Innovative perspectives on the value of diagnostic tests in clinical practice / Perspectivas innovadoras sobre el valor de las pruebas diagnósticas en la práctica clínica

Abstract Diagnostic tests have intrinsic characteristics such as sensitivity, specificity, overall accuracy and likelihood ratios which define their operational performance. It is not uncommon to find in the literature that test value and clinical utility are defined based exclusively on those characteristics. This paper introduces several arguments aimed at prompting a reflection regarding the characteristics that define the true value of diagnostic tests in clinical practice. It concludes with the view that the value of each diagnostic test needs to be established in accordance with the circumstances in which it is used, taking into account extrinsic characteristics such as in whom it is used, when, where and by who.

Resumen Las pruebas diagnósticas tienen características intrínsecas, como la sensibilidad, especificidad, exactitud global y las razones de verosimilitud, que definen su desempeño operacional. No es infrecuente encontrar en la literatura que se valore la prueba y se defina su utilidad clínica exclusivamente de acuerdo con estas características. En este documento se presentan varios argumentos que permiten reflexionar sobre las características que verdaderamente definen el valor de las pruebas diagnósticas en la práctica clínica. Se concluye con una perspectiva en la que el valor de cada prueba diagnóstica se establece de acuerdo con las circunstancias de uso de la misma: de quién, cuándo, dónde y en quién se use la prueba, y todas estas son características extrínsecas de una prueba diagnóstica.

Diagnostic efficacy of optimized T-SPOT.TB in differentiating spinal tu-berculosis from other spinal infection / 中国感染控制杂志

Objective To explore the efficacy of T-cell spot test of tuberculosis infection(T-SPOT.TB)in the differential diagnosis of spinal tuberculosis(STB),and optimize diagnostic efficacy through the optimal cut-off value of receiver operating characteristic(ROC)curve.Methods Clinical data of patients with spinal infection in a hospi-tal from January 2010 to May 2019 were collected,including preoperative T-SPOT.TB test results,white blood cell count,C-reactive protein,erythrocyte sedimentation rate,procalcitonin,and tuberculosis antibodies,etal.Clinical diagnosis was conducted based on diagnostic criteria.The sensitivity and specificity of T-SPOT.TB in preoperative diagnosis of STB and other spinal infection was analyzed,and the diagnostic efficacy of the optimized T-SPOT.TB indicators was evaluated.Results A total of 132 patients were included in this study,out of whom 78 patients(59.09％)were diagnosed with STB,and 54(40.91％)were diagnosed with non-tuberculosis(non-TB)spinal in-fection.The sensitivity and specificity of T-SPOT.TB in differential diagnosis of STB were 67.68％and 66.67％,respectively.Univariate logistic regression analysis showed that compared with non-TB spinal infection,the OR va-lue of T-SPOT.TB test in diagnosing STB was 4.188(95％CI:1.847-9.974,P＜0.001).The optimized T-SPOT.TB evaluation index through ROC curve to determine the optimal cut-off values of ESAT-6,CFP-10,and CFP-10+ESAT-6 for differential diagnosis of STB and non-TB spinal infection were 12.5,19.5,and 36,respec-tively,and area under curve(AUC)values were 0.765 6,0.741 5,and 0.778 6,respectively,all with good diag-nostic efficacy.CFP-10+ESAT-6 had the highest AUC.CFP-10+ESAT-6 specific spot count had higher efficacy in the diagnosis of STB,with a diagnostic accuracy of 75.56％,higher than 67.42％of pre-optimized T-SPOT.TB.Conclusion T-SPOT.TB test has high diagnostic efficacy in differentiating STB from non-TB spinal infection.Posi-tivity in T-SPOT.TB test,especially with spot count of CFP-10+ESAT-6 over 36,indicates a higher likelihood of STB.

Biological threats to global malaria elimination II Deletion in the malaria rapid diagnostic test target Plasmodium falciparum histidine-rich protein 2/3 genes / 中国血吸虫病防治杂志

The global malaria epidemic is still severe. Because of simple procedures, rapid detection and accuracy results, rapid diagnostic test (RDT) has become the most important and the most widely used diagnostic tool for malaria prevention and control. However, deletions in the RDT target Plasmodium falciparum histidine-rich protein 2/3 (Pfhrp2/3) genes may cause false-negative results of RDT, which has been included as one of the four biological threats to global malaria elimination. This article reviews the applications of RDT in the global malaria diagnosis, analyzes the threats and challenges caused by Pfhrp2/3 gene deletion, proposes methods for monitoring Pfhrp2/3 gene deletion, and summarizes the causes and countermeasures of negative RDT detections, so as to provide insights into consolidation of malaria elimination achievements in China and contributions to global malaria elimination.

A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective / Análise de custo-efetividade de um novo algoritmo para exame sequencial de hanseníase baseado em testes fabricados sob a perspectiva do SUS / Análisis de costo-efectividad de un nuevo algoritmo para el examen secuencial de lepra basado en pruebas fabricadas bajo la perspectiva del SUS

Abstract: Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.

Resumo: O Brasil tem o segundo maior número de casos de hanseníase (doença com carga significativa) do mundo. Apesar dos esforços globais e locais para eliminar esse problema de saúde pública, o diagnóstico inadequado ou tardio contribui para perpetuar sua transmissão, especialmente entre contatos intradomiciliares. Exames como o teste rápido de anticorpos IgM (RT) e a reação em cadeia da polimerase em tempo real (RT-PCR) foram desenvolvidos para superar as barreiras do diagnóstico precoce da hanseníase. Este estudo teve como objetivo analisar a relação custo-efetividade de um novo algoritmo de diagnóstico recomendado pelo governo brasileiro para diagnosticar a hanseníase em contatos domiciliares de casos confirmados de hanseníase, que inclui os testes RT e RT-PCR. Foi construído um modelo de árvore de decisão e adotada a perspectiva do Sistema Único de Saúde (SUS) considerando o período de um ano. Foram incluídos apenas os custos médicos diretos relacionados aos exames diagnósticos. A efetividade foi medida considerando o número de casos evitados de hanseníase. Diferentes cenários foram analisados. O uso sequencial de RT, baciloscopia e RT-PCR, conforme recomendado pelo Ministério da Saúde, foi comparado a um caso base (baciloscopia isolada), obtendo-se uma razão de custo-efetividade incremental de USD 616,46 por caso evitado de hanseníase. A análise de sensibilidade univariada mostrou que a prevalência de hanseníase entre contatos intradomiciliares foi a variável que mais influenciou o modelo. Este é o primeiro modelo econômico a analisar um algoritmo diagnóstico da hanseníase. Os resultados poderão auxiliar os gestores na definição de políticas e estratégias para a erradicação da hanseníase no Brasil.

