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Results for “Predictive Value of Tests”

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PubMed2006

Platelet function in patients with acute coronary syndrome (ACS) predicts recurrent ACS.

BACKGROUND: Platelet hyperfunction contributes to acute coronary syndromes (ACS). Thus, we hypothesized that platelet function under high shear stress predicts recurrent ACS during long-term follow-up of ACS patients. PATIENTS AND METHODS: Consecutive ACS patients (n = 208) were prospectively followed-up for an average of 28 months. Platelet function was measured with the platelet function analyzer (PFA-100; Dade Behring, Marburg, Germany) at baseline for collagen/adenosine diphosphate closure times (CADP-CT) and for collagen/epinephrine closure times (CEPI-CT) after infusion of a uniform dose of 250 mg aspirin. RESULTS: Of the conventional risk factors, only the prevalence of diabetes was higher in ACS patients with re-events. However, use of clopidogrel and use of beta blockers were also slightly lower in patients with re-events (P < 0.05). The unadjusted risk hazard ratio (HR) for re-events was 3.3 [95% confidence interval (95% CI): 1.4-7.4; P = 0.005] in those patients with the shortest CADP-CT values (lowest quartile). Similarly, the risk was 2.0-fold higher (95% CI: 1.1-3.6; P = 0.02) in ACS patients with CEPI-CT < 300 s as compared with CEPI-CT >or = 300 s. Inclusion of diabetes, clopidogrel and beta blockers in a multivariate Cox regression model enhanced the predictive value of CEPI-CT (HR: 2.7). Inclusion of von Willebrand factor levels did not alter the HR for recurrent ACS (HR: 2.1; 95% CI: 1.1-5.2; P = 0.03) for CEPI-CT < 300 s, but reduced the HR for CADP-CT (HR: 2.8, 95% CI: 0.8-9.8; P = 0.11). CONCLUSION: Shortened CT values reflect biologically relevant platelet hyperfunction in patients with ACS because they predict recurrent ACS.

Acute Disease↗

PubMed1989

[Prediction of radiosensitivity by micronucleus assay].

The correlation between cell survival curve and dose response curve of MN frequency following irradiations was studied using cytokinesis-block method. Both dose response curves were analyzed by linear quadratic model, i.e. SF = exp (- alpha D - beta D2) and MN frequency = aD + bD2 + c. A good correlation between alpha/beta and a/b ratios was observed in repeated paired experiments (gamma = 0.97). When the cells were treated with BUdR, alpha-type radiosensitizer, a value in dose response curve of MN frequency increased but b value did not. In 10 renal cell carcinomas, the linear correlations between cell surviving fractions and MN frequencies were observed. When radioresponses of 5 esophageal cancer cell lines were evaluated with MN assay, wide range of a/b ratios was found. These data present that MN frequency assay using CB method is available as a tool of rapid assay of radiosensitivity of cells.

Animals↗

PubMed1994

Evaluation of two enzyme-linked immunosorbent assays for the diagnosis of canine atopy.

Serum samples from 10 dogs without skin disease, 10 with non-atopic pruritic skin disease, and 10 atopic dogs were tested blind by using two enzyme-linked immunosorbent assays (ELISAS) (Veterinary Allergy Test Kit; All-Vet [test A] and Elisarest; Bloxham Laboratories [test B]) designed to detect immunoglobulin E antibodies to environmental allergens. All the dogs tested had at least three positive reactions when using test A, and 28 of the dogs had at least one positive reaction when using test B. The median numbers of positive reactions observed in the three groups of dogs were not significantly different for each test. Significantly more reactions were observed with test A in each group (P < 0.001) than with test B. The sensitivity of both the tests was 100 per cent, but the specificity of test A was 0 per cent and the specificity of test B was 10 per cent. The positive predictive values of tests A and B were 33.3 per cent and 35.7 per cent, respectively, and the negative predictive values were 0 and 100 per cent. The poor specificities and low positive predictive values indicate that the positive results obtained when using these ELISAS are of no diagnostic value in canine atopy.

Allergens↗

PubMed1990

Sensory integrative processing in delinquent-prone and non-delinquent-prone adolescents.

