1.A machine learning approach for the diagnosis of obstructive sleep apnoea using oximetry, demographic and anthropometric data.
Zhou Hao LEONG ; Shaun Ray Han LOH ; Leong Chai LEOW ; Thun How ONG ; Song Tar TOH
Singapore medical journal 2025;66(4):195-201
INTRODUCTION:
Obstructive sleep apnoea (OSA) is a serious but underdiagnosed condition. Demand for the gold standard diagnostic polysomnogram (PSG) far exceeds its availability. More efficient diagnostic methods are needed, even in tertiary settings. Machine learning (ML) models have strengths in disease prediction and early diagnosis. We explored the use of ML with oximetry, demographic and anthropometric data to diagnose OSA.
METHODS:
A total of 2,996 patients were included for modelling and divided into test and training sets. Seven commonly used supervised learning algorithms were trained with the data. Sensitivity (recall), specificity, positive predictive value (PPV) (precision), negative predictive value, area under the receiver operating characteristic curve (AUC) and F1 measure were reported for each model.
RESULTS:
In the best performing four-class model (neural network model predicting no, mild, moderate or severe OSA), a prediction of moderate and/or severe disease had a combined PPV of 94%; one out of 335 patients had no OSA and 19 had mild OSA. In the best performing two-class model (logistic regression model predicting no-mild vs. moderate-severe OSA), the PPV for moderate-severe OSA was 92%; two out of 350 patients had no OSA and 26 had mild OSA.
CONCLUSION
Our study showed that the prediction of moderate-severe OSA in a tertiary setting with an ML approach is a viable option to facilitate early identification of OSA. Prospective studies with home-based oximeters and analysis of other oximetry variables are the next steps towards formal implementation.
Humans
;
Oximetry/methods*
;
Sleep Apnea, Obstructive/diagnosis*
;
Male
;
Female
;
Middle Aged
;
Machine Learning
;
Polysomnography
;
Adult
;
Anthropometry
;
ROC Curve
;
Aged
;
Algorithms
;
Predictive Value of Tests
;
Sensitivity and Specificity
;
Neural Networks, Computer
;
Demography
2.Predictive value of norepinephrine equivalence score on the 28-day death risk in patients with sepsis: a retrospective cohort study.
Wenzhe LI ; Jingyan WANG ; Qihang ZHENG ; Yi WANG ; Xiangyou YU
Chinese Critical Care Medicine 2025;37(4):331-336
OBJECTIVE:
To elucidate the predictive value of norepinephrine equivalence (NEE) score on the 28-day death risk in patients with sepsis and provide evidence for its application in the diagnosis and treatment of sepsis and septic shock.
METHODS:
A retrospective cohort study was conducted based on the data of patients with sepsis from Medical Information Mart for Intensive Care-IV 2.2 (MIMIC-IV 2.2). The patients who received vasoactive agents within 6 hours after the diagnosis of sepsis or septic shock were enrolled, and they were divided into survival and non-survival groups based on their 28-day outcomes. The baseline characteristics, vital signs, and treatment data were collected. Multivariate Cox regression analysis was performed to identify factors influencing the 28-day death risk. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of various parameters on the 28-day death risk of septic patients. Kaplan-Meier survival curve was used to evaluate cumulative survival rate in patients classified by different quantitative parameters based on the cut-off values obtained from ROC curve analysis.