Resumen: Brasil tiene el segundo mayor número de casos de lepra (enfermedad con carga significativa) del mundo. A pesar de los esfuerzos globales y locales para eliminar ese problema de salud pública, el diagnóstico inadecuado o tardío contribuye a perpetuar su transmisión, sobre todo entre contactos intradomiciliarios. Los exámenes como la prueba rápida de anticuerpos IgM (RT) y la reacción en cadena de la polimerasa en tiempo real (RT-PCR) se desarrollaron para superar las barreras del diagnóstico precoz de la lepra. El objetivo de este estudio fue analizar la relación de costo-efectividad de un nuevo algoritmo de diagnóstico recomendado por el gobierno brasileño para diagnosticar la lepra en contactos domiciliarios de casos confirmados de lepra, que incluye las pruebas RT y RT-PCR. Se construyó un modelo de árbol de decisión y se adoptó la perspectiva del Sistema Único de Salud (SUS) teniendo en cuenta el periodo de un año. Solo se incluyeron los costos médicos directos relacionados con los exámenes diagnósticos. Se midió la efectividad teniendo en cuenta el número de casos de lepra evitados. Se analizaron distintos escenarios. Se comparó el uso secuencial de RT, baciloscopia y RT-PCR, conforme el Ministerio de Salud recomienda, con un caso base (baciloscopia aislada), y se obtuvo un cociente de costo-efectividad incremental de USD 616,46 por cada caso de lepra evitado. El análisis de sensibilidad univariante mostró que la prevalencia de lepra entre contactos intradomiciliarios fue la variable que más influyó el modelo. Este es el primer modelo económico que analiza un algoritmo diagnóstico de lepra. Los resultados podrán ayudar los gestores a definir políticas y estrategias para erradicar la lepra en Brasil.

Diagnostic Accuracy of Rapid Antibody Detection Test for Scrub Typhus

Objectives: To detect the diagnostic accuracy of rapid antibody detection test using IgM immunochromatography for scrub typhus in children. Methods: This cross-sectional study enrolled children aged 2 months-18 years hospitalized over a period of 18 months with undifferentiated fever of duration five days or more. The blood samples were subjected to serological tests like Weil-Felix, Scrub IgM ELISA, immunofluroscence assay (IFA) and rapid diagnostic test (IgM Immunochromatography). Diagnostic accuracy was measured against IFA as the gold standard. Results: A total of 90 children were included in the study, among which 43 children were positive for gold standard test IFA. Rapid diagnostic test showed sensitivity of 88.3%, specificity of 89.3%, positive predictive value of 88.3% and negative predictive value of 89.3%. The sensitivity, specificity, PPV and NPV of Weil-Felix test was 39.5%, 84.2%, 58.6 and 71.1%, respectively and of IgM ELISA was 93%, 89.3%,88.8% and 93.3%, respectively. Conclusion: IgM immunochromatography had good diagnostic accuracy for scrub typhus in children with acute undifferentiated fever.

The establishment and validation of the Chinese version of SARC-F scale for sarcopenia screening among elderly population: a multicenter study / 中华临床营养杂志

Objective:To establish the Chinese version of (strength, assistance with walking, rise from a chair, climb stairs and falls, SARC-F) scale using the standardized methods and to validate the reliability and validity for sarcopenia screening among elderly population.Methods:Following the recommended procedure by World Health Organization and European Union Geriatric Medicine Society Sarcopenia Special Interest Group, the translation process included forward translation, expert panel, back-translation, pre-testing and cognitive interviewing to generate the final version. In the pilot study, the test-retest reliability, inter-rater reliability, and internal consistency of the Chinese version of SARC-F scale were assessed. In the diagnostic test for clinical validation, the participants were consecutively recruited from communities and hospitals in Beijing and Tianjin between December 2021 and October 2022. The scale administration, anthropometry, and body composition measurement were conducted by trained investigators. Participants with the SARC-F score ≥ 4 were considered at risk of sarcopenia. Diagnostic tests and receiver operating characteristic curve analysis were performed against the definitions of sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP2) and Asian Working Group for Sarcopenia (AWGS2019), and the sensitivity, specificity, positive predictive value, negative predictive value and the area under curve were displayed.Results:The Chinese version of SARC-F scale was approved by the author that the translation has expressed the original meaning correctly. The Chinese version of SARC-F had good test-retest reliability (ICC = 0.914), inter-rater reliability ( r = 0.726), and internal consistency ( α = 0.729). There were altogether 1 882 participants included in the clinical validation. According to the diagnostic criteria of EWGSOP2 and AWGS2019, the Chinese version of SARC-F scale had low sensitivity (13.6% and 16.0%) and positive predictive value (44.6% and 35.4%), high specificity (95.1% and 94.7%) and negative predictive value (79.0% and 86.2%), and moderate AUC of 0.619 and 0.616 (all P < 0.001) for sarcopenia screening. Conclusions:The Chinese version of SARC-F scale was of good reliability and validity. The application of SARC-F in the primary healthcare settings would contribute to the early diagnosis of sarcopenia.

