Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Predictive”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources

Structure-based methods for predicting mutagenicity and carcinogenicity: are we there yet?

There is a great deal of current interest in the use of commercial, automated programs for the prediction of mutagenicity and carcinogenicity based on chemical structure. However, the goal of accurate and reliable toxicity prediction for any chemical, based solely on structural information remains elusive. The toxicity prediction challenge is global in its objective, but limited in its solution, to within local domains of chemicals acting according to similar mechanisms of action in the biological system; to predict, we must be able to generalize based on chemical structure, but the biology fundamentally limits our ability to do so. Available commercial systems for mutagenicity and/or carcinogenicity prediction differ in their specifics, yet most fall in two major categories: (1) automated approaches that rely on the use of statistics for extracting correlations between structure and activity; and (2) knowledge-based expert systems that rely on a set of programmed rules distilled from available knowledge and human expert judgement. These two categories of approaches differ in the ways that they represent, process, and generalize chemical-biological activity information. An application of four commercial systems (TOPKAT, CASE/MULTI-CASE, DEREK, and OncoLogic) to mutagenicity and carcinogenicity prediction for a particular class of chemicals-the haloacetic acids (HAs)-is presented to highlight these differences. Some discussion is devoted to the issue of gauging the relative performance of commercial prediction systems, as well as to the role of prospective prediction exercises in this effort. And finally, an alternative approach that stops short of delivering a prediction to a user, involving structure-searching and data base exploration, is briefly considered.

Animals↗

Three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight.

OBJECTIVE: To compare the accuracy of three-dimensional ultrasound-assessed fetal thigh volumetry in predicting birth weight with that of other commonly used formulas composed of biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) by two-dimensional ultrasound. METHODS: We assessed the thigh volume of 100 fetuses using three-dimensional ultrasound. Meanwhile, their BPD, AC, and FL were measured by two-dimensional ultrasound. All infants were delivered within 48 hours after the ultrasound examinations. From polynomial regression analysis, we generated a best-fit formula for the thigh volume to predict birth weight. The accuracy of this thigh-volume formula was compared with those of three formulas commonly used in the United States. In addition, another group of 50 fetuses was measured for prospective validation. RESULTS: The high volume assessed by three-dimensional ultrasound was highly correlated with birth weight (r = 0.89, n = 100, P < .0001). The best-fit formula for thigh volume to predict birth weight was linear, and it was superior to the other commonly used two-dimensional formulas in predicting birth weight. The predicting error (0 g), percent error (0.7%), absolute error (176.1 g), and absolute percent error (5.8%) of the thigh-volume formula were all smaller than those of the other formulas (n = 100, all P < .05). In addition, the thigh-volume formula predicted birth weight more accurately than the other two-dimensional formulas in the prospective-validation group. The three-dimensional formula had smaller mean values of predicting error (38.6 g), percent error (1.5%), absolute error (160.0 g), and absolute percent error (5.1%) than the two-dimensional formulas (n = 50, all P < or = .001), as well as the smallest variances of the above errors (178.1 g, 5.6%, 84.3 g, and 2.9%, respectively). CONCLUSION: The three-dimensional ultrasound-assessed thigh volume has better accuracy in predicting birth weight than the commonly used formulas by two-dimensional ultrasound, and it may improve fetal weight prediction in clinical practice. However, a large-scale prospective validation study may be needed to confirm our conclusions.

Adult↗

Ecotoxicity prediction using mechanism- and non-mechanism-based QSARs: a preliminary study.