The purposes of this study were to obtain a preliminary description of the sensory integrative and practic abilities of 114 non-delinquent-prone adolescents aged 12 through 18 years and to compare their performances with those of 12 delinquent-prone adolescents with learning problems. Ten of the 17 subtests of the Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) as well as the Finger Posture Imitation Test (Druker, 1980) and the MacQuarrie Test for Mechanical Ability (MacQuarrie, 1925/1953) were administered to both groups. It was hypothesized that performance on some tests would correlate with age in the non-delinquent-prone adolescents. It was also hypothesized that some delinquent-prone adolescents with learning problems would perform significantly worse on the tests of sensory integrative and practic abilities than would the non-delinquent-prone adolescents. A data analysis indicated that performance on the praxis tests, Manual Form Perception, Graphesthesia, and Bilateral Motor Coordination showed a significant age correlation. The results of this study indicated a difference between the two groups, and it was concluded that the delinquent-prone group performed more poorly on all of the praxis-related tests and on the absolute values of the tests of Postrotary Nystagmus, Standing and Walking Balance, and Bilateral Motor Coordination. Some of the vestibular- and praxis-related tests, therefore, may still provide useful information on children older than 8 years of age.

Adolescent↗

PubMed2005

Assessment of a platelet function analyser in horses: reference range and influence of a platelet aggregation inhibitor.

The objective of this study was to assess whether a new human platelet function analyser (the PFA-100) could be used to evaluate platelet function in horses and detect acetylsalicylic acid (ASA)-induced platelet dysfunctions. Citrated blood samples from 40 healthy horses were processed to obtain reference values for closure time (CT) using cartridges with collagen-ADP (CT-ADP) and collagen-epinephrine (CT-EPI) as platelet agonists. In addition, CT-ADP and CT-EPI were also measured before and 24 h after oral ASA administration in another 12 healthy horses. The sensitivity and specificity of the test were also determined. In normal horses, means+/-SD value for CT-ADP was 85.1+/-13.1 s (median, 82 s), and CT-EPI ranged from 158 to >300 s (median 291 s). Calculated reference ranges were 60.5-115.9 s and 158.5->300 s for CT-ADP and CT-EPI, respectively. Administration of ASA significantly (P<0.001) prolonged CT-ADP values from 91.0+/-13 to 113.5+/-14.4 s, and CT-EPI values were also significantly (P<0.008) prolonged after ASA administration. Sensitivity and specificity results for ADP cartridges showed that a prolonged CT value would be highly suggestive of a platelet aggregation inhibition. In conclusion, ADP cartridges can be used in horses to assess primary haemostasis and may be a valuable test for the detection of platelet aggregation inhibition.

Animals↗

PubMed2003

[The value of platelet function tests].

Platelet function tests are used to detect patients with abnormal platelet function, which may be inborn or acquired or to detect increased platelet activation which may be accompanied by an increased risk of thrombosis. Platelet function tests are also used to monitor platelet function inhibitors as aspirin, clopidogrel or platelet membrane glycoprotein IIb/IIIa-inhibitors. Incorrect blood sampling is a major source of error in measuring platelet function. Global tests besides platelet count and bleeding time are thrombelastography, the platelet function analyzer (PFA) and possibly in the future the new Impact-system. Specific tests measure platelet spreading and adhesion to defined surfaces. In a series of methods platelets are counted before and after passage of a filter. Some of these tests are partially standardized. The most frequently measured platelet function is aggregation induced by ADP, collagen or other substances as first described by Gustav Born. Some newer methods to perform aggregometry are described. Platelet activation can be detected by measuring spontaneous aggregation as in the PAT-test. Prospective trials with this test have shown that enhanced spontaneous aggregation is a risk factor for new vascular occlusions in diabetics and for myocardial infarctions in healthy individuals. The Wu and Hoak-test and the measurement of released platelet factor 4 or betaglobulin are of limited value. Flow cytometric methods are frequently used to measure platelet activation markers as CD 62 and others. Platelet induced thrombin generation is an interesting function to measure drug effects. None of the presently available platelet function tests is well standardized, so there is much room for improvement.

Blood Platelet Disorders↗

PubMed2002

Highly sensitive serum thyroglobulin and circulating thyroglobulin mRNA evaluations in the management of patients with differentiated thyroid cancer in apparent remission.