Índice videoquimográfico da função glótica: análise da precisão diagnóstica / Videokymographic index of glottic function: an analysis of diagnostic accuracy

RESUMO Objetivo Elaborar um indicador composto denominado Índice Videoquimográfico da Função Glótica - IVFG, a partir de parâmetros da videoquimografia digital, captados pelo exame de videolaringoscopia de alta velocidade de mulheres sem e com alterações laríngeas de etiologia comportamental. Método A amostra foi composta por 92 mulheres, destas 55 apresentaram disfonia comportamental, com presença de alterações laríngeas e vocais, e 37 mulheres sem alterações laríngeas e vocais, entre 18 a 45 anos. A avaliação vocal foi realizada por consenso pela análise perceptivo-auditiva da vogal /a/ em frequência e intensidade habituais, e classificação através do grau geral da disfonia, onde G0 indicou qualidade vocal neutra e G1 a 3 qualidade vocal alterada. As imagens laríngeas foram obtidas pela gravação da emissão da vogal /i/, em frequência e intensidade habituais para análise da videoquimografia digital. A construção do IVFG se deu pela escolha do ponto médio da glote para análise e, elaboração foi realizada regressão logística pelo programa MINITAB 19. Resultados A regressão logística contou com duas etapas, sendo que a etapa 1 constou da análise de todas as variáveis, onde as variáveis abertura máxima e fechamento glótico apresentaram significância estatística (p-valor <0.05) e o modelo se encontrou bem ajustado de acordo com o teste de Hosmer-Lemeshow (p-valor=0,794); na etapa 2, as variáveis selecionadas foram novamente analisadas e o modelo também se mostrou bem ajustado (p-valor=0,198). O IVFG foi definido por IVFG=e^(8,1318-0,2941AbMax-0,0703FechGlo)/1+e^(8,1318-0,2941AbMax-0,0703FechGlo). Conclusão O IVFG apresenta valor de corte igual a 0,71. A probabilidade de acerto é de 81,5%, sensibilidade 76,4%, especificidade de 89,2%.

ABSTRACT Purpose To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology. Methods The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program. Results Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value <0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo). Conclusion The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

SD bioline malaria rapid diagnostic test performance and time to become negative after treatment of malaria infection in southwest Nigerian children

Context and Aim: Given the challenges of microscopy, we compared its performance with SD Bioline malaria rapid diagnostic test (MRDT) and polymerase chain reaction (PCR) and evaluated the time it took for positive results to become negative after treatment of children with acute uncomplicated malaria. Subjects and Methods: We present the report of 485 participants with complete MRDT, microscopy, and PCR data out of 511 febrile children aged 3­59 months who participated in a cohort study over a 12 month period in rural and urban areas of Ibadan, Nigeria. MRDT positive children received antimalaria and tested at every visit over 28 days. Speciation was also carried out by PCR. Results: With microscopy as the gold standard, SD-Bioline™ had 95.2% sensitivity, 66.4% specificity, 67.5% positive predictive value (PPV), and 94.9 negative predictive value (NPV), while with PCR the findings were 84.3% sensitivity, 66.5% specificity, 72.7% PPV, and 80.1% NPV. PCR speciation of malaria parasites revealed 91.6% Plasmodium falciparum, 18.9% Plasmodium malariae, and 4.4% Plasmodium ovale. Among the 47 children with P. malariae infections, 66.0% were coinfected with P. falciparum, while 54.6% cases of P. ovale occurred as coinfections with P. falciparum. The median time to a negative MRDT was 23.2 days, while the median time to a negative malaria microscopy was 3.8 days. The two survival curves were significantly different. Conclusions: The SD BiolineTM MRDT performed well, with remarkable persistence of rapid test-positive for an average of 23 days post treatment. The prevalence of P. malaria is somewhat greater than expected.

Impacto de la pandemia covid-19 en cirugia de abdomen / Impact of the covid-19 pandemic on abdominal surgery

La rápida propagación de COVID-19 ha hecho que exista una reorganización radical de los recursos sanitarios. Con el objetivo de ver el Impacto de la pandemia COVID-19 en cirugía de abdomen en el IGBJ-La Paz y COSSMIL. Se realizó un estudio descriptivo, retrospectivo y transversal entre marzo a octubre de 2019 previo a la pandemia y marzo a octubre de 2020 durante el periodo de la pandemia. El estudio reunió 836 pacientes, 563 (67.34%) en el grupo de pre-pandemia y 273 (32.66%) en el periodo pandémico, los procedimientos quirúrgicos disminuyeron de 2.3 a 1.2 con p=0,000, las cirugías vesiculares disminuyeron de 51.5% vs 45.4%, cirugía apendicular de 84(14.9%) a 68(24.9%). Los procedimientos electivos disminuyeron de 331 a 79 (80.7% vs 19.3%) p=0.000. Los procedimientos laparoscópicos disminuyeron de 305 (70.4%) a 107 (26.0%) con una p=0.000. Durante la pandemia se estudió 273, de los cuales 7 COVID-19 positivos, el método diagnóstico para COVID-19 más utilizado fue la TC de tórax y ELISA para COVID-19, factor de riesgo más frecuente fue hipertensión arterial 11(4.1%), el tiempo quirúrgico en pacientes COVID-19 positivos /negativos fue de 137 min (+ 30 min), días postoperatorio de 5.6 días en pacientes no COVID-19 y 2.8 días en pacientes COVID+, este último grupo presento 2 complicaciones, 1 absceso de pared de difícil resolución y 1 fallecido. El impacto de la pandemia fue reflejado en una reducción de los procedimientos de cirugía abdominal, en especial en cirugías electivas y laparoscópicos. Durante la pandemia la prueba diagnóstica para COVID-19 más utilizada fue TC de tórax y ELISA, los COVID-19 positivos no tuvieron morbilidad asociada, no se encontró diferencias estadísticas en el tiempo quirúrgico, ni en la estadía postoperatoria entre los pacientes COVID-19 positivos/negativos; los pacientes COVID-19+ presentaron complicaciones.