In ecotoxicology, mechanism-based quantitative structure-activity relationships (QSARs) are usually developed with higher quality than QSARs without regard to toxicity mechanism. Correctly determining the mechanism of a compound, which is not always easy, is required to use mechanism-based QSARs for toxicity prediction. The mechanism determination step may introduce extra errors in addition to the intrinsic prediction errors of mechanism-based QSARs, thus compromising these QSARs' performance compared with QSARs regardless of mechanism. In this study, the mechanism identification-toxicity prediction (MI-TP) approach was compared with the direct toxicity prediction (DTP) approach using a data set containing phenol toxicity to Tetrahymena pyriformis. A statistical mechanism classification model for mechanism prediction, four mechanism-based QSARs and a single QSAR without discriminating between mechanisms were developed for toxicity prediction. Toxicity of phenols in an external data set was predicted following the MI-TP and DTP approaches. Results indicated that the mechanisms of several phenols in the external test set were incorrectly predicted which led to significant over- or under-estimation of their toxicity. Overall, the MI-TP approach did not yield more accurate toxicity prediction than the DTP approach.

Animals↗

Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis.

BACKGROUND: Certain infections can trigger chronic fatigue syndromes (CFS) in a minority of people infected, but the reason is unknown. We describe some factors that predict or are associated with prolonged fatigue after infectious mononucleosis and contrast these factors with those that predicted mood disorders after the same infection. METHODS: We prospectively studied a cohort of 250 primary-care patients with infectious mononucleosis or ordinary upper-respiratory-tract infections until 6 months after clinical onset. We sought predictors of both acute and chronic fatigue syndromes and mood disorders from clinical, laboratory, and psychosocial measures. FINDINGS: An empirically defined fatigue syndrome 6 months after onset, which excluded comorbid psychiatric disorders, was most reliably predicted by a positive Monospot test at onset (odds ratio 2.1 [95% CI 1.4-3.3]) and lower physical fitness (0.35 [0.15-0.8]). Cervical lymphadenopathy and initial bed rest were associated with, or predicted, a fatigue syndrome up to 2 months after onset. By contrast, mood disorders were predicted by a premorbid psychiatric history (2.3 [1.4-3.9]), an emotional personality score (1.21 [1.11-1.35]), and social adversity (1.7 [1.0-2.9]). Definitions of CFS that included comorbid mood disorders were predicted by a mixture of those factors that predicted either the empirically defined fatigue syndrome or mood disorders. INTERPRETATION: The predictors of a prolonged fatigue syndrome after an infection differ with both definition and time, depending particularly on the presence or absence of comorbid mood disorders. The particular infection and its consequent immune reaction may have an early role, but physical deconditioning may also be important. By contrast, mood disorders are predicted by factors that predict mood disorders in general.

Chi-Square Distribution↗

Prediction of right ventricular and posterior wall ST elevation by coronary care nurses: the 12-lead electrocardiograph versus the 18-lead electrocardiograph.

OBJECTIVES: To determine the value of routine versus selective use of the 18-lead electrocardiogram in determining the size of an acute inferior myocardial infarction (MI). DESIGN: Prospective, quasi-experimental, random assignment. SETTING: The coronary care unit (CCU) of a major teaching hospital in South Australia. PATIENTS: Fifty-two patients admitted to the CCU with acute evolving inferior MI. OUTCOME MEASURES: Correlation and comparison of the predictions of the right ventricular (RV) and posterior wall (PW) lead ST elevation with prospectively chosen markers on the 12-lead electrocardiogram--ST elevation in lead III > II and precordial ST depression, and the predictions by coronary care nurses. PROCEDURE: The results of 18-lead electrocardiograms of 52 consecutive patients admitted to the CCU with acute evolving inferior MI were classified according to prospectively chosen criteria. Coronary care nurses were randomly assigned four 12-lead electrocardiograms and asked to "blindly" predict ST elevation in the concurrent RV and PW leads. RESULTS: ST elevation in lead III > II demonstrated a sensitivity and positive predictive accuracy of 86% to 1 mm of ST elevation in the RV leads. ST depression in V1, V2, and V3 similarly demonstrated a 75% sensitivity and 89% positive predictive accuracy to 1 mm of ST elevation in the PW leads. In comparison, coronary care nurses proved to be as accurate in their predictions of additional PW ST elevation (p = 0.73), but were significantly less able to predict RV ST elevation (p = 0.049). These predictions were independent of the level of experience and qualifications. CONCLUSIONS: Discriminating between smaller and larger types of inferior MIs has the potential to alter patient management: Thirty-two percent of patients in the study demonstrated additional ST elevation in both the RV and PW leads. Both of the 12-lead electrocardiogram markers used in this study proved reasonably accurate in predicting additional ST elevation in the leads that normally comprise the 18-lead electrocardiogram. Recognition of these markers has the potential to expedite the need for the additional 18-lead electrocardiogram when rapid assessment of infarction size is required. However, the routine use of the 18-lead electrocardiogram is supported by this study.

