ABSTRACT
Objective: To assess the accuracy of B-type natriuretic peptide (BNP) in addition to myoglobin, creatine kinase-MB (CK-MB), and troponin I to diagnose patients with non ST-segment elevation myocardial infarction (NSTEMI) at the emergency department. Methods: During January to July 2007, a total of 100 patients with suspected acute myocardial infarction at the emergency department were included. 50 were classified as NSTEMI and 50 as non-NSTEMI according to the final hospital diagnosis. Blood samples for investigation of myoglobin, CK-MB, troponin I, and BNP analysis were collected in EDTA tubes concomitantly with routine blood specimens from the emergency department and measured by Biosite Triage Cardioprofiler Panel (Biosite Inc., San Diego, CA) Results: The diagnostic sensitivity of Myoglobin and BNP (cut-off value of 100 pg/mL) for acute myocardial infarction (AMI) was significantly higher than CK-MB and troponin-I at the emergency department (76 and 82 vs. 36 and 24 %, respectively, P< 0.001). BNP in addition to myoglobin, CK-MB, and troponin I improved the diagnostic sensitivity from 86% to 100%. The optimum cut-off point levels for myoglobin, CK-MB, troponin-I, and BNP were 150 ng/mL, 3.8 ng/mL, 0.15 ng/mL and 147 pg/mL respectively. Using the optimal cutoff point, the sensitivity was 96 % and specificity was 46 % in diagnosis for myocardial infarction. Conclusion: Multiple cardiac markers by use of quantitative point-of-care testing for myoglobin, CK-MB, troponin-I and BNP are useful for ruling out patients presenting to the emergency department with suspected NSTEMI.
ABSTRACT
Objective: To evaluate the correlation and agreement of erythrocyte and leukocytes count in cerebrospinal fluid (CSF) among two different manual methods and automated method. Methods: We evaluated the correlations and agreements of the CSF RBC counts, WBC counts and WBC differential counts between two manual methods and automated method by using the ADVIA 120 CSF assay. Results: We studied 83 CSF specimens in all methods. Absolute cell counts showed a high correlation and agreement between methods, with correlation coefficient (rs) for all absolute counts of more than 0.89 and intraclass correlation (ICC) more than 0.9. The correlation and agreement of WBC differential counts from CSF specimens which had more than 20 WBCs/µL were also evaluated, which revealed good results only for polymorphonuclear cells, neutrophils and lymphocytes (rs = 0.796, 0.835 and 0.779, respectively and ICC = 0.954, 0.899 and 0.907, respectively). When WBC counts more than 5 cells/µL in automated method were used as a cut-off point, the sensitivity is 100% but specificity is very low (60.87%). The cut-off point of 5 WBCs/µL for manual method and 11 WBCs/µL for automated method gave the highest agreement (Kappa 0.874, sensitivity 91.43% and specificity 95.65%). Conclusion: The ADVIA 120 CSF assay provide a useful and efficient method for excluding the normal CSF specimens at cut-off 5 WBCs/µL.