Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease / 대한소아소화기영양학회지

PURPOSE: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. METHODS: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. RESULTS: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75–1). CONCLUSION: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75–1). This cut-off may be used in combination with clinical judgment to diagnose CD.

Paediatric Risk of Mortality III Score to Predict Outcome in Patients Admitted to PICU with Dengue Fever

Background: The objective of the current study was to evaluate the ability of PRISM III score calculated within 24 hours of PICU admission to predict outcome in patients with dengue fever. Materials & Methods: The prospective cohort study included children admitted to PICU with diagnosis of ‘Dengue with warning sign’ and ‘Severe Dengue’. Outcome included PICU mortality, length of PICU stay (LOS), need for mechanical ventilation and renal replacement therapy (RRT). PRISM III score was calculated and compared with outcome groups. Calibration of the score was measured using Hosmer‑Lemeshow modification of chi square test and discrimination using Area under the curve of Receiver Operating Characteristic curves. Results: This study included 151 patients with 54.3% Dengue with warning signs and 45.7% severe Dengue. Median PRISM III-24 score of patients who died (p-0.001), required RRT (p-0.006), mechanical ventilation (p-0.032) and those with prolonged LOS (p-0.003) were significantly higher. Hosmer‑Lemeshow modification of chi square test to assess calibration showed good fit of PRISM III-24 model to predict mortality (χ2-2.022; p-0.846), need for RRT (χ2-3.564; p-0.614), prolonged LOS (χ2-4.360; p-0.499) and need for mechanical ventilation (χ2-7.497; p-0.186).  ROC curve for the PRISM III-24 model to predict the discriminating power yield an AUC of 0.923 (95% CI: 0.829-1.000) for mortality, 0.953 (95% CI: 0.896-1.000) for need for RRT, 0.682 (95% CI: 0.494-0.870) for need for mechanical ventilation and 0.663 (95% CI: 0.563-0.764) for prolonged LOS. Conclusion: PRISM III is an effective tool to predict mortality and need for RRT in patient with dengue fever