 282 with uncertain types of dementia, and 15 with mixed dementia. Receiver operating characteristic curve analysis was performed to test the ability of TMT scores to differentiate between NC and cognitive impairment.

Results

Age, education, and sex were significantly associated with TMT completion time. The TMT‐A exhibited sensitivity of 77.8% and specificity of 92.0% with cut‐off value of 98.5 seconds for discriminating AD from NC. The TMT‐B had sensitivity of 83.3% and specificity of 91.8% with a cut‐off value of 188.5 seconds for discriminating AD from NC. The TMT‐A had sensitivity of 85.7% and specificity of 81.6% for discriminating NC from VaD with a cut‐off value of 77.5 seconds, and the TMT‐s had sensitivity of 81.6% and specificity of 83.9% with a cut‐off value of 147.5 seconds. The TMT had less sensitivity distinguishing MCI from NC.

Conclusion

The Chinese version of the TMT is reliable for detecting AD or VaD but poor at distinguishing MCI from NC.     

Efficacy of leukocyte esterase dipstick test as a rapid test in diagnosis of spontaneous bacterial peritonitis

INTRODUCTION Apart from variceal bleeding, spontaneous bacterial peritonitis (SBP) is another serious complication that can develop in cirrhotic patients. Prompt diagnosis and treatment are essential for the survival of patients with SBP[1,2]. Unfortunate…     

Coagulation and inflammation biomarkers may help predict the severity of community‐acquired pneumonia

Background and objective: There are limited data on the relationship between the severity of community‐acquired pneumonia (CAP) and biomarkers of inflammation and coagulation. The aim of this study was to evaluate the association between the severity of CAP and serum levels of antithrombin III (AT‐III), protein C (P‐C), D‐dimers (D‐D) and CRP, at hospital admission. Methods: This was a prospective observational study in 77 adults (62.3% men), who were hospitalized for CAP. The severity of CAP was assessed using the confusion, uraemia, respiratory rate ≥30 breaths/min, low blood pressure, age ≥65 years (CURB‐65) score. Results: Forty patients (52%) had severe CAP (CURB‐65 score 3–5). Serum levels of AT‐III were lower and levels of D‐D and CRP were higher in patients with severe CAP than in patients with mild CAP (CURB‐65 score 0–2) (P < 0.001 for all comparisons). Levels of P‐C were lower in patients with severe CAP compared with those with mild CAP, but the difference was not significant (P = 0.459). At a cut‐off point of 85%, AT‐III showed a sensitivity of 80% and a specificity of 75%, as a determinant of the need for hospitalization. At a cut‐off point of 600 ng/mL, D‐D showed a sensitivity of 90% and a specificity of 75% and at a cut‐off point of 110 mg/L, CRP showed a sensitivity of 83% and a specificity of 79%, as determinants of the need for hospitalization. Conclusions: Serum levels of AT‐III, D‐D and CRP at admission appear to be useful biomarkers for assessing the severity of CAP.     

Performance of a third‐generation TSH‐receptor antibody in a UK clinic

Background UK national guidelines recommend the measurement of TSH receptor antibodies (TRAb) in certain clinical scenarios. A commercial third‐generation TRAb autoantibody M22‐biotin ELISA assay was introduced in May 2008 in our centre. Objective To evaluate the diagnostic performance of a TRAb assay in a retrospective and subsequently a prospective cohort in a UK centre. Design A retrospective review of patients with thyroid disease followed by a prospective observational study in consecutive patients with newly found suppressed serum thyrotrophin (TSH). Patients and Measurements Medical records of 200 consecutive patients with thyroid disorders who had TRAb measured since the introduction of the assay. In a prospective study 44 patients with newly identified hyperthyroidism (TSH < 0·02 mIU/l) had sera assayed for TRAb prior to their clinic appointment at which a final diagnosis was sought. Results In the retrospective cohort, the manufacturer’s cut‐off point of TRAb ≥0·4 U/l resulted in a positive predictive value (PPV) of 95%, sensitivity 85%, specificity 94% and negative predictive value (NVP) 79% to diagnose Graves’ disease using defined criteria. Receiver operating characteristic (ROC) analysis determined an optimal cut‐off point of TRAb ≥3·5 U/l with a 100% specificity to exclude patients without Graves’ disease at the cost though of a lower sensitivity (43%). In the prospective study, the sensitivity, PPV, specificity and NPV were all 96% using the ≥0·4 U/l cut‐off. When combining hyperthyroid patients from both cohorts the assay sensitivity and specificity at ≥0·4 U/l cut‐off were 95% and 92% respectively. A positive TRAb result increased the probability of Graves’ disease for a particular patient by 25–35% and only six (2·5%) patients had a diagnosis of hyperthyroidism of uncertain aetiology after TRAb testing. Conclusions The assay studied specifically identifies patients with Graves’ disease. It is a reliable tool in the initial clinical assessment to determine the aetiology of hyperthyroidism and has the potential for cost‐savings.     