We studied the potential role of innovative diagnostic tools for the management of patients with differentiated thyroid cancer (DTC). Several methods for the detection of the tumor marker thyroglobulin (Tg) have been employed in 36 patients in apparent remission at the moment of the study. All patients had negative anti-Tg antibodies and were evaluated during L-T(4) suppressive therapy before and after stimulation with recombinant human TSH (rhTSH). Serum Tg was measured by means of conventional [nonhighly sensitive (nhs)] or highly sensitive (hs) immunoassays with positive cut-off values set at 1.0 and 0.18 microg/liter, respectively. The RT-PCR conditions for the qualitative determination of Tg mRNA from peripheral blood were optimized to prevent interference by illegitimate transcription. The patients have been classified on the basis of a hs-basal Tg testing by taking into account the results of their baseline samples in hs immunoassay and RT-PCR method; hs-basal Tg testing was considered positive when the marker was detectable in at least one of the two tests. The predictive value of hs-basal Tg testing was estimated on the basis of a global clinical evaluation, including serum Tg response after rhTSH stimulation and reports of contemporary (131)I scan and neck ultrasound. The clinical evaluation was considered positive when at least one of these criteria yielded positive results. Although nhs-Tg measurement was poorly predictive of the clinical status, basal hs-Tg evaluation was found to be concordant with the clinical evaluation in 71% of cases. Results of basal Tg mRNA detection did not vary after rhTSH stimulation and were concordant with the clinical evaluation in 66% of cases. Tg mRNA evaluation alone showed 10 apparently false-positive results, and serum basal hs-Tg was falsely negative in 11 additional cases, suggesting that a suitable predictability could be obtained by the association of these 2 parameters. Indeed, the combination of hs-Tg assay and mRNA detection in the hs-basal Tg testing allowed the identification of 22 patients with a positive persistent/recurrent disease or normal thyroid residue, as well as identification of all 6 patients with a negative clinical evaluation. In conclusion, the combined evaluation of circulating Tg mRNA and serum Tg by means of hs noncompetitive immunoassay (hs-basal Tg testing) can give useful information on the clinical status of patients with DTC who are apparently disease-free, even on L-T(4) TSH-suppressive therapy. Therefore, these combined evaluations retain a potential role in the clinical monitoring of DTC patients. In particular, a negative hs-basal Tg testing would indicate disease remission and the opportunity to lengthen the intervals between rhTSH stimulations and/or to shift patients to a less profound TSH suppression with L-T(4).

Adenocarcinoma, Follicular↗

PubMed1987

A one-step enzyme-linked immunosorbent assay to detect anti-CMV antibodies; development and clinical validation.

A simple one-step ELISA to detect anti-CMV antibodies was developed. The test was based on the inhibition principle, and used anti-CMV coated microtitre plates, CMV nuclear antigen and anti-CMV Fab'-HRP conjugate; total assay time was 1.5 h. The use of Fab'-HRP conjugates improved discrimination between positive and negative sera as compared with IgG-HRP conjugates. In an in-house clinical study, the one-step ELISA showed a 98.4% correlation with the latex agglutination test. The test could be demonstrated to be suitable for both serum and citrate- or EDTA-plasma specimens; heparin-plasma gave somewhat higher absorbance values. In an external clinical validation, the one-step ELISA showed a 99.5% correlation with the latex agglutination test, and was found to be highly suitable for screening of blood donor specimens in a blood bank setting.

Antibodies, Viral↗

PubMed2006

Maternal selective serotonin reuptake inhibitor intake does not seem to affect neonatal platelet function tests.

Recently, concerns have been raised regarding the potential impairment of neonatal platelet function and the potential risk of bleeding in neonates born to mothers treated with selective serotonin reuptake inhibitors (SSRI). Our aim was to test whether the platelet function of neonates born to SSRI-treated mothers was impaired when compared to non-SSRI-exposed neonates. In a single-center prospective study, platelet function was evaluated using a cone and platelet analyzer (CPA) device and compared between mother-infant pairs as well as normal non-SSRI-exposed infants. Twenty-seven SSRI-exposed and 27 non-SSRI-exposed full-term neonates and their 23 mothers were tested. No correlation was found between SSRI exposure among either neonates or mothers and parameters of surface coverage (SC) and average size (AS), manifesting platelet function as tested by CPA. SC was similar among SSRI-exposed babies as compared to those in the control group, whereas the size of platelet aggregates (AS) was higher among controls. Neither maternal diseases nor SSRI intake were associated with impaired platelet function and lower SC values, nor were any perinatal conditions. None of the babies suffered from bleeding. We conclude that maternal SSRI therapy does not impair whole-blood CPA-tested platelet function of healthy full-term neonates.

Adult↗

PubMed2005

Predictive model for assessing cognitive impairment by quantitative electroencephalography.

