Development and validation of a simple tool composed of items on dyspnea, respiration rates, and C-reactive protein for pneumonia prediction among acute febrile respiratory illness patients in primary care settings.

BACKGROUND: Acute febrile respiratory illness (AFRI) patients are susceptible to pneumonia and suffer from significant morbidity and mortality throughout the world. In primary care settings, the situation is worse. Limited by computerized tomography resources and physician experiences, AFRI patients in primary care settings may not be diagnosed appropriately, which would affect following treatment. In this study, we aimed to develop and validate a simple prediction model to help physicians quickly identify AFRI patients of pneumonia risk in primary care settings. METHODS: A total of 1977 AFRI patients were enrolled at two fever clinics in Shanghai, China, and among them, 727 patients who underwent CT scans were included in the analysis. Acute alveolar or interstitial infiltrates found on CT images were diagnosed with pneumonia. Characteristics and blood parameters were compared between pneumonia and non-pneumonia patients. Then a multivariable model for pneumonia prediction was developed through logistic regression analysis. Its value for pneumonia prediction was prospectively assessed in an external multi-center population, which included 1299 AFRI patients in primary settings from 5 different provinces throughout China. RESULTS: In the model development population, pneumonia patients (n = 227) had a longer duration of fever; higher frequencies of purulent sputum, dyspnea, and thoracic pain; and higher levels of respiration rates and C-reactive protein (CRP) than non-pneumonia patients (n = 500). Logistic regression analysis worked out a model composed of items on dyspnea, respiration rates > 20/min, and CRP > 20 mg/l (DRC) for pneumonia prediction with an area under curve (AUC) of 0.8506. In the external validation population, the predictive accuracy of the DRC model was the highest when choosing at least one positive item (1 score) as a cut-off point with a sensitivity of 87.0% and specificity of 80.5%. DRC scores increased with pneumonia severity and lung lobe involvement and showed good performance for both bacterial and viral pneumonia. For viral pneumonia, dyspnea plus respiration rates > 20/min had good predictive capacity regardless of CRP concentration. CONCLUSIONS: DRC model is a simple tool that predicts pneumonia among AFRI patients, which would help physicians utilize medical resources rationally in primary care settings.

[Value evaluation of follicle stimulating hormone and luteinizing hormone in the diagnosis of precocious puberty in girls by ROC curve analysis].

OBJECTIVE: To study the value of follicle stimulating hormone (FSH), luteinizing hormone (LH) and LH/FSH ratio in the diagnosis of precocious puberty in girls by ROC curve analysis. METHODS: Gonadotropin-releasing hormone (GnRH) stimulation test was performed on 220 girls with pseudo-sexual precocity and 61 girls with true sexual precocity. Blood LH and FSH levels were measured before and after 30 and 60 minutes of taking the GnRH test. The ratio of LH to FSH was calculated. Sensitivity and best point for the diagnosis of precocity according to LH, FSH and LH/FSH ratio were analyzed by ROC curve analysis. RESULTS: The area under the ROC curve was 0.90 and 0.95 according to LH level and LH/FSH ratio respectively for the diagnosis of precocity. The best point for diagnosis by LH was 10.15 IU/L, with a sensitivity of 0.92 and specificity of 0.89. The best point for diagnosis by LH/FSH ratio was 0.60, with a missed diagnosis rate of 6.0% and specificity of 0.91. When true sexual precocity was diagnosed based on one index between LH>10.15 IU/L and LH/FSH ratio>0.60, sensitivity was 0.97 and specificity was 0.94. When the diagnosis of true sexual precocity was diagnosed based on both LH>10.15 IU/L and LH/FSH>0.60, sensitivity was 0.85 and specificity was 1.00. CONCLUSIONS: True sexual precocity can be diagnosed when both LH>10.15 IU/L and LH/FSH ratio>0.60. Only one of the two indexes for the diagnosis of true sexual precocity is presented, further observation is necessary to decrease missed diagnosis and misdiagnosis.