Diagnostic accuracy of des‐gamma‐carboxy prothrombin for hepatocellular carcinoma in a French cohort using the Lumipulse® G600 analyzer

The increasing incidence of hepatocellular carcinoma (HCC) in Western countries requests reliable tumour markers for preclinical diagnosis. We evaluated the diagnostic accuracy of des‐gamma‐carboxy prothrombin (DCP), in comparison with alpha‐fetoprotein (AFP) in a French cohort using a new analyser. One hundred and sixty‐two patients with virus‐related cirrhosis (46 HCC patients and 116 controls) were recruited in this retrospective proof‐of‐concept study. DCP was measured on new Lumipulse^® G600 analyzer and AFP on usual Cobas e602 analyzer in serum samples that were collected at the time of HCC diagnosis for HCC patients or during follow‐up for controls. DCP and AFP levels were higher in HCC patients. The area under receiver operating characteristic curve was larger for DCP than for AFP (0.89 vs 0.77, P=.03). At the cut‐off value of 128 mAU/mL, sensitivity and specificity for DCP were 74% and 92%. At the cut‐off value of 20 μg/L, sensitivity and specificity for AFP were 63% and 82%. NRI_>0 for the association of “AFP+DCP” were 101%, P<.0001, and 23%, P=.03, compared to “AFP” or “DCP” alone, respectively. We conclude that DCP outperformed AFP for the detection of HCC.     

Strategies to detect abnormal glucose metabolism in people at high risk of cardiovascular disease from the ORIGIN (Outcome Reduction with Initial Glargine Intervention) trial population

Background: To investigate whether the combination of HbA1c and fasting plasma glucose (FPG) can be used for the diagnosis of diabetes and impaired glucose tolerance (IGT) in people at high risk of cardiovascular disease (CVD). Methods: A cross‐sectional study was performed on 2907 people at high risk of cardiovascular events but without a previous diagnosis of diabetes. Optimal cut‐off points and the diagnostic potential of FPG, HbA1c, and their combination were determined. Results: The sensitivity of the usually applied FPG cut‐off point of 7.0 mmol/L to diagnose diabetes mellitus was low (59.0%). Receiver operating characteristic (ROC) curve analysis indicated that the optimal cut‐off points for the diagnosis of diabetes using FPG and HbA1c were 6.4 mmol/L (sensitivity 75.7%; specificity 77.5%; likelihood ratio 3.37) and 5.9% (41 mmol/mol; sensitivity 68.7%; specificity 67.1%; likelihood ratio 2.09), respectively. To diagnose IGT, the optimal cut‐off points for FPG and HbA1c were 6.1 mmol/L (sensitivity 57.1%; specificity 57.9%) and 5.7% (39 mmol/mol; sensitivity 63.8%; specificity 60.3%), respectively. For diabetes, combining cut‐off points for FPG and HbA1c identified four categories with likelihood ratios ranging from 5.59 to 0.21, and post‐test probabilities between 69.3% and 7.8%. For IGT, likelihood ratios varied between 2.05 and 0.56, whereas post‐test probabilities ranged from 84.0% to 58.8%. Conclusions: Using FPG alone results in the underdiagnosis of glucometabolic abnormalities in people at high risk of CVD. Using an algorithm with both HbA1c and FPG improves the detection of diabetes, but not IGT, and could be easily implemented in patient care.     