The rapid spread of COVID-19 has led to a radical reorganization of health resources. This study aimed to analyze the impact of the COVID-19 pandemic on abdominal surgery at IGBJ-La Paz and COSSMIL hospitals. A descriptive, retrospective and cross-sectional study was carried out between March to October 2019 prior to the pandemic, and March to October 2020 during the pandemic period. The study enrolled 836 patients, 563 (67.34%) in the pre-pandemic group and 273 (32.66%) in the pandemic period. Surgical procedures decreased from 2.3 to 1.2 (p=0,000), gallbladder surgeries decreased from 51.5% to 45.4%, appendiceal surgery from 84 (14.9%) to 68(24.9%). Elective procedures decreased from 331(80.7%) to 79 (19.3%), p=0.000. Laparoscopic procedures decreased from 305 (70.4%) to 107 (26.0%), p=0.000. During the pandemic, 273 patients were enrolled, of which 7 were COVID-19 positive, the most used diagnostic method for COVID-19 was chest CT and ELISA test, the most frequent risk factor was arterial hypertension 11 (4.1% ), surgical time in COVID-19 positive/negative patients was 137 min (± 30 min), postoperative days of 5.6 days in non-COVID-19 patients and 2.8 days in COVID+ patients, the latter group had complications, one patient presented wall abscess of difficult resolution, and one patient passed away. The pandemic impact was reflected in a reduction in abdominal surgery procedures, especially in elective and laparoscopic surgeries. During the pandemic, the most used diagnostic test for cOviD-19 were chest CT and ELISA test, positive COVID-19 patients had no associated morbidity, no statistical differences were found in surgical time and postoperative hospital stay days between positive/negative COVID19 patients. COVID-19+ patients presented complications.

Situación epidemiológica de la tuberculosis en Chile 2020-2021: repercusiones de la pandemia de COVID-19 / Epidemiological situation of tuberculosis in Chile 2020-2021: repercussions of the COVID-19 pandemic

La situación epidemiológica y operacional de la tuberculosis en el mundo se vio afectada por la pandemia de COVID-19 durante los años 2020 y 2021. A nivel global, el número de casos de tuberculosis notificados disminuyó en un 18% el año 2020 con respecto al año anterior, y el número de muertes por esta causa mostró un aumento en el mismo año. En Chile, se observó una caída similar en el número de casos diagnosticados el año 2020, en directa relación con una disminución del 70% en el número de muestras procesadas para diagnóstico de tuberculosis pulmonar. El presente trabajo detalla indicadores epidemiológicos y operacionales del control de la tuberculosis en Chile para los años 2020 y 2021, y analiza su relación con el impacto de la pandemia COVID-19 sobre las actividades del Programa Nacional de Tuberculosis.

The COVID-19 pandemic during 2020 and 2021 affected the epidemiological and operational situation of tuberculosis control worldwide. Globally, there was a reduction of 18% in the number of notified cases of tuberculosis in 2020 in comparison to the previous year, and the number of deaths increased in the same year. In Chile, there was a similar fall in the number of notified cases, in direct relation to a decrease of 70% in the number of diagnostic tests performed for pulmonary tuberculosis at a national level. This article details the epidemiological and operational indicators of tuberculosis control in Chile during 2020-2021, and analyzes their relation with the impact of COVID-19 pandemic on the activities of the National Tuberculosis Program.

Troponina I de alta sensibilidad para el descarte temprano del infarto agudo de miocardio / High sensitivity troponin I to early rule out for acute myocardial infarction

Resumen Introducción: La mayor utilidad de las troponinas de alta sensibilidad (Tn-hs) es descartar tempranamente el infarto agudo de miocardio (IAM). El algoritmo recomendado por la guía de práctica clínica (GPC) del Ministerio de Salud de Colombia para descartar el IAM es respaldado por evidencia de baja calidad y no ha sido validado en población colombiana. Objetivo: evaluar la capacidad de este algoritmo empleando troponina I de alta sensibilidad (TnI-hs) para descartar el IAM sin elevación del segmento ST (IAMSEST). Métodos: se analizaron pacientes con sospecha de síndrome coronario agudo (SCA) atendidos en un servicio de urgencias de un centro de alta complejidad. El desenlace primario fue el diagnóstico de IAMSEST tipo 1 y tipo 4b. Se determinaron las características operativas para los puntos de corte del algoritmo para el desenlace primario, reingreso hospitalario y muerte a 30 días. Resultados: se incluyeron 2.282 pacientes en los que el desenlace primario ocurrió en 389. El algoritmo de la GPC colombiana tuvo S del 90,9% (IC 95%: 74-100) y VPN del 99% (IC 95%: 99-100) utilizando el percentil 99 (p99) no discriminado por sexo, pero tanto la S como el VPN mejoraron al 100% cuando se utilizó el p99 por sexo. Conclusión: el algoritmo recomendado por la GPC colombiana utilizando TnI-hs y con el p99 ajustado por sexo tiene excelente capacidad para descartar de manera temprana y segura el diagnóstico de IAMSEST.

Abstract Introduction: The greatest utility of high-sensitivity troponins (Tn-hs) is to rule out acute myocardial infarction (AMI) early. The algorithm recommended by the Colombian practice guideline clinical (CPG) of Health’s Ministry to rule out AMI is supported by low-quality evidence and has not been validated in the Colombian population. This research aims to evaluate the ability of this algorithm using high sensitivity troponin I (TnI-hs) to rule out AMI without ST segment elevation (STEMI). Methods: Patients with suspected acute coronary syndrome (ACS) treated in an emergency department of a highly complex center were analyzed. The primary outcome was the diagnosis of STEMI type 1 and type 4b. The operativing characteristics for the algorithm cut-off points were determined for the primary outcome, hospital readmission death at and 30 days. Results: 2282 patients were included in whom the primary outcome occurred in 389. The Colombian CPG algorithm had S of 90.9% (95% CI 74-100) and NPV of 99% (95% CI 99-100) using the 99th percentile (p99) not discriminated by sex, but both S and NPV improved 100% when p99 was used by sex. Conclusion: The algorithm recommended by the Colombian CPG using TnI-hs and with the p99 adjusted for sex has an excellent capacity to rule out early and safely the diagnosis of STEMI.