RESULTS:
A total of 7 744 patients who met the Sepsis-3 diagnostic criteria and received vasopressor treatment within 6 hours post-diagnosis were enrolled, of which 5 997 cases survived and 1 747 died, with the 28-day mortality of 22.6%. Significant differences were observed between the two groups regarding age, gender, height, body weight, race, type of intensive care unit (ICU), acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, Charlson comorbidity index (CCI) score, underlying comorbidities, and vital signs. Compared with the survival group, the non-survival group had poorer blood routine, liver and kidney function, coagulation function, blood gas analysis and other indicators. Multivariate Cox regression analysis revealed that age > 65 years old [hazard ratio (HR) = 0.892, 95% confidence interval (95%CI) was 0.801-0.994, P = 0.039] and male (HR = 0.735, 95%CI was 0.669-0.808, P < 0.001) were protective factors for 28-day death in patients with sepsis, and NEE score (HR = 1.040, 95%CI was 1.021-1.060, P < 0.001), shock index (HR = 1.840, 95%CI was 1.675-2.022, P < 0.001), APACHE II score (HR = 1.076, 95%CI was 1.069-1.083, P < 0.001), SOFA score (HR = 1.035, 95%CI was 1.015-1.056, P < 0.001), and CCI score (HR = 1.135, 95%CI was 1.115-1.155, P < 0.001) were independent risk factors for 28-day death in septic patients. ROC curve analysis showed that the area under the ROC curve (AUC) of NEE score for predicting the 28-day death risk of septic patients was 0.743 (95%CI was 0.730-0.756), which was comparable to the predictive value of APACHE II score (AUC = 0.742, 95%CI was 0.729-0.755) and ratio of mean arterial pressure (MAP)/NEE score (MAP/NEE; AUC = 0.738, 95%CI was 0.725-0.751, both P > 0.05), and better than SOFA score (AUC = 0.609, 95%CI was 0.594-0.624), CCI score (AUC = 0.658, 95%CI was 0.644-0.673), shock index (AUC = 0.613, 95%CI was 0.597-0.629) and ratio of diastolic blood pressure (DBP)/NEE score (DBP/NEE; AUC = 0.735, 95%CI was 0.721-0.748, all P < 0.05). According to the cut-off values of APACHE II and NEE scores obtained from ROC curve analysis, the patients were stratified for Kaplan-Meier survival curve analysis, and the results showed that the 28-day cumulative survival rate in the septic patients with an APACHE II score ≤ 22.5 was significantly higher than that in those with an APACHE II > 22.5 (Log-Rank test: χ2 = 848.600, P < 0.001), and the 28-day cumulative survival rate in the septic patients with an NEE score ≤0.120 was significantly higher than that in those with an NEE score > 0.120 (Log-Rank test: χ2 = 832.449, P < 0.001).
CONCLUSIONS
NEE score is an independent risk factor for 28-day death in septic patients who received vasoactive treatment within 6 hours of diagnosis and possesses significant predictive value. It can be used for severity stratification in sepsis management.
Humans
;
Retrospective Studies
;
Sepsis/diagnosis*
;
Male
;
Female
;
Norepinephrine/therapeutic use*
;
Middle Aged
;
Aged
;
Prognosis
;
Predictive Value of Tests
;
Shock, Septic/mortality*
;
Adult
;
ROC Curve
;
Risk Factors
;
Survival Rate
;
Aged, 80 and over
3.Predictive value of early lactic acid/albumin ratio for acute skin failure in patients with sepsis.
Yan TANG ; Yannan KANG ; Xiumei LIU
Chinese Critical Care Medicine 2025;37(7):628-632
OBJECTIVE:
To explore the predictive efficacy of the early lactic acid/albumin ratio (LAR) for the occurrence of acute skin failure (ASF) in patients with sepsis.
METHODS:
A retrospective study was conducted to collect the clinical data of 115 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Dalian Medical University from June 2022 to March 2024. The patients' gender, age, length of ICU stay, past medical history, and severity scores, use of mechanical ventilation or vasoactive drugs, albumin (Alb), lactic acid (Lac), mean arterial pressure (MAP), and blood gas analysis indicators within 24 hours of ICU admission were collected, and LAR was calculated. The patients were divided into two groups based on whether they developed ASF, and the clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors for the occurrence of ASF in patients with sepsis. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of LAR for the occurrence of ASF in patients with sepsis.