Point‐of‐care testing as a tool for screening for diabetes and pre‐diabetes

Aim To determine the utility of finger‐prick point‐of‐care testing (POCT) of blood glucose for the detection of dysglycaemia. Methods A fasting POCT and an oral glucose tolerance test (OGTT) with laboratory assays were performed as part of the baseline screening for 5309 participants enrolled in the Te Wai o Rona Diabetes Prevention Strategy. Participants were aged 46 ± 19 years with no self‐reported diabetes. Dysglycaemia, including diabetes, was defined using World Health Organization criteria. Agreement between the two fasting plasma glucose measurements and their screening properties (with sensitivity and specificity for cut points) were compared using receiver operator characteristic analysis. Results A total of 3225 participants had both capillary and venous fasting blood sampled within 30 min and then underwent OGTT. New diabetes was found in 161 participants (5.0%) and pre‐diabetes in 414 [impaired glucose tolerance 299 (9.3%), impaired fasting glucose 115 (3.6%)]. The mean difference in capillary and venous measures was 0.02 mmol/l (95% confidence interval ?0.04 to +0.01; limits of agreement –1.37 to 1.33 mmol/l). Capillary POCT was a poorer predictor of dysglycaemia and impaired glucose tolerance and new diabetes (area under curve 0.76 and 0.71) than venous laboratory analysis (area under curve 0.87 and 0.81 respectively). Optimal screening criteria were best at a venous glucose of 5.4 mmol/l; 77% sensitivity/specificity. Conclusions POCT significantly underestimated the true blood glucose at diagnostic levels for diabetes. POCT cannot be recommended as a means of screening for or diagnosing diabetes or pre‐diabetes.     

Lack of clinical utility of the Siriraj Stroke Score

Background : The ability to distinguish between infarct and haemorrhage is essential to the management of acute cerebrovascular disease. In hospitals where emergency neuroimaging is not available, the use of stroke scores has been proposed to distinguish ischaemic from haemorrhagic stroke. Aims : To determine the accuracy of the Siriraj Stroke Score in distinguishing ischaemic from haemorrhagic stroke in a cohort of Chinese patients. Methods: We prospectively assessed and calculated the Siriraj stroke Score from 253 patients with acute stroke. The sensitivity, specificity, positive and negative predictive values of this score were determined. Results : For cerebral haemorrhage, the sensitivity and specificity were both 90% or above, but the positive predictive value was not greater than 70%. For cerebral infarct, the sensitivity and specificity were around 80%, while the positive predictive value exceeded 90%. Analysis by plotting receiver operating characteristic curves failed to find other cut‐off points that would improve the performance of the Siriraj Stroke Score. Conclusions: Considering the inconsistent results from this study and previous studies of the Siriraj Stroke Score, we suggest that scoring systems that only require a small number of variables are unlikely to achieve the level of accuracy needed for clinical decision‐making. (Intern Med J 2002; 32: 311?314)     

Comparing the Montreal Cognitive Assessment and Rowland Universal Dementia Assessment Scale in a multicultural rehabilitation setting

In Australia it is recommended that all older people undergoing rehabilitation have a cognitive screen. We performed a longitudinal study comparing the correlation of two cognitive screening tools – the Rowland Universal Dementia Assessment Scale (RUDAS) and Montreal Cognitive Assessment (MoCA) with discharge outcomes in a geriatric inpatient setting. The RUDAS cut‐off (<23/30) was associated with discharge to a nursing home (sensitivity 52%, specificity 70%). This was also noted with a MoCA cut‐off <18/30 (sensitivity 57%, specificity 69%). Furthermore the association between the RUDAS and discharge destination was independent of its association with the Functional Independence Measure (r = 0.116; P = 0.275) and had a shorter administration time. Both RUDAS and MoCA scores could be used as predictors of discharge destination in a multicultural population.     

Serum pepsinogen II: a neglected but useful biomarker to differentiate between diseased and normal stomachs