Avaliação de Estudante com Altas Habilidades/Superdotação Pré e Pós-Oferta de Enriquecimento Curricular / Evaluation of Student with High Ability/Giftedness Pre and Post Curriculum Enrichment Offer / Evaluación de Estudiante con Altas Capacidades/ Superdotación Pre y Post Oferta de Enriquecimiento Curricular

Objetiva-se apresentar o processo de avaliação e confirmação dos indicadores de Altas Habilidades/Superdotação de um estudante, pré e pós-oferta de enriquecimento intracurricular e extracurricular. A pesquisa configura-se como descritiva, do tipo casuístico. Participou do estudo um estudante com indicadores de Altas Habilidades/Superdotação, matriculado nos anos iniciais do Ensino Fundamental de uma escola pública estadual do interior de São Paulo. A coleta de dados foi realizada na escola e no Centro de Psicologia Aplicada de uma Universidade Pública da cidade, por meio de uma avaliação multimodal, envolvendo uma bateria de instrumentos aplicados junto à mãe e ao estudante, incluindo avaliação pedagógica, psicológica e psicomotora. Os resultados indicaram que o estudante apresenta fortes indicadores de Altas Habilidades/Superdotação, demonstrando desempenho acima da média, com destaque em matemática, leitura e escrita, os quais puderam ser confirmados tanto pela avaliação pedagógica quanto pela psicológica, e alto desempenho na área de psicomotricidade. A oferta de enriquecimento intracurricular e extracurricular contribuiu para melhorar o desempenho do estudante.

The objective is to present the process of evaluating and confirming the indicators of High Abilities/Giftedness of a student, pre and post-offer for intracurricular and extracurricular enrichment. The research is descriptive, of the casuistic type. A student with indicators of High Abilities/Giftedness, enrolled in the early years of Elementary School from a state public school in the state of São Paulo, participated in the study. Data collection was carried out at the school and at the Applied Psychology Center of a Public University in the city through a multimodal assessment, involving a battery of instruments applied to the mother and student, including pedagogical, psychological and psychomotor assessment. The results indicated that the student has strong indicators of High Abilities/Giftedness, demonstrating above-average performance, especially in mathematics, reading and writing, which could be confirmed by both the pedagogical and psychological assessment, and high performance in the area of psychomotricity. Offering intra and extra-curricular enrichment has contributed to improving the student's performance.

El objetivo deste estudio es presentar el proceso de evaluación y confirmación de los indicadores de Altas Capacidades/Superdotación, antes y después de la oferta de enriquecimiento intracurricular y extracurricular. La investigación es descriptiva, de tipo casuístico. Participó en el estudio un estudiante con indicadores de Altas Capacidades/ Superdotación matriculado en los primeros años de la Escuela Primaria, de una escuela pública estatal en el interior de São Paulo. La recolección de datos se realizó en la escuela y en el Centro de Psicología Aplicada de una Universidad Pública de la ciudad. Através de una evaluación multimodal, que involucró una batería de instrumentos aplicados a la madre y al alumno, incluyendo evaluación pedagógica, psicológica y psicomotora. Los resultados indicaron que el estudiante tiene fuertes indicadores de Altas Capacidades/Superdotación, demostrando un desempeño superior al promedio, con énfasis en matemáticas, lectura y escritura, lo cual podría ser confirmado tanto por la evaluación pedagógica, la psicológica y de alto desempeño en el área de Psicomotricidad. Ofrecer enriquecimiento intra y extracurricular ha contribuido a mejorar el rendimiento de los estudiantes.

Lung ultrasound for the diagnosis of pneumonia in children in recent 5 years: a meta-analysis / 中国小儿急救医学

Objective:To assess the accuracy of lung ultrasound(LUS) to predict pneumonia in pediatric patients using meta-analysis.Methods:The PubMed, the Cochrane Library, EMbase databases from January 2015 to March 2020 were searched.The retrieved outcome data to evaluate the efficacy of LUS for the diagnosis of pneumonia in patients under 18 years of age were included.Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies.Meta-analysis was then conducted using MetaDisc 1.4, RevMan 5.3 and Stata 15.0 softwares.Results:Twelve diagnostic studies were included, which involved 2 484 patients.The results of meta-analysis showed that compared with the gold standard, the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio of LUS were 0.90(95% CI 0.88-0.91), 0.88(95% CI 0.85-0.90), 8.64(95% CI 3.79-19.72), 0.12(95% CI 0.06-0.26) and 77.58(95% CI 28.39-211.99), respectively.The area under the summary receiver operating characteri stic curve was 0.96.Subgroup analysis showed that there was no difference in LUS′s diagnostic accuracy for pneumonia with different department, different diagnostic gold standard, and different level of sonographer training. Conclusion:Current evidence shows that LUS has a high accuracy in the diagnosis of pneumonia in children.

Repeatability of CASIA2 for measuring the tilt and decentration of crystalline lens and intraocular lens under non-mydriatic and mydriatic conditions / 中华实验眼科杂志