RESULTS:
A total of 115 patients with sepsis were enrolled in the final analysis, among whom 35 developed ASF and 80 did not. The incidence of ASF was 30.43%. Univariate analysis showed that compared with the non-ASF group, the ASF group had higher acute physiology and chronic health evaluation II (APACHE II) score, proportion of using vasoactive drugs, Lac, and LAR as well as lower Alb and MAP, with statistically significant differences. Multivariate Logistic regression analysis was conducted on the factors with statistical significance in the univariate analysis, and the results showed that Alb [odds ratio (OR) = 0.639, 95% confidence interval (95%CI) was 0.474-0.862, P = 0.003], Lac (OR = 17.228, 95%CI was 1.517-195.641, P = 0.022), MAP (OR = 0.905, 95%CI was 0.855-0.959, P = 0.001), and LAR (OR < 0.001, 95%CI was < 0.001-0.005, P = 0.033) were independent risk factors for the occurrence of ASF in patients with sepsis. ROC curve analysis showed that the area under the ROC curve (AUC) of LAR for predicting the occurrence of ASF in patients with sepsis was 0.867 (95%CI was 0.792-0.943), which was superior to Alb, Lac, and MAP [AUC (95%CI) was 0.739 (0.648-0.829), 0.844 (0.760-0.929), and 0.860 (0.783-0.937), respectively]. When the optimal cut-off value of LAR was 0.11, the sensitivity was 65.7%, the specificity was 96.3%, and the Youden index was 0.620. Patients were grouped based on the optimal cut-off value of LAR, and the results showed that the incidence of ASF in the LAR > 0.11 group was significantly higher than that in the LAR ≤ 0.11 group [88.89% (24/27) vs. 12.50% (11/88), P < 0.05].
CONCLUSIONS
LAR has early predictive value for the occurrence of ASF in patients with sepsis, and its efficacy is superior to that of Lac or Alb alone.
Humans
;
Sepsis/blood*
;
Retrospective Studies
;
Lactic Acid/blood*
;
Male
;
Female
;
Intensive Care Units
;
Middle Aged
;
Risk Factors
;
Predictive Value of Tests
;
Serum Albumin/analysis*
;
ROC Curve
;
Aged
4.Clinical predictive value of sphinor kinase 1, D-lactic acid and intestinal fatty acid binding protein for septic gastrointestinal injury.
Donghui NING ; Yu GE ; Fan YANG ; Lixia GENG
Chinese Critical Care Medicine 2025;37(8):715-720
OBJECTIVE:
To investigate the predictive value of sphinor kinase 1 (sphk1), D-lactic acid, and intestinal fatty acid binding protein (I-FABP) for gastrointestinal injury in patients with sepsis.
METHODS:
A prospective observational study was conducted. Sixty-eight patients with sepsis and gastrointestinal dysfunction admitted to the department of critical care medicine of the First Affiliated Hospital of Baotou Medical College Inner Mongolia University of Science and Technology from May 2024 to March 2025 were enrolled (sepsis group), and they were divided into acute gastrointestinal injury (AGI) I-IV groups according to the definition and grading criteria of AGI proposed by the European Society of Intensive Care Medicine in 2012. Twenty non-sepsis patients without AGI admitted to the intensive care unit during the same period were enrolled as the control group (non-sepsis group). Within 30 minutes of patient enrollment, plasma sphk1, D-lactic acid, and I-FABP levels were determined by enzyme linked immunosorbent assay (ELISA). General data such as gender, age were recorded, and levels of procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), lactic acid (Lac), and acute physiology and chronic health evaluation II (APACHEII), sequential organ failure assessment (SOFA) were measured. Spearman method was used to analyze the correlation between sphk1, I-FABP, D-lactic acid and other indicators. The receiver operator characteristic curve (ROC curve) was used to evaluate the predictive value of sphk1, D-lactic acid, I-FABP, APACHEII score, and SOFA score for gastrointestinal injury in patients with sepsis.