Clinical Competence↗

A prevalidation study on the in vitro skin irritation function test (SIFT) for prediction of acute skin irritation in vivo: results and evaluation of ECVAM Phase III.

A prevalidation study sponsored by the European Centre for the Validation of Alternative Methods (ECVAM) on in vitro tests for acute skin irritation is aimed at identifying non-animal tests capable of discriminating irritants (I) from non-irritants (NI), as defined according to European Union and OECD. This paper reports on Phase III for one of the methods, the skin integrity function test (SIFT), assessing the protocol performance of the SIFT, in terms of reproducibility and predictive ability, in three laboratories. The barrier function properties of excised mouse skin were determined using a set of 20 coded chemicals (10 I, 10 NI), using the endpoints of trans-epidermal water loss (TEWL) and electrical resistance (ER). The basis of the SIFT prediction model is if the ratios of the pre- and post-application values for either TEWL or ER are greater than five-fold, then the test chemical is deemed irritant (I). If the ratio of both parameters is less than five-fold then the chemical is deemed non-irritant (NI). Analysis of variance (ANOVA) indicated that the intra-lab reproducibility was acceptable but that the inter-lab reproducibility was not. Overall, the SIFT test under-predicted the irritancy of the test chemicals chosen for Phase III with an overall accuracy of only 55%. The sensitivity value (ability to correctly predict I) was only 30%. The specificity (ability to predict NI) of the test was better at 80%. A retrospective examination of the SIFT results was undertaken using Student's t-test and a significance level of P<0.05 to predict an irritant based on changes in the TEWL ratio values. This improved the predictivity of the SIFT test, giving a specificity of 60%, a sensitivity of 80% and an overall accuracy of 70%. Appropriate modifications to the prediction model have now been made and the SIFT will be re-examined in a new validation exercise to investigate the potential of this non-animal method to predict acute skin irritation potential.

Animals↗

Acute childhood pyelonephritis: predictive value of positive sonographic findings in regard to later parenchymal scarring.

RATIONALE AND OBJECTIVES: The authors evaluated the importance of positive sonographic findings in acute childhood pyelonephritis. MATERIALS AND METHODS: A total of 290 children (91 boys, 199 girls, aged 4 days to 15 years [median, 394 days]) with clinically suspected acute pyelonephritis underwent initial renal gray-scale ultrasound (US) and dimercaptosuccinate scintigraphic examination within 3 days of onset. A total of 173 patients underwent color or energy US examination. One hundred fifteen children with normal scintigraphic or pathologic findings (other than acute pyelonephritis) were excluded from further study; 170 patients with abnormal scintigraphic findings underwent follow-up scintigraphic scanning 60-90 days later. RESULTS: When pathologic structures other than acute pyelonephritis were not considered, the diagnostic value of gray-scale US was poor, with a sensitivity of 45.5%, a specificity of 86.6%, a positive predictive value of 88.8%, and a negative predictive value of only 40.6%. In regard to future renal scarring, gray-scale US had a positive predictive value of 67.7%, a negative predictive value of 40%, and a likelihood ratio of 1.16. Abnormal Doppler findings helped predict future scarring with a positive predictive value of 85.7%, a negative predictive value of 37.2%, a very low sensitivity of 26.9%, a high specificity of 90.6%, and a likelihood ratio of 2.87. CONCLUSION: Positive US Doppler findings in children with clinically suspected acute pyelonephritis indicate the need for immediate treatment. A positive initial gray-scale US examination does not predict future renal scarring, but a positive Doppler examination indicates a high probability of scarring. Negative gray-scale or Doppler US does not exclude a diagnosis of acute pyelonephritis and it cannot predict an absence of future scarring.