OBJECTIVE: To assess the utility of quantitative electroencephalographic analysis as an indicator of cognitive impairment, we examined the correlation between Mini-Mental State Examination (MMSE) scores and quantitative electroencephalographic (QEEG) power values in elderly patients and constructed a regression model to predict MMSE scores. BACKGROUND: Because of the growing number of elderly individuals with cognitive deficits, there is an increasing need for simple and objective methods with which to evaluate cognitive function. Although QEEG is reportedly a useful method for this purpose, few researchers have constructed a QEEG-based model for predicting the degree of cognitive impairment in clinical settings. METHOD: We evaluated brain function using QEEG in 44 elderly patients with memory complaints and compared the results with their MMSE scores. RESULTS: In the correlation analysis, no significant correlation was found between MMSE scores and QEEG power values. However, a regression model created using relative QEEG and gender for predicting MMSE scores had an adjusted R2 of 0.471. CONCLUSIONS: This finding suggests that QEEG analysis may be a useful indicator of cognitive decline in patients with memory complaints.

Aged↗

PubMed1998

Contribution of neuropsychological data to the prediction of temporal lobe epilepsy surgery outcome.

PURPOSE: We empirically examined the contribution of neuropsychological data to the prediction of postoperative seizure control relative to base rate information in an existing series of patients undergoing anterior temporal lobectomy (ATL). METHODS: A discriminant function predicting surgery outcome (seizure-free vs. non-seizure-free) was computed separately for samples of patients with left (n = 79) and right (n = 62) temporal lobectomy (LATL, RATL). Predictor variables included 14 measures tapping five neurocognitive domains. The predicted base rates were compared with the actual base rates in the two samples. Finally, overall predictive accuracy was examined in optimal versus suboptimal ATL patients. RESULTS: The base rate of seizure freedom in the LATL group was 74.70%; that in the RATL group was 66.10%. The predictive function for the LATL group achieved a hit rate of 80.00% and a positive predictive power of 92.11%. The function for the RATL group achieved a hit rate of 83.33% and a positive predictive power (PPP) of 89.66%. The overall predictive accuracy for the optimal group was only 55%, but that in the suboptimal group was 72%. CONCLUSIONS: Neuropsychological data used in a multivariate statistical fashion may be able to offer an incremental increase in the prediction of postoperative seizure freedom relative to existing base rates of surgery success in patients with ATL epilepsy. The use of neuropsychological data may be of greatest predictive value in a population of ATL candidates with suboptimal findings with a lower base rate of postoperative seizure freedom, but may actually reduce predictive accuracy in a group of ATL candidates from an optimal population with an already high base rate of surgical success.

Adult↗

PubMed2001

Which bioengineering assay is appropriate for irritant patch testing with sodium lauryl sulfate?

For testing with sodium lauryl sulphate (SLS), measurements of transepidermal water loss (TEWL) and cutaneous blood flow with laser Doppler (LD) are considered to be the most reliable methods. The aim of this study was to determine which method of measurement should be preferred when conducting SLS testing under varying conditions. Patch testing with SLS at different concentrations and exposure times was performed. TEWL values were compared with those of LD. TEWL values showed distinct changes at low SLS concentrations and short application periods. By contrast, higher SLS concentrations were necessary to increase LD values. Short application of patches changed TEWL rather than LD values. When evaluating SLS patch testing by bioengineering methods, TEWL measurement appears to be more suitable for a test procedure that provokes mild skin reactions (SLS concentration <1%), whereas LD measurement is more appropriate to evaluate pronounced skin reactions (SLS concentration >or=1%).

Dermatitis, Irritant↗

PubMed2002

High predictive value of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for survival in systemic lupus erythematosus.

OBJECTIVE: We previously reported high Systemic Lupus International Collaborating Clinics (SLICC) scores in fatal cases of systemic lupus erythematosus (SLE) from our inception cohort. This study was done to clarify if the SLICC damage scores 5 years after diagnosis predicted the outcome. METHODS: We studied 80 patients with SLE (70 women, 10 men), all enrolled and diagnosed during the years 1981 through 1991 in our inception cohort, and all alive 5 years after inclusion into the cohort. In all patients the SLICC/American College of Rheumatology (ACR) damage index (DI) was scored at 5 years after SLE diagnosis, and these scores were tested for predictive value. The outcomes were survival or late mortality within the following median observation period of 7 years. All surviving patients were followed through 1999, and no patient was lost to followup. RESULTS: At study entry, 5 years after the diagnosis of SLE, 37 patients had no damage to score with SLICC. Of the remaining 43 patients, 25 had a score of 1 and 18 had a score of 2 or more. In total, 14 fatalities occurred within 7 years after study entry, 7 among the 18 with initial SLICC/ACR DI of 2 or more compared with 7 fatalities among the 62 with less or no damage (p < 0.01). Cardiovascular or cerebrovascular SLICC/ACR DI items were more common in fatal cases than in survivors (p < 0.001). A SLICC score at 5 years of 2 or more increased the relative risk for fatality by 3.4 (95% CI 1.5-14.4), and had a predictive value of 38%. A SLICC score of 0 at 5 years gave an odds ratio in favor of survival of 0.06 (95% CI 0.0-0.5) and had a predictive value for survival of 97%. During an extended followup for one more year the predictive value of damage for fatalities was even more pronounced (p = 0.003, log-rank). CONCLUSION: SLICC damage scores registered 5 years after SLE diagnosis have a high predictive value for survival during the following median observation time of 7 years. These data provide strong evidence that the items included in the SLICC score are clinically relevant.