RESULTS:
Among the 68 sepsis patients, 13 were classified as AGI grade I, 16 as AGI grade II, 23 as AGI grade III, and 16 had AGI grade IV. There were no statistically significant differences in gender, age, and abdominal infection rate among the groups. The SOFA score and APACHEII score of the sepsis group were significantly higher than those of the non-sepsis group; and the APACHEII score of the AGI IV group was significantly higher than that of the AGI I and AGI II groups. The levels of sphk1, D-lactic acid, I-FABP, PCT, Lac and hs-CRP in the sepsis group were significantly higher than those in the non-sepsis group, and each indicator gradually increased with the increase of AGI grade. Correlation analysis showed that plasma sphk1, D-lactic acid, and I-FABP in patients with sepsis-induced gastrointestinal injury were positively correlated with PCT, Lac, APACHEII score, and AGI grade (all P < 0.05), and sphk1 was positively correlated with I-FABP and D-lactic acid (r values were 0.773 and 0.782, respectively, both P < 0.05). ROC curve analysis showed that sphk1, D-lactic acid, I-FABP, APACHEII score, and SOFA score had high predictive value for gastrointestinal injury in patients with sepsis, with area under the curve (AUC) of 0.996, 0.987, 0.976, 0.901, and 0.934 (all P < 0.05). When the optimal cut-off value of sphk1 was 60.46 ng/L, the sensitivity and specificity were 95.6% and 100%, respectively; when the optimal cut-off value of D-lactic acid was 1 454.3 μg/L, the sensitivity and specificity were 95.6% and 100%, respectively; when the optimal cut-off value of I-FABP was 0.91 ng/L, the sensitivity and specificity were 95.6% and 100%, respectively; when the optimal cut-off value of APACHEII score was 14.5, the sensitivity and specificity were 80.9% and 85.0%, respectively; when the optimal cut-off value of SOFA score was 3.5, the sensitivity and specificity were 85.3% and 95.0%, respectively.
CONCLUSIONS
The levels of plasma sphk1, I-FABP, and D-lactic acid were significantly elevated in patients with sepsis and gastrointestinal injury. These indicators can serve as sensitive and relatively specific serological markers for early prediction of intestinal mucosal damage.
Humans
;
Lactic Acid/blood*
;
Fatty Acid-Binding Proteins/blood*
;
Sepsis/complications*
;
Prospective Studies
;
Male
;
Female
;
Middle Aged
;
Predictive Value of Tests
;
Adult
;
Aged
;
Gastrointestinal Diseases/blood*
;
Prognosis
5.Predictive Value of Abdominal CT Images Combined With Serological Indicators for Ureteral Involvement in Idiopathic Retroperitoneal Fibrosis.
Ting-Ting WANG ; Chao JIANG ; Li NING ; Lu-Lu SUN ; Lu-Feng TIAN ; Wu ZHE
Acta Academiae Medicinae Sinicae 2025;47(1):48-54
Objective To analyze the value of abdominal CT images combined with serological indicators in predicting the ureteral involvement in idiopathic retroperitoneal fibrosis(IRF). Methods The CT images of 79 IRF patients were analyzed retrospectively,including the involved sites and enhancement characteristics of the lesions.According to the inclusion and exclusion criteria,43 patients with complete serological data were selected and assigned into a ureteral involvement group(n=29)and a non-ureteral involvement group(n=14) according to whether ureters were involved in IRF.Logistic regression analysis was performed to select independent risk factors for ureteral involvement in IRF.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of the CT arterial phase enhancement magnitude and serum cystatin C(CysC)for ureteral involvement in IRF. Results The CT images of IRF usually showed a soft tissue density lesion encompassing the abdominal aorta,iliac arteries,ureters,and retroperitoneal tissue,with a wide range of distribution.The ureteral involvement group and the non-ureteral involvement group showed differences in gender(P=0.031),CT arterial phase enhancement amplitude(P=0.014),CT venous phase enhancement amplitude(P=0.032),and serum CysC(P=0.036).Logistic regression analysis showed that gender(P=0.034),CT arterial phase enhancement amplitude(P=0.046),and serum CysC(P=0.041)were independent risk factors for ureteral involvement in IRF.The area under the curve for CT arterial phase enhancement combined with serum CysC to predict ureteral involvement in IRF was 0.776.Ten patients had lower levels of erythrocyte sedimentation rate(P<0.001),C-reactive protein(P=0.021),and IgG4(P<0.001)in the follow-up period than before treatment. Conclusion The combination of abdominal CT images with serological indicators demonstrates high accuracy in predicting the ureteral involvement in IRF,providing reference for early clinical diagnosis.