Acute Disease↗

Pretreatment prediction of interferon-alfa efficacy in chronic hepatitis C patients.

BACKGROUND & AIMS: Interferon has been used widely to treat patients with chronic hepatitis C infections. Prediction of interferon efficacy before treatment has been performed mainly by using viral information, such as viral load and genotype. This information has allowed the successful prediction of sustained responders (SR) and non-SRs, which includes transient responders (TR) and nonresponders (NR). In the current study we examined whether liver messenger RNA expression profiles also can be used to predict interferon efficacy. METHODS: RNA was isolated from 69 liver biopsy samples from patients receiving interferon monotherapy and was analyzed on a complementary DNA microarray. Of these 69 samples, 31 were used to develop an algorithm for predicting interferon efficacy, and 38 were used to validate the precision of the algorithm. We also applied our methodology to the prediction of the efficacy of interferon/ribavirin combination therapy using an additional 56 biopsy samples. RESULTS: Our microarray analysis combined with the algorithm was 94% successful at predicting SR/TR and NR patients. A validation study confirmed that this algorithm can predict interferon efficacy with 95% accuracy and a P value of less than .00001. Similarly, we obtained a 93% prediction efficacy and a P value of less than .0001 for patients receiving combination therapy. CONCLUSIONS: By using only host data from the complementary DNA microarray we are able to successfully predict SR/TR and NR patients for interferon therapy. Therefore, this technique can help determine the appropriate treatment for hepatitis C patients.

Adult↗

Early response in biochemical markers predicts long-term response in bone mass during hormone replacement therapy in early postmenopausal women.

Based on data from 153 early postmenopausal women who completed a double-blind, randomized 3 year study of graded hormone replacement therapy (HRT) doses or placebo, we investigated the value of bone markers to predict prevention of bone loss. Absolute values of serum and urinary CrossLaps (S-CTX and U-CTX) after 2 weeks of treatment were significantly correlated to 3 year bone mass response (r = -0. 28/-0.35; p < 0.001). These associations were fully expressed at 6 months (r = -0.61/-0.64; p < 0.001). Receiver operating characteristic analyses revealed that the predictive capacity of one measurement of a resorption marker after 6 months' treatment performed similarly as assessment of hip bone mass over 3 years in predicting preservation of spinal bone mass over 3 years. Comparable results were obtained using percent change from baseline in resorption markers at both 6 and 12 months, whereas for formation markers percent change was superior to absolute value at 6 months but not at 12 months. Values of accuracy for S-CTX for a cutoff of 1881 pmol/L at 6 months were 85.2% (sensitivity), 74.3% (specificity), 90.5% (positive predictive value), and 63.4% (negative predictive value); U-CTX performed similarly, whereas the values for the formation markers were slightly lower. A cutoff for S-CTX of 1245 pmol/L eliminated false-positive individuals (those who had a decrease below the cutoff but lost bone). In the false-negative group, which was composed of individuals whose S-CTX did not decrease below the cutoff but had preserved bone mass, S-CTX was significantly associated with spinal bone mass response (r = -0. 41; p < 0.01), indicating these women had been treated with a dose that was not at its optimum for their individual bone turnover. For this cutoff, the values were 49.5% (sensitivity), 97.1% (specificity), 98% (positive predictive value), and 40% (negative predictive value). In conclusion, early bone marker measurements predict long-term preservation of bone mass during HRT. Resorption markers seem superior to formation markers, which reflects that the primary effect of HRT is on bone resorption. A strategy with two cutoff levels may optimize the use of bone markers to predict bone mass response. Whether resorption markers can be used to guide individualized treatment remains to be investigated.

Biomarkers↗

Neural nets and prediction of the recovery rate from neuromuscular block.