Background and Aim: Serum pepsinogen II (sPGII) is underutilized and considered an inconspicuous biomarker in clinical practice. We refocused on this neglected but novel biomarker and conducted the present study, aiming to elucidate the normal level of sPGII in healthy Chinese patients and to investigate the clinical utility of sPGII for gastric disease screening. Methods: In 2008–2009, a total of 2022 participants from northern China were selected and enrolled in the study. sPGII and Helicobacter pylori (H. pylori)–immunoglobulin G were measured with ELISA. Results: sPGII showed a normal value of 6.6 microg/L in a total of 466 patients with endoscopically‐ and histologically‐normal stomachs. A small sex difference was observed: the average value of sPGII was 7 microg/L and 6 microg/L in males and females, respectively (P < 0.001). In the differentiation between healthy and diseased (endoscopically‐diseased stomach or gastritis/atrophic gastritis in endoscopic biopsies) stomach mucosae, the best sPGII cut‐off value was 8.25 microg/L (sensitivity 70.6%, specificity 70.8%). In screening the H. pylori seropositivity, the optimum cut‐off sPGII value was 10.25 microg/L (sensitivity 71.6%, specificity 70.1%). Conclusions: We demonstrated that the mean values of sPGII in a healthy Chinese population are 7 microg/L and 6 microg/L for males and females, respectively. sPGII significantly increases in diseased and H. pylori‐infected stomach, and the best sPGII cut‐off value is 8.25 microg/L in the differentiation between patients with healthy and diseased stomach mucosae. Furthermore, Chinese patients with sPGII greater than 10.25 microg/L are at greater risk of various H. pylori‐related gastropathies, and are therefore prior candidates for gastro‐protection therapy.     

Performance of HbA1c for detecting newly diagnosed diabetes and pre‐diabetes in Chinese communities living in Beijing

Aim To determine the performance of glycated haemoglobin (HbA_1c) as a screening tool for detecting newly diagnosed diabetes (NDM) and pre‐diabetes. Methods A diabetes survey was conducted in Beijing among community dwellers who were willing to participate in the survey. Included in the survey were 903 individuals aged 21–79 years without previously diagnosed diabetes and in whom HbA_1c and other required covariates had been measured. NDM and pre‐diabetes (impaired glucose tolerance + impaired fasting glucose) were defined according to the World Health Organization 1999 criteria based on 75‐g oral glucose tolerance test. Receiver operating characteristic curve (ROC) was plotted to determine the performance of HbA_1c. Results The prevalence of NDM and pre‐diabetes was 11.1% and 22.4%, respectively. At an optimal HbA_1c cut‐off point of ≥ 6.0%, the test gave a sensitivity of 80.0% and a specificity of 89.8% for diagnosing NDM; at an optimal cut‐off point of ≥ 5.7%, the sensitivity was 59.4% and specificity 73.9% for diagnosing pre‐diabetes. Individuals with HbA_1c≥ 6.0% tended to be more obese than those with HbA_1c < 6.0%, but blood pressure and lipid profiles did not differ between the two groups. Conclusions HbA_1c as a single screening test is adequate to detect newly diagnosed diabetes but is not able to identify pre‐diabetes in this obese Chinese population.     

New guidelines for lupus anticoagulant: sensitivity and specificity of cut-off values calculated with plasmas from healthy controls in mixing and confirmatory tests

Introduction: The updated guidelines for lupus anticoagulant (LA) diagnosis indicate locally calculate the cut‐off values of the index of circulating anticoagulant (ICA) and the clotting time in seconds (s) for mixing studies and % of correction (%C) for confirmatory tests. We assess sensitivity (SEN) and specificity (SPC) of the cut‐off values obtained as the 99th percentile from 60 plasmas of healthy individuals. Methods: We analysed 647 plasmas from patients studied in the last 3 years, and results were revaluated according to the new criteria and cut‐off values. Four hundred and three had LA, and 75 of them were under oral anticoagulants (OA). We performed three screening tests: activated partial thromboplastin time (APTT), diluted Russell viper venom time (dRVVT) and dilute prothrombin time (dPT), and previous diagnosis was carried out using our home‐made cut‐off calculated by receiver operating characteristics curves. We reanalysed the mixing and confirmatory data of APTT/dRVVT, the tests selected in the new guidelines. To evaluate SPC, 244 plasmas (160 OA and 84 congenital deficient patients) were studied. Results: Considering mixing studies, the cut‐off values demonstrate that SEN of ICA‐APTT was 94% and of clotting time in second (s) 83%, with an SPC of 77% and 84%, respectively. For ICA‐dRVVT, SEN was 72% and for clotting time in second (s) 77%, with SPC of 98% and 84%, respectively. The cut‐off values for %C for confirmatory APTT show good SEN 82% and high SPC 96%; for confirmatory dRVVT lower SEN 77%, but a SPC of 100%. Conclusion: The combination of mixing and confirmatory tests interpreted according to the new guidelines can clearly differentiate LA from other coagulopathies.     