Humans
;
Male
;
Female
;
Retroperitoneal Fibrosis/pathology*
;
Middle Aged
;
Retrospective Studies
;
Tomography, X-Ray Computed
;
Aged
;
Adult
;
Ureter/diagnostic imaging*
;
Predictive Value of Tests
;
Cystatin C/blood*
6.The value of ultrasonography in predicting the outcomes of simple long bone fractures treated by closed intramedullary nail fixation.
Tilak Rommel PINTO ; Chiranjeevi Srinivasa GOWDA ; Anston Vernon BRAGGS ; Kiyana MIRZA ; Aravinda HEGDE K
Chinese Journal of Traumatology 2025;28(3):181-186
PURPOSE:
Ultrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure.
METHODS:
This was a descriptive longitudinal study of 40 skeletally mature patients from November 2016 to February 2019, who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics.
RESULTS:
Ultrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union.
CONCLUSION
Ultrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.
Humans
;
Fracture Fixation, Intramedullary/methods*
;
Male
;
Female
;
Ultrasonography/methods*
;
Adult
;
Fracture Healing
;
Tibial Fractures/diagnostic imaging*
;
Middle Aged
;
Femoral Fractures/diagnostic imaging*
;
Longitudinal Studies
;
Bone Nails
;
Young Adult
;
Predictive Value of Tests
;
Aged
;
Treatment Outcome
;
Adolescent
7.Multidetector computed tomography angiography for diagnosis of traumatic aneurysms associated with penetrating head injuries.
Konstantin Nickolaevich BABICHEV ; Aleksandr Viktorovich SAVELLO ; Alla Vladimirovna ISAEVA ; Dmitrij Vladimirovich SVISTOV ; Igor' Anatol'evich MEN'KOV ; Dzhamaludin Magomedrasulovich ISAEV
Chinese Journal of Traumatology 2025;28(2):91-95
PURPOSE:
To analyze the diagnostic efficacy of computed tomography angiography compared to digital cerebral angiography for the diagnosis of traumatic aneurysms (TAs) associated with combat-related penetrating head injuries and propose the most suitable angiography protocol in this clinical context.
METHODS:
A retrospective analysis was conducted on patients admitted to the neurosurgical clinic for penetrating traumatic brain injuries between February, 2022 and July, 2024, for whom both cerebral multidetector computed tomography angiography (MCTA) and digital cerebral angiography (DCA) were available. The inclusion were patients (1) with penetrating head injuries, (2) with missile trajectory traverses through the Sylvian or great longitudinal fissure, (3) basal cisterns with/or major subarachnoid hemorrhage. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. DCA was considered as the gold standard of diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. Descriptive statistics and nonparametric statistics were used to analyze the study results and their differences, respectively.
RESULTS:
A total of 40 patients with 45 TAs were included in the study. Of these, 26 patients (65.0%) were found to have aneurysms on MCTA. The median diameter of the aneurysms diagnosed by MCTA was 4.9 (3.6, 4.8) mm (range of 2.5 - 10.4 mm). However, the mean diameter of TAs not detected by MCTA but diagnosed by DCA was (3.0 ± 1.3) mm (range of 1.3 - 4.9 mm). MCTA demonstrated sensitivity and specificity of 35.5% and 99.5%, respectively, with positive and negative predictive values of 92.3% and 90.7%.
CONCLUSIONS
A low sensitivity of MCTA for the diagnosis of TAs associated with combat-related penetrating head injuries was reported. When MCTA is inconclusive in the setting of radiologic predictors of cerebral artery injury, DSA may be required.
Humans
;
Male
;
Retrospective Studies
;
Adult
;
Multidetector Computed Tomography/methods*
;
Intracranial Aneurysm/etiology*
;
Computed Tomography Angiography/methods*
;
Female
;
Head Injuries, Penetrating/diagnostic imaging*
;
Middle Aged
;
Cerebral Angiography/methods*
;
Predictive Value of Tests
;
Sensitivity and Specificity
;
Young Adult
8.Postoperative laboratory markers as predictors of early spinal surgical site infections: A retrospective cohort study.