BACKGROUND AND OBJECTIVE: The aim was to train artificial neural nets to predict the recovery of a neuromuscular block during general anaesthesia. It was assumed that the initial/early neuromuscular recovery data with the simultaneously measured physical variables as inputs into a well-trained back-propagation neural net would enable the net to predict a rough estimate of the remaining recovery time. METHODS: Spontaneous recovery from neuromuscular block (electrically evoked electromyographic train-of-four responses) were recorded with the following variables known to affect the block: multiple minimum alveolar concentration, end-tidal CO2 concentration, and peripheral and central temperature. RESULTS: The mean prediction errors, mean absolute prediction errors, root-mean-squared prediction errors and correlation coefficients of all the nets were significantly better than those of average-based predictions used in the study. The root-mean-squared prediction error of the net - employing minimum alveolar concentrations from the whole recovery period (the recovery time from E2/E1 = 0.30 to E4/E1 = 0.75; E1 = first response of train-of-four, E2 = second response of train-of-four, etc.)--were significantly smaller than those of other nets, or the same net employing minimum alveolar concentrations only from the initial recovery period (from E2/E1 = 0.30 to E4/E1 = 0.25). CONCLUSIONS: Neural nets could predict individual recovery times from the neuromuscular block significantly better than the average-based method used here, which was supposed to be more accurate than guesses by any clinician. The minimum alveolar concentration was the only monitored variable that influenced the recovery rate, but it did not aid neural net prediction.

Anesthesia Recovery Period↗

In silico prediction of aqueous solubility, human plasma protein binding and volume of distribution of compounds from calculated pKa and AlogP98 values.

We have investigated whether three important ADME (absorption, distribution, metabolism, excretion) related properties (aqueous solubility, human plasma protein binding, and human volume of distribution at steady-state) can be predicted from chemical structure alone if only the predicted predominant ionisation state and lipophilicity (calculated logP [P = octanol-water partition coefficient]) are considered. A simple, fast method for the in silico prediction of aqueous solubility of predominantly uncharged compounds has been developed, while some potential is shown for the prediction of predominantly charged or zwitterionic compounds. Ten other known in silico prediction methods for aqueous solubility have also been evaluated. It has furthermore been demonstrated that the molecular weight (MW) profile of training sets for the development of aqueous solubility prediction methods can influence their predictive performance with regard to test sets of either matching or diverging profiles. The same property descriptors which have been found most relevant for the prediction of aqueous solubility have also proved useful for the prediction of human plasma protein binding and human volume of distribution at steady-state.

Blood Proteins↗

Using self-reported data to predict expenditures for the health care of older people.

OBJECTIVES: To create and test a method for using self-reported data to predict future expenditures for the health care of older people. DESIGN: A two-stage regression model of the relationship between self-reported data and Medicare expenditures during the following year was constructed from a randomly selected (derivation) half of a cohort of fee-for-service Medicare beneficiaries. For the other (validation) half of the cohort, two sets of predictions of 12-month Medicare expenditures were generated, one using the new two-stage model and the other using the principal inpatient diagnostic cost group (PIP-DCG) method now used to risk-adjust capitation payments to Medicare + Choice health plans. Both sets of predictions were compared with Medicare's actual 12-month expenditures for the validation cohort. SETTING: Ramsey County, Minnesota. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 70 and older (N = 13,682) who responded to a mailed survey. MEASUREMENTS: Predicted-to-observed ratio (PTOR) of Medicare expenditures. RESULTS: For the validation cohort, Medicare's actual 12-month expenditures totaled $26.5 million. The two-stage model predicted Medicare expenditures of $26.4 million (PTOR = 1.00); the PIP-DCG method predicted $31.2 million (PTOR = 1.18). Within subpopulations of healthy and ill beneficiaries, the two-stage model's predictions remained considerably more accurate than the PIP-DCG predictions. CONCLUSION: Self-reported data may predict future Medicare expenditures more accurately than administrative data about beneficiaries' demographic characteristics, and previous hospitalizations.