Objective:To investigate the repeatability and correlation in tilt and decentration measurement of crystalline lens and intraocular lens (IOL) under non-mydriatic and mydriatic conditions using swept-source ocular coherence tomography CASIA2.Methods:A diagnostic test study was conducted.A total of 109 cataract patients (157 eyes) who received phacoemulsification with IOL implantation surgery in the Affiliated Hospital of North Sichuan Medical College from March to July 2020 were enrolled.The decentration and tilt of crystalline lens and IOL under non-mydriatic and mydriatic conditions were measured for three times by a single examiner using CASIA2 before and one week after surgery.The 0.5% compound tropicamide eye drops were used to dilate.Repeatability was evaluated by within-standard deviation, test-retest repeatability (TRT), coefficient of variation (CoV) and intraclass correlation coefficient (ICC). The correlation in decentration and tilt of crystalline lens and IOL between before and after mydriasis was assessed by Pearson correlation coefficient.This study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of the Affiliated Hospital of North Sichuan Medical College (No.2020ER030-1). Written informed consent was obtained from all subjects before any medical examination.Results:The decentration of crystalline lens under non-mydriatic and mydriatic conditions was (0.217±0.112)mm and (0.220±0.110)mm, respectively, and the tilt was (5.017±1.422)° and (5.310±1.645)°, respectively.The decentration of IOL under non-mydriatic and mydriatic conditions was (0.245±0.136)mm and (0.250±0.145)mm, respectively, and the tilt was (5.144±1.345)° and (5.437±1.646)°, respectively.No significant difference was found between non-mydriatic and mydriatic conditions (all at P>0.05). Under both non-mydriatic and mydriatic conditions, the crystalline lenses of both eyes decentered and tilted toward the inferotemporal direction, and the IOL of right eyes decentered toward the inferior and tilted toward the inferotemporal direction, and the IOL of left eyes decentered and tilted toward the inferotemporal direction.Except the crystalline lens decentration, the measurement repeatability of crystalline lens tilt, IOL decentration and tilt in cataract patients before and after mydriasis was good, with ICC range in 0.815-0.984, TRT<50% and CoV≤14.840%.The measurement repeatability of crystalline lens decentration was poor, and the measurement repeatability of decentration axis, tilt and tilt axis of crystalline lens, and the repeatability of decentration and tilt of IOL were good in both eyes, with ICC range in 0.757-0.998, TRT<50% and CoV≤17.763%.There were good correlations in decentration, decentration axis, tilt and tilt axis of crystalline lens and IOL between non-mydriatic and mydriatic conditions (all r≥0.679, all at P<0.01). Conclusions:The measurement repeatability of decentration axis, tilt and tilt axis of crystalline lens and IOL, as well as the decentration of IOL by CASIA2 before and after mydriasis is good.The correlations of the measured parameters before and after mydriasis are good.

Establishment of a new diagnostic model for significant liver tissue damage in patients with chronic hepatitis B virus infection in the immune tolerance phase / 中华传染病杂志

Objective:To establish and evaluate a new diagnostic model for significant liver tissue damage in patients with chronic hepatitis B virus (HBV) infection in the immune tolerance phase.Methods:The clinical data of 275 chronic HBV infection patients in the immune tolerance phase who underwent liver biopsy from January 2015 to November 2020 in the Hwa Mei Hospital, University of Chinese Academy of Sciences were included. According to the liver pathological changes, patients were divided into <G2 group and ≥G2 group, <S2 group and ≥S2 group, non-significant liver pathological damage group (GS0 group, <G2+ <S2) and significant liver pathological damage group (GS1 group, G2 and/or ≥S2). The liver pathological changes and clinical features were analyzed to establish the diagnostic model. The prediction value of the model was compared. Statistical analysis was conducted by linear regression analysis, and the area under the receiver operating characteristic curve, sensitivity and specificity for the diagnostic value of the model were calculated.Results:Among 275 patients, 43 cases (15.64%) had liver histologic activity ≥G2, 30 cases (10.91%) with liver fibrosis ≥S2, and 55 cases (20.00%) with liver damage of GS1. The correlated independent risk factors associated with significant liver pathological damage were age, levels of hepatitis B e antigen, γ-glutamyl transpeptidase, platelet count, alkaline phosphatase and alanine aminotransferase (all P<0.050). The diagnostic model of Y G/S was established according to these factors. The diagnostic efficacy of Y G/Swas highest for patients with liver histologic activity≥G2 and liver pathological damage GS1, with the areas under the curve of 0.783 and 0.811, respectively. The threshold of Y G/S was 0.18, with the sensitivity, specificity and negative predictive value of 0.782, 0.736 and 93.10%, respectively. When Y G/S <0.05, the sensitivity, negative predictive value and negative likelihood ratio were 0.982, 97.96% and 0.08, respectively. When Y G/S≥0.25, the specificity and positive likelihood ratio were 0.905 and 5.14, respectively. When Y G/S≥0.30, the specificity and positive likelihood ratio were 0.959 and 9.33, respectively. Conclusions:Approximately 20.00% of patients with chronic HBV infection in immune tolerance phase have significant liver pathological damage. The diagnostic model of Y G/S (<0.05 or ≥0.30) has certain evaluation value for significant liver pathological damage, and could help these patients avoid liver biopsy to a certain extent.

Reasonably conduct the multiple Logistic regression analysis combined with the ROC curve analysis / 四川精神卫生

The purpose of this paper was to introduce how to reasonably carry out the method of the multiple Logistic regression analysis by combining the ROC curve analysis. Firstly， it introduced two groups of the basic concepts related to the ROC curve analysis， that was， the statistical description of common diagnostic indicators and the ROC curve analysis method of the diagnostic data. Secondly， it introduced the core contents of the ROC curve analysis， that was， the calculation of the area under the ROC curve and the comparison of the area under multiple ROC curves. Thirdly， through an example of a diagnostic test， the whole process of how to use SAS software for the analysis was introduced， the contents were as follows： ① the analysis using only multiple Logistic regression analysis； ② the multiple Logistic regression analysis combined with the ROC curve analysis. The conclusion was that， for the diagnostic test data， combining the multiple Logistic regression analysis with the ROC curve analysis could obtain richer and more reasonable statistical analysis results.