Accuracy of glycated haemoglobin in screening for pre‐diabetes in Asian Indians—a community survey: the Chandigarh Urban Diabetes Study (CUDS)

Aim To compare American Diabetes Association and International Expert Committee recommended cut‐off values of HbA_1c for detecting the presence of pre‐diabetes against plasma glucose values obtained from oral glucose tolerance tests in Asian Indians. Methods A cross‐sectional randomly sampled population survey involving 2368 adults, aged ≥ 20 years. HbA_1c was measured on a Bio‐Rad 10 system in 1972 subjects. Results Of the 1972 subjects studied, 329 were detected to have pre‐diabetes based on isolated impaired fasting glucose in 125 subjects (6.3%), isolated impaired glucose tolerance in 141 subjects (7.1%) and the presence of both in 63 subjects (3.2%). The HbA_1c cut‐off of 34 mmol/mol (5.7%), as recommended by the American Diabetes Association for detecting the presence of pre‐diabetes, showed sensitivity of 62%, specificity 77%, with a positive predictive value of 34.7%, a negative predictive value of 89.5% and accuracy of 67.8%; whereas the HbA_1c cut‐off recommended by the International Expert Committee of 42 mmol/mol (6%) had a sensitivity of 36%, specificity of 90%, positive predictive value of 42.7%, negative predictive of 85.4% and an accuracy of 77%. However, both these HbA_1c cut‐offs underdiagnosed the presence of pre‐diabetes in 38 and 64% of these subjects, respectively. Conclusions The American Diabetes Association and the International Expert Committee recommended HbA_1c cut‐off values and oral glucose tolerance tests identify different pre‐diabetes cohorts. Long‐term prospective studies are required to define the usefulness of one over the other.     

Evaluation of the asthma control test: a reliable determinant of disease stability and a predictor of future exacerbations

Background and objective: This study assessed the asthma control test (ACT) cut‐off values for asthma control according to the Global Initiative for Asthma guideline in adults and the effectiveness of ACT scores in predicting exacerbations and serial changes in ACT scores over time in relation to treatment decisions. Methods: Subjects completed ACT together with same‐day spirometry and fractional concentration of exhaled nitric oxide (FeNO) measurement at baseline and at 3 months. Physicians, blinded to the ACT scores and FeNO values, assessed the patient's asthma control in the past month and adjusted the asthma medications according to management guidelines. Asthma exacerbations and urgent health‐care utilization (HCU) at 6 months were recorded. Results: Three hundred seventy‐nine (120 men) asthmatics completed the study. The ACT cut‐off for uncontrolled and partly controlled asthma were ≤19 (sensitivity 0.74, specificity 0.67, % correctly classified 69.5) and ≤22, respectively (sensitivity 0.73, specificity 0.71, % correctly classified 72.1). Baseline ACT score had an odds ratio of 2.34 (95% confidence interval: 1.48–3.69) and 2.66 (1.70–4.18) for urgent HCU and exacerbations, respectively, at 6 months (P < 0.0001). However, baseline FeNO and spirometry values had no association with urgent HCU and exacerbations. The 3‐month ACT score of ≤20 correlated best with step‐up of asthma medications (sensitivity 0.65, specificity 0.81, % correctly classified 72.8). For serial changes of ACT scores over 3 months, the cut‐off value was best at ≤3 for treatment decisions with low sensitivity (0.23) and % correctly classified (57.3%) values. Conclusions: Single measurement of ACT is useful for assessing asthma control, prediction of exacerbation and changes in treatment decisions.     

Optimal cut‐off point for homeostasis model assessment of insulin resistance to discriminate metabolic syndrome in non‐diabetic Japanese subjects

We have recently established a ‘health‐associated’ reference interval of homeostasis model assessment of insulin resistance (HOMA‐IR) between 0.4 and 2.4. In the present study, the aim was to establish a ‘decision‐based’ limit of HOMA‐IR for the discrimination of metabolic syndrome (MetS) in non‐diabetic Japanese subjects. The receiver–operating characteristic curve of HOMA‐IR for detecting MetS was developed using data from 6868 non‐diabetic subjects (3727 men, 3141 women). The optimal cut‐off point was determined based on the point that yielded the minimum value of the square root of [(1 – sensitivity)² + (1 – specificity)²]. HOMA‐IR = 1.7 was determined as the optimal cut‐off value, with a sensitivity and specificity of 73.4% and 70.5% for men, and 81.5% and 77.0% for women, respectively. In conclusion, the optimal cut‐off value for HOMA‐IR to discriminate MetS in non‐diabetic Japanese subjects appears to be 1.7. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00194.x , 2012)     