Aged↗

Development and cross-validation of a prediction equation for estimating resting energy expenditure in healthy African-American and European-American women.

OBJECTIVE: To develop, validate, and cross-validate a formula for predicting resting energy expenditure (REE) in African-American and European-American women. DESIGN: A cross-sectional study of REE in women. Participants were randomly assigned to one of two groups. One group served to develop and validate a new equation for predicting REE while the second was used to cross-validate the prediction equation. The accuracy of the equation was compared to several existing formulae. SETTING: University metabolic laboratory, Memphis, TN, USA. SUBJECTS: Healthy, premenopausal African-American and European-American women between 18 and 39 y of age. The validation sample included 239 women (age: 28.4 y, wt: 70.7 kg, body mass index (BMI): 25.2 kg/m(2), REE: 5840 kJ/day), while the cross-validation sample consisted of 232 women (age: 27.5 y, wt: 70.7 kg, BMI: 25.2 kg/m(2), REE: 5784 kJ/day). RESULTS: The prediction equation derived from the current sample, which included adjustments for ethnicity, was the only formula that demonstrated a high level of accuracy for predicting REE in both African-American and European-American women. The mean difference between REE predicted from the new formula and measured REE was 28 kJ/day (s.d.=668) for European-American women and 142 kJ/day (s.d.=584) for African-American women. CONCLUSIONS: Previous equations for predicting energy needs may not be appropriate for both African-American and European-American women due to ethnic differences in REE. A new equation that makes adjustments in predicted REE based on ethnicity is recommended for determining energy needs in these groups (Predicted REE (kJ/day)=616.93-14.9 (AGE (y))+35.12 (WT (kg))+19.83 (HT (cm))-271.88 (ETHNICITY: 1=African American; 0=European American)). SPONSORSHIP: Support for this study was provided by Grant #HL53261 from the National Heart, Lung, and Blood Institute.

Adolescent↗

Additional anthropometric measures may improve the predictability of basal metabolic rate in adult subjects.

BACKGROUND: The most commonly used predictive equation for basal metabolic rate (BMR) is the Schofield equation, which only uses information on body weight, age and sex to derive the prediction. However, because body composition is a key influencing factor, there will be error in calculating an individual's basal requirements based on this prediction. OBJECTIVE: To investigate whether adding additional anthropometric measures to the standard measures can enhance the predictability of BMR and to cross-validate this within a separate subgroup. DESIGN: Cross-sectional study of 150 Caucasian adults from Scotland, with a body mass index range of 16.7-49.3 kg/m(2). All subjects underwent measurement of BMR, body composition, and 148 also had basic skinfold and circumference measures taken. The resultant equation was tested in a subgroup of 39 obese males. RESULTS: The average difference between the predicted (Schofield equation) and measured BMR was 502 kJ/day. There was a slight systematic bias in this error, with the Schofield equation underestimating the lowest values. The average discrepancy between predicted and actual BMR was reduced to 452 kJ/day, with the addition of fat mass, fat-free mass, an overall 10% improvement on the Schofield equation (P=0.054). Using an equation derived from principal components analysis of anthropometry measurements similarly decreased the difference to 458 kJ/day (P=0.039). Testing the equation in a separate group indicated a 33% improvement in predictability of BMR, compared to the Schofield equation. CONCLUSIONS: In the absence of detailed information on body composition, utilizing anthropometric data provides a useful alternative methodology to improve the predictability of BMR beyond that achieved from the standard Schofield prediction equation. This should be confirmed in more individuals, both within the obese and normal weight category.

Adult↗

Influence of methods used in body composition analysis on the prediction of resting energy expenditure.