Comparison of Rapid Influenza Diagnostic Tests With Digital Readout Systems and Conventional Rapid Influenza Diagnostic Test for Influenza Virus Detection

@#Introduction: Rapid diagnosis for influenza virus infection is essential for proper patient management, delivering prompt treatment and reducing unnecessary antiviral therapy. Early diagnosis helps in disease prevention and control. Real-time reverse transcription-polymerase chain reaction (RT-PCR) assay yields high sensitivity and specificity in detecting influenza virus infection. However, it is relatively expensive and requires trained personnel and special equipment. In this study, we compared two rapid influenza diagnostic tests (RIDTs): digital readout systems (STANDARD™ F Influenza A/B FIA, fluorescence immunoassay) and conventional visual confirmation (QuickNavi™-Flu2, chromatography immunoassay) with the real-time RT-PCR assay. Methods: Two hundred ninety-eight respiratory samples were obtained from patients suspected of influenza infection at Siriraj Hospital from December 2018 to December 2019. Results: Real-time RT-PCR results showed the detection of influenza A virus in 99 samples (60%), influenza B virus in 61 samples (37%) and co-infection by both viruses in 5 samples (3%) by the real-time RT-PCR assay. The QuickNavi™-Flu2 sensitivity for detecting influenza A and B viruses were 81.73% and 84.85%, and the specificity was 100%. The STANDARD™ F Influenza A/B FIA sensitivity for detecting influenza A and B viruses were 84.62% and 83.33%, respectively. The specificity for influenza A virus detection was 99.25% and 94.74% for influenza B virus. Conclusion: The STANDARD™ F Influenza A/B FIA and the QuickNavi™-Flu2 showed acceptable and comparable sensitivity and specificity. Both RIDTs are potential alternative methods of real-time RT-PCR for rapid screening of influenza virus infection.

A pandemic guided by the SARS-CoV-2 PCR test: What should the clinician know?

Amidst an ever-evolving pandemic, the demand for timely and accurate diagnosis of coronavirus disease 2019 (COVID-19) continues to increase. Critically, managing and containing the spread of the disease requires expedient testing of infected individuals. Presently, the gold standard for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains the polymerase chain reaction (PCR) test. Potential vulnerabilities of this testing methodology can range from preanalytical variables to laboratory-related analytical factors and, ultimately, to the interpretation of results.

Adaptación al español chileno de la Evaluación Cognitiva Dinámica de Terapia Ocupacional de Loewenstein (DLOTCA) / Adaptação Transcultural para o espanhol chileno da Avaliação Cognitiva Dinâmica de Terapia Ocupacional de Loewenstein (DLOTCA) / Adaptation to Chilean Spanish of Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA)

Resumen Objetivo Adaptar la décima versión en inglés de la Dynamic Loewestein Occupational Therapy Cognitive Assessment al español chileno. Método Se realizó adaptación al español del manual de aplicación de DLOTCA. El proceso siguió las pautas generales para la traducción y adaptación de instrumentos de la Organización Mundial de la Salud (OMS), con traducción directa, panel de discusión de expertos, retrotraducción, pruebas previas y entrevistas cognitivas con usuarios. Resultados Se obtuvo una traducción directa al español por dos terapeutas ocupacionales bilingües que fue sometida a ajustes por un panel de expertos compuesto por 6 terapeutas ocupacionales, del total de 28 sub test el comité de expertos no tuvo discrepancia en 20 de ellos, de los 8 restantes se realizaron modificaciones. Se realiza una retrotraducción de la versión obtenida, donde solo hubo discrepancias con un término lo que fue resuelto por el equipo investigador. Finalmente se aplicó una prueba previa/pre test a 13 personas adultas con daño cerebral, los ajustes en esta etapa fueron ortográficos y de sustitución de algunos términos por palabras más comúnmente utilizados en la lengua chilena, verificando la consistencia en la comprensión de los ítems independientemente de los resultados obtenidos. Se produjeron tres versiones antes de la versión final, todas las etapas se desarrollaron de manera sistemática, logrando una traducción comprensible y consistente con la población chilena. Conclusiones Finalmente se ha puesto a disposición de la comunidad científica una versión en español chileno del instrumento DLOTCA.

Resumo ObjetivoAdaptar a décima versão em inglês do Dynamic Loewestein Occupational Therapy Cognitive Assessment para o espanhol chileno. MétodoO manual de aplicação DLOTCA foi adaptado para o espanhol. O processo seguiu as diretrizes gerais para tradução e adaptação de instrumentos da Organização Mundial da Saúde (OMS), com tradução direta, painel de discussão de especialistas, retrotradução, pré-testes e entrevistas cognitivas com os usuários. ResultadosA tradução direta para o espanhol foi obtida por dois terapeutas ocupacionais bilíngues que foi submetida a ajustes por um painel de especialistas composto por 6 terapeutas ocupacionais, do total de 28 subtestes, o comitê de especialistas não apresentou discrepância em 20 deles, das quais 8 modificações restantes foram feitas. Foi realizada a retrotradução da versão obtida, com apenas discrepâncias com um termo, o que foi resolvido pela equipe de pesquisa. Por fim, uma prova prévia / pré-teste foi aplicado a 13 adultos com lesão cerebral, os ajustes nesta etapa foram de grafia e substituição de alguns termos por palavras mais utilizadas na língua chilena, verificando a consistência na compreensão dos itens, independentemente dos resultados obtidos. Três versões foram produzidas antes da versão final, toda as etapas foram desenvolvidas de forma sistemática, alcançando uma tradução compreensível e consistente para a população chilena. Conclusões: Uma versão em espanhol chileno do instrumento DLOTCA foi finalmente disponibilizada para a comunidade científica.

Abstract Objective To adapt the tenth version in English of the Dynamic Loewenstein Occupational Therapy Cognitive Assessment to Chilean Spanish. Method The DLOTCA application manual was adapted into Spanish. The process followed the general guidelines for the translation and adaptation of instruments of the World Health Organization (WHO), with direct translation, a panel discussion of experts, back translation, pre-tests, and cognitive interviews with users. Results A direct translation into Spanish was obtained by two bilingual occupational therapists that were subjected to adjustments by a panel of experts composed of 6 occupational therapists, of the total of 28 sub-tests, the expert committee had no discrepancy in 20 of them, of which 8 remaining modifications were made. A back translation of the version obtained is carried out, where there were only discrepancies with one term, which was resolved by the research team. Finally, a pre-test was applied to 13 adults with brain damage, the adjustments in this stage were spelling and substitution of some terms for words more commonly used in the Chilean language, verifying the consistency in the understanding of the items independently of the results obtained. Three versions were produced before the final version, all stages were developed in a systematic way, achieving an understandable and consistent translation with the Chilean population. Conclusions A version in Chilean Spanish of the DLOTCA instrument has finally been made available to the scientific community.

