Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Proteomics Research Center and Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Sci Rep. 2020 Feb 27;10(1):3633. doi: 10.1038/s41598-020-60524-2.
Graft-versus-host disease (GVHD) is one of the major causes of morbidity and mortality in 25-70% of patients. The gold standard (GS) test to confirm the diagnosis of GVHD has some limitations. The current study was conducted to evaluate the accuracy of three serum markers in diagnosing GVHD without a GS. 94 patients who were hospitalized for allogeneic transplantation were studied. Mean levels from day of haematopoietic stem cell transplantation (HSCT) to discharge of serum uric acid (UA), lactate dehydrogenase (LDH), and creatinine (Cr) were measured for all participants. We adapted a Bayesian latent class analysis to modelling the results of each marker and combination of markers. The Sensitivity, Specificity, and area under receiver operating characteristic curve (AUC) for LDH were as 51%, 81%, and 0.70, respectively. For UA, the Sensitivity, Specificity, and AUC were 54%, 75%, and 0.71, respectively. The estimated Sensitivity, Specificity, and AUC of Cr were 72%, 94%, and 0.86, respectively. Adjusting for covariates, the combined Sensitivity, Specificity, and AUC of the optimal marker combination were 76%, 83%, and 0.94, respectively. To conclude, our findings suggested that Cr had the strongest diagnosis power for GVHD. Moreover, the classification accuracy of the three-marker combination outperforms the other combinations.
移植物抗宿主病（GVHD）是导致 25-70%患者发病和死亡的主要原因之一。GVHD 确诊的金标准（GS）检测存在一定局限性。本研究旨在评估在无 GS 的情况下，三种血清标志物诊断 GVHD 的准确性。对因异基因移植而住院的 94 例患者进行了研究。对所有参与者，从造血干细胞移植（HSCT）当天到出院，测量血清尿酸（UA）、乳酸脱氢酶（LDH）和肌酐（Cr）的平均水平。我们采用贝叶斯潜在类别分析对每种标志物和标志物组合的结果进行建模。LDH 的灵敏度、特异性和接受者操作特征曲线（ROC）下面积（AUC）分别为 51%、81%和 0.70。UA 的灵敏度、特异性和 AUC 分别为 54%、75%和 0.71。Cr 的估计灵敏度、特异性和 AUC 分别为 72%、94%和 0.86。调整协变量后，最佳标志物组合的联合灵敏度、特异性和 AUC 分别为 76%、83%和 0.94。总之，我们的研究结果表明，Cr 对 GVHD 具有最强的诊断能力。此外，三种标志物组合的分类准确性优于其他组合。