OBJECTIVE: There are considerable differences in published prediction algorithms for resting energy expenditure (REE) based on fat-free mass (FFM). The aim of the study was to investigate the influence of the methodology of body composition analysis on the prediction of REE from FFM. DESIGN: In a cross-sectional design measurements of REE and body composition were performed. SUBJECTS: The study population consisted of 50 men (age 37.1+/-15.1 years, body mass index (BMI) 25.9+/-4.1 kg/m2) and 54 women (age 35.3+/-15.4 years, BMI 25.5+/-4.4 kg/m2). INTERVENTIONS: REE was measured by indirect calorimetry and predicted by either FFM or body weight. Measurement of FFM was performed by methods based on a 2-compartment (2C)-model: skinfold (SF)-measurement, bioelectrical impedance analysis (BIA), Dual X-ray absorptiometry (DXA), air displacement plethysmography (ADP) and deuterium oxide dilution (D2O). A 4-compartment (4C)-model was used as a reference. RESULTS: When compared with the 4C-model, REE prediction from FFM obtained from the 2C methods were not significantly different. Intercepts of the regression equations of REE prediction by FFM differed from 1231 (FFM(ADP)) to 1645 kJ/24 h (FFM(SF)) and the slopes ranged between 100.3 kJ (FFM(SF)) and 108.1 kJ/FFM (kg) (FFM(ADP)). In a normal range of FFM, REE predicted from FFM by different methods showed only small differences. The variance in REE explained by FFM varied from 69% (FFM(BIA)) to 75% (FFM(DXA)) and was only 46% for body weight. CONCLUSION: Differences in slopes and intercepts of the regression lines between REE and FFM depended on the methods used for body composition analysis. However, the differences in prediction of REE are small and do not explain the large differences in the results obtained from published FFM-based REE prediction equations and therefore imply a population- and/or investigator specificity of algorithms for REE prediction.

Absorptiometry, Photon↗

A comparison of sonographic cervical parameters in predicting spontaneous preterm birth in high-risk singleton gestations.

OBJECTIVES: To assess the role of cervical sonography and to compare various sonographic cervical parameters in their ability to predict spontaneous preterm birth in high-risk singleton gestations. DESIGN: A prospective cohort of 469 high-risk gestations were longitudinally evaluated between 15 and 24 weeks' gestation on 1265 occasions with transvaginal cervical sonography and transfundal pressure. The cervical parameters obtained were funnel width and length, cervical length, percent funneling and cervical index. The information obtained was used for patient management. Restriction of physical activities was initiated at cervical lengths of < or = 2.5 cm with cerclage as an option for cervical lengths of < or = 2.0 cm. RESULTS: Receiver operating characteristic curve analyses showed that a cervical length of < or = 2.5 cm between 15 and 24 weeks' gestation was equal to the other sonographic cervical parameters in its ability to predict spontaneous preterm birth. The sensitivities for delivery at < 28, < 30, < 32 and < 34 weeks' gestation were 94%, 91%, 83% and 76%, respectively, while the negative predictive values were 99%, 99%, 98% and 96%, respectively. The placement of a cerclage did not influence the positive and negative predictive values. In comparison to women with other risk factors, cervical length was best in the prediction of preterm birth in women with a prior mid-trimester loss; an optimal cut-off of < or = 1.5 cm had sensitivities for delivery at < 28, < 30, < 32 and < 34 weeks' gestation of 100%, 100% 92% and 81%, respectively. The rate of preterm delivery at < 34 weeks' gestation increased dramatically when the cervical length was < or = 1.5 cm. Cervical length was the only independent variable that entered the logistic regression model for the prediction of preterm delivery at < 34 weeks' gestation. CONCLUSIONS: In high-risk singleton gestations a cervical length of < or = 2.5 cm was equal to other sonographic cervical parameters in its ability to predict spontaneous preterm birth and was better for the prediction of earlier forms of prematurity (at < 28 and < 30 weeks) than later forms (at < 32 and < 34 weeks). The optimal cervical lengths and their performance for predicting prematurity may be influenced by obstetric risk factors.

Adult↗

A flow cytometric platelet immunofluorescence crossmatch for predicting successful HLA matched platelet transfusions.