Using the Short Physical Performance Battery to screen for frailty in young‐old adults with distinct socioeconomic conditions

Aim: To analyze the Short Physical Performance Battery's (SPPB) ability in screening for frailty in community‐dwelling young elderly from cities with distinct socioeconomic conditions. Methods: Elderly (65–74 years‐of‐age) from Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64) were evaluated with the SPPB to assess physical performance. Frailty was defined as the presence of ≥3 of the following criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. Linear regression and receiver operating characteristics analyses were carried out. Results: The SPPB correlated with frailty (R² = 0.33), with better results for Saint Bruno. A cut‐off of 9 in the SPPB had good sensitivity (92%) and specificity (80%) in discriminating frail from non‐frail in Saint Bruno (area under the curve [AUC] = 0.81), but showed fair results in Santa Cruz (AUC = 0.61, sensitivity = 81% and specificity = 52%). Conclusions: The SPPB better discriminated frailty in elderly with higher socioeconomic conditions (Saint Bruno). Geriatr Gerontol Int 2013; 13: 421–428 .     

Prospective evaluation of a new stool antigen test for the detection of Helicobacter pylori, in comparison with histology, rapid urease test, (13)C-urea breath test, and serology

Background and Aims: This study aimed to evaluate the efficacy of a new polyclonal enzyme immunoassay for the detection of Helicobacter pylori (H. pylori) antigen in stool by determination of the optimal cut‐off value in the screening population. Methods: A consecutive 515 patients undergoing a routine health check‐up were prospectively enrolled. H. pylori infection was defined if at least two of four tests (histology, rapid urease test, ¹³C‐urea breath test, and serology) were positive. A stool antigen test (EZ‐STEP H. pylori) was performed for the detection of H. pylori. The optimal cut‐off value was determined by the receiver–operator characteristic curve. The diagnostic performance of each test was evaluated with regard to the histological diagnosis of atrophic gastritis (AG)/intestinal metaplasia (IM), degree of AG/IM, and old age. Results: Sensitivity, specificity, positive and negative predictive values, and accuracy of the stool antigen test were 93.1%, 94.6%, 95.1%, 92.3%, and 93.8%, respectively. The sensitivity of histology, rapid urease test, and the ¹³C‐urea breath test ranged from 89.1% to 97.6%, and their specificity was > 98%, while serology had high sensitivity, but low specificity. The accuracy of the stool antigen test was comparable to that of other methods (93.6–95.9%), whereas it was higher than that of serology. The stool antigen test still showed good diagnostic performance in the setting of progression of AG/IM and in patients over 40 years. Conclusions: The performance of a new stool antigen test was comparable to that of other methods in the diagnosis of H. pylori infection for the screening population, even with the presence of AG/IM.     

An age‐adapted approach for the use of D‐dimers in the exclusion of deep venous thrombosis

A normal D‐dimer (DD) concentration for the exclusion of deep venous thrombosis (DVT) has a low specificity in older patients and compression ultrasonography is often required. Three D‐dimer assays, STA Liatest, Tina‐quant, and Innovance, are evaluated in symptomatic outpatients suspected for DVT with emphasis on its performance in older patients by using different cut‐off levels. This study includes 466 outpatients suspected for having DVT. The diagnostic accuracy, measured as sensitivity and area under the curve of the receiver operation characteristic curve is good for all DD assays. The specificity of the DD assays combined with a low pretest probability varies from 42.6 to 51.5%. The specificity of the three DD assays in patients ≥60 years varies, however, between 24.6 and 40.9%. Several cut‐off values in different age‐subgroups are studied. For patients <60 years, the most accurate cut‐off value is 500 μg/L for all DD assays. For patients ≥60 years, a threshold of 750 μg/L has the best results with NPV of 100% for all assays and specificity of 48.5% (STA Liatest), 60.6% (Tina‐quant), and 49.2% (Innovance), respectively. For the three assays, the number needed to test (NNT) decreases in both subgroups of patients compared to the standard algorithm. A cut‐off level of 750 μg/L for patients ≥60 years improves the clinical performance of DD assays in combination with the PTP score without the loss of NPV. The NNT improves substantially with an age‐adapted algorithm. Am. J. Hematol., 2009. © 2009 Wiley‐Liss, Inc.