Tianhong CHEN ; Renxin CHEN ; Hongliang ZHANG ; Qinyu FENG ; Lin CAI ; Jingfeng LI
Chinese Journal of Traumatology 2025;28(6):412-417
PURPOSE:
To screen laboratory markers with predictive value in early spinal surgical site infections (SSI) that are diagnosed within 30 days postoperatively.
METHODS:
Patients who underwent surgical treatment for internal spinal fixation between March 2022 and March 2023 in our hospital were retrospectively studied. The inclusion criteria were aged >18 years, undergoing internal fixation surgery, complete medical records with >30 days of postoperative follow-up, diagnosis was made within 30 days postoperatively, and an informed consent form was obtained. The exclusion criteria were abnormal white blood cell count or neutrophil percentage in the preoperative blood routine and combined diseases that may affect the C-reactive protein (CRP) or procalcitonin (PCT) values, including lower respiratory tract infection, renal insufficiency, and liver disease. We collected patients' personal information, surgical information, and blood laboratory data, including CRP, PCT, lymphocyte-neutrophil ratio, platelet-neutrophil ratio, and routine blood tests on preoperative and postoperative days 3, 5, and 7, from these patients. These data were statistically analyzed to determine which laboratory markers were statistically significant. The diagnostic value and optimal diagnostic threshold of these laboratory markers were further determined by receiver operating characteristic curve analysis.
RESULTS:
A total of 106 patients were enrolled in this study, of whom 8 patients were diagnosed with early SSI. A total of 4 laboratory markers were screened, namely, CRP on postoperative day 7 (optimal diagnostic threshold of ≥64.1 mg/L, sensitivity of 100%, specificity of 76.5%, area under the curve (AUC) of 0.908), PCT on postoperative day 7 (optimal diagnostic threshold of ≥0.2 ng/mL, sensitivity of 87.5%, specificity of 94.1%, AUC of 0.967), lymphocyte count on postoperative day 5 (optimal diagnostic threshold of ≤0.67 × 109/L, sensitivity of 50%, specificity of 95.9%, AUC of 0.760), and lymphocyte count on postoperative day 7 (optimal diagnostic threshold of ≤1.32 × 109/L, sensitivity of 87.5%, specificity of 55.1%, AUC of 0.721).
CONCLUSION
We concluded that CRP and PCT levels on postoperative day 7 and lymphocyte counts on postoperative days 5 and 7 are useful markers in screening for early spinal SSI.
Humans
;
Retrospective Studies
;
Male
;
Female
;
Biomarkers/blood*
;
Middle Aged
;
C-Reactive Protein/analysis*
;
Surgical Wound Infection/blood*
;
Procalcitonin/blood*
;
Adult
;
Aged
;
Postoperative Period
;
ROC Curve
;
Predictive Value of Tests
;
Spine/surgery*
9.Peak growth hormone and insulin-like growth factor 1 levels in girls with isolated premature thelarche and their predictive value for central precocious puberty.
Jie CHEN ; Kun-Di WANG ; Rong HUANG ; Shu-Fang LIU ; Qi YANG ; Li YANG
Chinese Journal of Contemporary Pediatrics 2025;27(11):1360-1366
OBJECTIVES:
To compare serum insulin-like growth factor 1 (IGF-1) and peak growth hormone (GH) levels between girls with isolated premature thelarche (IPT) and central precocious puberty (CPP), to construct a prediction model for progression from IPT to CPP, and to assess its diagnostic value.
METHODS:
Girls diagnosed with IPT (n=111) between January 2022 and August 2023 at the China-Japan Friendship Hospital and the Xinjiang Production and Construction Corps Hospital were retrospectively included. According to follow-up outcomes, participants were categorized into a CPP group (35 cases) and an IPT group (36 cases). A clinical prediction model for progression to CPP was constructed by multivariable logistic regression, and the contributions of IGF-1 and peak GH were evaluated. Restricted cubic spline analysis was used to assess the dose-response relationships of IGF-1 and peak GH with CPP. Decision curve analysis was applied to evaluate clinical utility.