Platelet crossmatching may provide a useful way of selecting donors for effective platelet transfusions in patients refractory to random donor platelet concentrates due to alloimmunization. We assessed the predictive value of a flow cytometric platelet immunofluorescence crossmatch test for the outcome of HLA matched platelet transfusions in a group of alloimmunized patients. Platelet immunofluorescence (PIFT) crossmatches were performed for 104 HLA-matched platelet transfusions administered to 30 patients. A negative PIFT crossmatch correctly predicted a successful platelet transfusion (1 h post-transfusion platelet recovery >20%) in 56/75 (75%) cases. We also considered non-immunological factors that, in combination with alloimmunization, might have contributed to an unsuccessful transfusion result, i.e. fever, septicaemia, splenomegaly, disseminated intravascular coagulation and bleeding. The predictive value of a negative PIFT crossmatch was better when these non-immunological factors were absent [48/59 (81%) correct predictions] than when these factors were present [8/16 (50%) correct predictions] (P=0.01; chi-square test). The effect of ABO incompatibility between donor and recipient on the predictive value of the PIFT crossmatch was also analysed. Positive PIFT crossmatches occurred more frequently in ABO incompatible donor-recipient combinations [in 18/28 (64%) cases] than in ABO-compatible donor-recipient combinations [in 11/76 cases (14%)] (P<0.001, chi-square test). Successful platelet transfusions were observed on 53/76 (70%) occasions in ABO compatible transfusions as compared to 16/28 (57%) in ABO incompatible transfusions. This difference was not statistically significant (P=0.23; chi-square test). Consequently, a negative PIFT crossmatch appeared to be non-predictive for the transfusion outcome in cases of ABO incompatibility between donor and recipient. We conclude that the PIFT crossmatch for platelet donor selection in addition to matching for HLA antigens, is predictive for the outcome of ABO compatible transfusions in alloimmunized recipients and prediction levels are increased when non-immunological causes for platelet refractoriness are absent.

ABO Blood-Group System↗

Extrapolation of reciprocal creatinine plot is not reliable in predicting the onset of dialysis in patients with progressive renal insufficiency.

BACKGROUND: Reciprocal creatinine plot is often used to monitor patients with progressive renal insufficiency and to predict the onset of dialysis, although the latter practice has not been validated. OBJECTIVE: We examined whether extrapolating the reciprocal creatinine plot can predict the onset of dialysis. SETTING: Single centre study in the dialysis unit of a University teaching hospital. DESIGN: We studied 170 consecutive patients with progressive renal insufficiency referred to a single nephrology unit and subsequently dialysed. Reciprocal creatinine plot was constructed by all available serum creatinine values before dialysis (the 'definitive plot'). Four 'interim plots' were constructed for each patient by using serum creatinine below 400, 500, 600 and 700 micromol L(-1). Interim plots with at least five points and Pearson's r > 0.9 were analysed. The date of dialysis was predicted from the least squares linear regression formula and a target serum creatinine level cor- responding to estimated creatinine clearance of 7 mL min-1, at which dialysis was recommended. RESULTS: The median duration of observation was 25 months. After serum creatinine 500 micromol L(-1), the slope of the interim plot remained stable and extrapolation was possible in 117 patients (68.8%). However, the limits of agreement for predicting the onset of dialysis were wide (from -11.7 to +9.5 months). At this creatinine level, the onset of dialysis fell within 1 month of the predicted onset in only 41 patients (24.1%). The limits of agreement for prediction narrowed when time points of higher serum creatinine were included into the plot. However, nine patients (5.3%) required dialysis within 1 month at creatinine 600 micromol L(-1) and the dialysis was not predicted by the reciprocal creatinine plot. Target serum creatinine did not correlate with acute serum creatinine at which dialysis was started (r = 0.051, P = 0.51). A slower decline in renal function was associated with a higher prediction error (r = 0.212, P = 0.014). CONCLUSIONS: The onset of dialysis cannot be predicted by extrapolation of the reciprocal creatinine plot because of individual variation in the renal function that require dialysis. Dialysis would be almost imminent in some patients by the time serum creatinine reaches a level that allows accurate construction and extrapolation of a plot.

Biomarkers↗