De lo complejo a lo simple… deshidrogenasa láctica como marcador de severidad en pacientes con infección por SARS-CoV-2 / From complex to simple... lactic dehydrogenase as a severity marker in patients with SARS-CoV-2 infections / Do complexo ao simples… Desidrogenase láctica como marcador de gravidade em pacientes com infecção por SARS-CoV-2

resumen está disponible en el texto completo

Abstract: Introduction: The reference standard for the diagnosis of COVID-19 remains reverse transcriptase polymerase chain reaction (RT-PCR)-positive, while plain chest computed tomography (CT) has been more sensitive and specific in severity classification. In defining the severity of SARS-CoV-2, clinical, imaging and laboratory criteria have been specified, mentioning several markers, including lactate dehydrogenase (LDH). Historically, LHD has been of interest as a biomarker associated with lung damage, with a greater peak during the influenza A H1N1 pandemic, and taken as a marker in the definition of severity. Objective: To determine the diagnostic performance of serum LHD levels on admission to the ICU as a marker of severity in patients with SARS-CoV-2 infection. Material and methods: Observational, analytical, longitudinal and prospective study, carried out in two stages, the first (April 1, 2020 to September 30, 2020) consisted of a correlation study between serum LHD levels at Intensive Care Unit (ICU) admission and simple chest CT, a moderate correlation was obtained between serum LHD levels and severity score by pulmonary tomography, with an r = 0.5 and p < 0.0001; a severity-associated serum LHD cut-off point of 396 U/dL was obtained (p < 0.001, sensitivity 86.02%, specificity 75%). The second stage was extended until December 31, 2020, in which analysis is performed for diagnostic test performance, in inferential statistics correlation tests are performed, a multiple linear regression model is built, analysis was performed for diagnostic tests by building two-by-two contingency Tables, determining sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and Bayesian analysis. Results: 155 patients were included in the study to determine the diagnostic performance of serum LHD levels in patients with severe SARS-CoV-2 infection; by multiple linear regression analysis, it was determined that LHD levels on admission to the ICU is a predictor of severity in patients with SARS-CoV-2. A sensitivity of 0.92, specificity 0.41, with PPV 0.854, NPV 0.57 and an accuracy of 0.83, an LR + 1.57 and LR- 0.63 were obtained. In the post-test probability results, patients with DHL > 396 U/dL have a 86.3% probability of developing severe COVID-19. DHL levels have a direct correlation with ICU days of stay and days of invasive mechanical ventilation with statistical significance (p = 0.001, p = 0.033 respectively). Conclusion: Serum LHD levels have a high sensitivity to diagnose COVID-19 severity; and in the absence of simple chest CT, it can predict severe lung damage. It constitutes a test with high screening power in severe cases of COVID-19; with a probability of almost double (LR + 1.6) that of predicting a severe case.

Resumo: Introdução: O padrão de referência para o diagnóstico de COVID-19 continua sendo a reação em cadeia da polimerase com transcriptase reversa positiva (RT-PCR), enquanto a tomografia computadorizada (TC) de tórax simples tem se mostrado mais sensível e específica na classificação de gravidade. Na definição da gravidade do SARS-CoV-2, foram especificados critérios clínicos, de imagem e laboratoriais, mencionando vários marcadores, incluindo a desidrogenase láctica (DHL). A DHL ao longo da história tem sido de interesse como biomarcador associado a danos pulmonares, com maior boom durante a pandemia de influenza A H1N1, e tomado como marcador na definição de gravidade. Objetivo: Determinar o desempenho diagnóstico de dois níveis séricos de DHL na admissão à UTI como marcador de gravidade em pacientes com infecção por SARS-CoV-2. Métodos: Estudo observacional, analítico, longitudinal e prospectivo, realizado em duas etapas, a primeira (01 de abril de 2020 a 30 de setembro de 2020) consistiu em um estudo de correlação entre os níveis séricos de DHL na admissão na UTI e TC simples de tórax, um foi obtida correlação entre os níveis séricos de DHL e o escore de gravidade pela tomografia pulmonar, com r 0.5 ep < 0.0001; um ponto de corte para DHL sérico associado à gravidade de 396 U/dL foi obtido (p < 0.001, sensibilidade 86.02%, especificidade 75%). A segunda etapa foi estendida até 31 de dezembro de 2020, na qual são realizadas análises para realização de testes diagnósticos, testes de correlação em estatística inferencial, construção de um modelo de regressão linear múltipla, análise para testes diagnósticos, construção tabelas de contingência dois a dois, determinando sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, razões de verossimilhança e análise Bayesiana. Resultados: 155 pacientes foram incluídos no estudo para determinar o desempenho diagnóstico dos níveis séricos de DHL em pacientes com infecção grave por SARS-CoV-2; pela análise de regressão linear múltipla, determina-se que os níveis de DHL na admissão à UTI é um preditor de gravidade em pacientes com SARS-CoV-2. Obteve-se sensibilidade de 0.92, especificidade de 0.41, com VPP 0.854, VPN 0.57 e exatidão de 0.83, LR+ 1.57 e LR- 0.63. Nos resultados de probabilidade pós-teste, pacientes com DHL > 396 U/Dl têm probabilidade de 86.3% de desenvolver doença grave por COVID-19. Os níveis de DHL têm correlação direta com os dias de permanência na UTI e os dias de tratamento invasivo ventilação mecânica com significância estatística (p = 0.001, p = 0.33 respectivamente). Conclusão: Os níveis séricos de DHL têm alta sensibilidade para diagnosticar gravidade por COVID-19; e na ausência de TC simples de tórax, pode predizer danos pulmonares graves. Constitui um teste com alto poder de escrutínio em casos graves de COVID-19; com quase o dobro da probabilidade (LR + 1.6) de predizer uma condição grave.