RESULTS:
IGF-1 and peak GH were higher in the CPP group than in the IPT group (P<0.05). Compared with model 1 (without IGF-1 and peak GH), model 2 (with IGF-1 and peak GH) showed significantly higher area under the curve, integrated discrimination improvement, and net reclassification improvement (all P<0.05). Model 2 (χ 2=6.054, P=0.889) also demonstrated better goodness-of-fit than model 1 (χ 2=7.717, P=0.634). Nonlinear dose-response relationships were observed for peak GH and IGF-1 with CPP (P for overall trend <0.05; P for nonlinearity <0.05). Decision curve analysis indicated that combined prediction using IGF-1 and peak GH provided greater net benefit than either biomarker alone.
CONCLUSIONS
Peak GH and IGF-1 are closely associated with progression from IPT to CPP in girls. A clinical prediction model incorporating peak GH and IGF-1 can improve prediction of progression to CPP and yield higher net benefit.
Humans
;
Female
;
Puberty, Precocious/etiology*
;
Insulin-Like Growth Factor I/analysis*
;
Child
;
Retrospective Studies
;
Human Growth Hormone/blood*
;
Predictive Value of Tests
;
Child, Preschool
;
Logistic Models
10.The Predictive Value of Age, D-Dimer, and FIB in Non-Thrombotic Diseases.
Zhao-Bing LUO ; Chao-Zan NONG ; Li-Bing HUANG ; Bai-Hui WEN
Journal of Experimental Hematology 2025;33(3):858-862
OBJECTIVE:
To explore the predictive value of age, D-Dimer and fibrinogen (FIB) for non-thrombotic.
METHODS:
A retrospective analysis was conducted on a total of 1 384 coagulation test cases from January to August 2024 at Nanning No. 8 People's Hospital. Among them, the control group comprised 400 non-thrombotic cases with D-Dimer test results within the reference range. The thrombotic group comprised 57 clinically diagnosed thrombotic patients. The research group comprised 927 non-thrombotic cases with D-Dimer levels exceeding the reference range. The diagnosis treatment records, age information, plasma D-Dimer, and FIB test results of each group were collected. The changes and correlations of age, D-Dimer, and FIB indicators were compared and analyzed among the three groups. A new combination factor was generated by fitting a Logistic binary regression model. ROC curves were used to evaluate the predictive value of each index for non-thrombotic disease in both the research group and the thrombotic group.
RESULTS:
Compared with the control group, the thrombotic group and the research group had significantly higher age, D-Dimer, and FIB levels (P < 0.001). Further comparative analysis showed that the research group had significantly lower age and D-Dimer levels than the thrombotic group, the FIB level was significantly higher than that of the thrombotic group (P < 0.001). Spearman correlation analysis showed that the correlation coefficient between age and D-Dimer in the research group was higher than that in the control group and thrombotic group (P < 0.01), the thrombotic group had the highest negative correlation coefficient between FIB and D-Dimer (P < 0.01). The ROC curve analysis results showed that the AUC values of age, plasma D-dimer, and FIB independently predicted non-thromb diseases were 0.726, 0.735, and 0.611, respectively. A new combined factor was generated by fitting age, D-dimer, and FIB with a logistic binary regression model. The AUC value of the combined prediction of non-thrombotic diseases was the maximum at 0.832, which had high diagnostic value, and its sensitivity and specificity were 0.572 and 0.070.
CONCLUSION
Elevated D-dimer levels were associated with age, increased FIB, and a variety of non-thrombotic diseases, and combination of age, D-dimer, and FIB had a certain predictive value for non-thrombotic diseases, but the combined model had a low specificity, other information needs to be combined in the clinic to improve diagnostic accuracy.
Humans
;
Fibrin Fibrinogen Degradation Products
;
Retrospective Studies
;
Fibrinogen
;
Predictive Value of Tests
;
Thrombosis
;
Age Factors
;
ROC Curve
;
Male
;
Female
;
Middle Aged
;
Adult

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