Adult↗

PubMed2003

A comparison of MMPI-2 decision rules in the diagnosis of nonepileptic seizures.

The differential diagnosis of epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) continues to be a common concern in epilepsy treatment centers. The MMPI/MMPI-2 is the most commonly studied psychological measure in the differential diagnosis of ES and PNES. Wilkus, Dodrill, and Thompson (1984) and Derry and McLachlan (1996) both developed decision rules for use with the MMPI and MMPI-2 to assist in this diagnostic discrimination. Both sets of decision rules were evaluated in a sample of ES (n=58), PNES ( n=29) and epilepsy plus PNES (n=19) patients. Validity of the epilepsy diagnosis was established with 24-hr video-EEG monitoring in all cases. The two sets of decision rules applied to the MMPI-2 showed sensitivities of 68% and 48% and specificity values of 55% and 58%. Calculation of positive and negative predictive power for both sets of rules at three different base rates suggests that use of these rules can result in a large number of false positive diagnoses of PNES.

Adult↗

PubMed2005

Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age.

OBJECTIVE: The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age. DESIGN/METHODS: Of 330 ELBW infants admitted in 1992-1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months' corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months' CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years' postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status. RESULTS: For all ELBW children, the mean MDI was 75.6 +/- 16 versus a mean KABC of 87.8 +/- 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 +/- 16 and the mean KABC was 92.3 +/- 15. Rates of cognitive impairment, defined as an MDI or KABC of <70, dropped from 39% at 20 months' CA to 16% at 8 years for the total ELBW population and from 29% to 7% for the neurosensory-intact subgroup. The positive predictive value of having an MPC of <70 given an MDI of <70 was 0.37 (95% confidence interval [CI]: 0.27, 0.49) for all ELBW infants, 0.20 (95% CI: 0.10, 0.35) for the neurosensory-intact subgroup, and 0.61 (95% CI: 0.42, 0.77) for the neurosensory-impaired subgroup. The negative predictive values were 0.98, 0.99, and 0.85 for the 3 groups, respectively. Neurosensory impairment at 20 months' CA predicted lack of improvement of cognitive function (odds ratio: 6.9; 95% CI: 2.4, 20.2). Children whose cognitive scores improved between 20 months and 8 years had significantly better school performance than those whose scores stayed at <70, but they did less well than those whose scores were persistently >70. CONCLUSIONS: The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI.

Blindness↗

PubMed1998

How reliable is the short synacthen test for the investigation of the hypothalamic-pituitary-adrenal axis?

The best test for the assessment of the hypothalamic-pituitary-adrenal (HPA) axis remains a matter of controversy. We compared the performance of the short synacthen test (SST, 250 microg) with the insulin stress test (IST) to assess the reliability of the former as a first line test. Patients with pituitary disease underwent both the SST and the IST. The results in patients who had both tests within 4 weeks of each other, and where these were not separated by a therapeutic intervention, were compared. Basal, 30 and 60 min cortisol levels were obtained from the SST. Basal and maximal cortisol level after adequate hypoglycaemia (glucose<2.2 mmol/l) were recorded for the IST. Sixty-nine paired test results were available for analysis. With a 30 min 'pass' plasma cortisol value of 500 nmol/l on the SST, 7/69 (10%) patients who passed the SST failed the IST set at a 'pass' maximum value of 500 nmol/l. At a 'pass' cortisol value of 600 nmol/l on the SST, 3/69 (4%) who passed the SST failed the IST. Assuming the IST as the gold standard, the sensitivity of an SST 'pass' of 600 nmol/l is 85% with a specificity of 96%. During the conventional dose SST (250 microg) a 30 min plasma cortisol value of 600 nmol/l is more reliable than a value of 500 nmol/l, and using the former criterion the SST can safely be used as a first line test for the evaluation of the HPA axis in patients with pituitary disease. However, if the result is borderline or there is clinical suspicion of mild hypocorticotrophism an IST or other test of the HPA axis may be warranted.

Cosyntropin↗

PubMed1992

Predictive value of pulmonary function tests before marrow transplantation.

OBJECTIVE: To evaluate association between pulmonary function tests (PFT) performed before marrow transplantation and mortality after transplant. SETTING: A single marrow transplantation research center. DESIGN: Case-series review. PATIENTS: All patients between January 1986 and July 1990 who performed PFT before a first marrow transplant for the treatment of malignancy (n = 1297) were included in study. Six hundred twenty-eight (48 percent) patients had morphologically or cytologically active malignant neoplasms at the time of transplant. Allogeneic marrow transplants were performed in 1,056 (82 percent) and autologous transplants were performed in 235 (18 percent). Three hundred seventy-two (29 percent) patients received HLA-nonidentical donor marrow. Graft-vs-host disease prophylaxis was methotrexate and cyclosporine in 901 (85 percent) of the allogeneic recipients. Most patients were prepared for transplant with total body irradiation in addition to cyclophosphamide (n = 1,059, 82 percent), while 230 (18 percent) were conditioned with busulfan and cyclophosphamide. MEASUREMENTS AND MAIN RESULTS: The overall mortality during the first six months of follow-up was 44 percent. Respiratory failure requiring assisted mechanical ventilation occurred in 23 percent (n = 298) of patients. A proportional hazards regression analysis was used to evaluate the predictive value of PFT results: (1) FEV1/FVC; (2) P(A-a)O2 gradient; (3) TLC; and (4) Dcosb (the latter two presented a percent of predicted). Abnormalities in TLC, Dcosb, and P(A-a)O2 were found to be significantly associated with death in univariate analysis. Next, the value of PFT for prediction above and beyond other baseline covariates was evaluated by first using the step-up stepwise proportional hazards model to select predictive variables other than the PFT variables. Then each of the PFT variables was tested in the presence of these other variables. The factors of age, primary diagnosis, relapse status, and donor-recipient HLA nonidentity were found to be risks for death and were entered as covariates. Each of the variables of PFT were entered stepwise into the model. Dcosb (RR = 1.43 for a value 80 percent of predicted) and P(A-a)O2 (RR = 1.28 for a value of 20 mm Hg) were found to be independent risk factors for death. The use of assisted mechanical ventilation appeared to increase proportionately with the increase in mortality among patients with abnormal Dcosb or P(A-a)O2. CONCLUSIONS: Decreased Dcosb and increased P(A-a)O2 gradient before marrow transplant carry significantly increased risk of death after marrow transplant. The risk associated with abnormal PFT is less than that associated with other recognized risk factors, such as relapse status and donor-recipient HLA nonidentity. Respiratory failure does not appear to account entirely for the increased mortality associated with abnormal pretransplant PFT. PFT should be used in assessing fully the risks to recipients of marrow transplants for malignancy, but should not be used as absolute exclusion criteria for transplantation.

Adolescent↗

PubMed1999

Timing of peak serum cortisol values in preterm infants in low-dose and the standard ACTH tests.

The low-dose ACTH test seems to reveal mild cases of adrenal insufficiency and is beginning to be preferred over the standard ACTH test in the evaluation of adrenal suppression both in infants and in adults. The concentration-time profile of plasma cortisol in infants after a low ACTH dose is obscure. In this crossover study, we compared timing of the peak values in the low-dose and the standard ACTH stimulation tests in preterm and full-term infants. We performed the standard ACTH tests (250 microg/1.73 m2) and the low-dose ACTH tests (1 microg/1.73 m2) on 10 infants (26-40 wk gestational age) and measured serum cortisol concentration at 0, 30, 40, 60, and 120 min by RIA. Nine of the infants had received postnatal glucocorticoid treatment, and most of them had also been treated with dexamethasone antenatally. In the low-dose test, the peak values occurred at 30 or 40 min in 9/10 patients. In the standard-dose test, the peak values occurred at 60 or 120 min in 8/10 patients. These results are comparable with those from adults. According to this study, blood samples for the low-dose ACTH test in infants should be taken before dosing and between 30 and 40 min after dosing.

Adult↗