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Published in: BMC Infectious Diseases 1/2008

Open Access 01-12-2008 | Study protocol

Toward an operative diagnosis in sepsis: a latent class approach

Authors: Gisela D De La Rosa, Marta L Valencia, Clara M Arango, Carlos I Gomez, Alex Garcia, Sigifredo Ospina, Susana Osorno, Adriana Henao, Fabián A Jaimes

Published in: BMC Infectious Diseases | Issue 1/2008

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Abstract

Background

Recent data have suggested that 18 million of new sepsis cases occur each year worldwide, with a mortality rate of almost 30%. There is not consensus on the clinical definition of sepsis and, because of lack of training or simply unawareness, clinicians often miss or delay this diagnosis. This is especially worrying; since there is strong evidence supporting that early treatment is associated with greater clinical success. There are some difficulties for sepsis diagnosis such as the lack of an appropriate gold standard to identify this clinical condition. This situation has hampered the assessment of the accuracy of clinical signs and biomarkers to diagnose sepsis.

Methods/design

Cross-sectional study to determine the operative characteristics of three biological markers of inflammation and coagulation (D-dimer, C-reactive protein and Procalcitonin) as diagnostic tests for sepsis, in patients admitted to hospital care with a presumptive infection as main diagnosis.

Discussion

There are alternative techniques that have been used to assess the accuracy of tests without gold standards, and they have been widely used in clinical disciplines such as psychiatry, even though they have not been tested in sepsis diagnosis. Considering the main importance of diagnosis as early as possible, we propose a latent class analysis to evaluate the accuracy of three biomarkers to diagnose sepsis.
Literature
1.
2.
go back to reference Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003, 348 (16): 1546-1554. 10.1056/NEJMoa022139.CrossRefPubMed Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003, 348 (16): 1546-1554. 10.1056/NEJMoa022139.CrossRefPubMed
3.
go back to reference Angus DC, Wax RS: Epidemiology of sepsis: an update. Crit Care Med. 2001, 29 (7 Suppl): S109-116. 10.1097/00003246-200107001-00035.CrossRefPubMed Angus DC, Wax RS: Epidemiology of sepsis: an update. Crit Care Med. 2001, 29 (7 Suppl): S109-116. 10.1097/00003246-200107001-00035.CrossRefPubMed
4.
go back to reference Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001, 345 (19): 1368-1377. 10.1056/NEJMoa010307.CrossRefPubMed Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001, 345 (19): 1368-1377. 10.1056/NEJMoa010307.CrossRefPubMed
5.
go back to reference Vincent JL, Abraham E, Annane D, Bernard G, Rivers E, Van den Berghe G: Reducing mortality in sepsis: new directions. Crit Care. 2002, 6 (Suppl 3): S1-18. 10.1186/cc1860.CrossRefPubMedPubMedCentral Vincent JL, Abraham E, Annane D, Bernard G, Rivers E, Van den Berghe G: Reducing mortality in sepsis: new directions. Crit Care. 2002, 6 (Suppl 3): S1-18. 10.1186/cc1860.CrossRefPubMedPubMedCentral
6.
go back to reference Faraone SV, Tsuang MT: Measuring diagnostic accuracy in the absence of a "gold standard". Am J Psychiatry. 1994, 151 (5): 650-657.CrossRefPubMed Faraone SV, Tsuang MT: Measuring diagnostic accuracy in the absence of a "gold standard". Am J Psychiatry. 1994, 151 (5): 650-657.CrossRefPubMed
7.
go back to reference Walter SD, Frommer DJ, Cook RJ: The estimation of sensitivity and specificity in colorectal cancer screening methods. Cancer Detect Prev. 1991, 15 (6): 465-469.PubMed Walter SD, Frommer DJ, Cook RJ: The estimation of sensitivity and specificity in colorectal cancer screening methods. Cancer Detect Prev. 1991, 15 (6): 465-469.PubMed
8.
go back to reference Pfeiffer RM, Gail MH, Brown LM: Probability of helicobacter pylori infection based on IgG levels and other covariates using a mixture model. J Epidemiol Biostat. 2000, 5 (5): 267-275.PubMed Pfeiffer RM, Gail MH, Brown LM: Probability of helicobacter pylori infection based on IgG levels and other covariates using a mixture model. J Epidemiol Biostat. 2000, 5 (5): 267-275.PubMed
9.
go back to reference Albert PS, McShane LM, Shih JH: Latent class modeling approaches for assessing diagnostic error without a gold standard: with applications to p53 immunohistochemical assays in bladder tumors. Biometrics. 2001, 57 (2): 610-619. 10.1111/j.0006-341X.2001.00610.x.CrossRefPubMed Albert PS, McShane LM, Shih JH: Latent class modeling approaches for assessing diagnostic error without a gold standard: with applications to p53 immunohistochemical assays in bladder tumors. Biometrics. 2001, 57 (2): 610-619. 10.1111/j.0006-341X.2001.00610.x.CrossRefPubMed
10.
go back to reference Butler JC, Bosshardt SC, Phelan M, Moroney SM, Tondella ML, Farley MM, Schuchat A, Fields BS: Classical and latent class analysis evaluation of sputum polymerase chain reaction and urine antigen testing for diagnosis of pneumococcal pneumonia in adults. J Infect Dis. 2003, 187 (9): 1416-1423. 10.1086/374623.CrossRefPubMed Butler JC, Bosshardt SC, Phelan M, Moroney SM, Tondella ML, Farley MM, Schuchat A, Fields BS: Classical and latent class analysis evaluation of sputum polymerase chain reaction and urine antigen testing for diagnosis of pneumococcal pneumonia in adults. J Infect Dis. 2003, 187 (9): 1416-1423. 10.1086/374623.CrossRefPubMed
11.
go back to reference Boelaert M, Rijal S, Regmi S, Singh R, Karki B, Jacquet D, Chappuis F, Campino L, Desjeux P, Le Ray D, koirala S, Van der Stuyft P: A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis. Am J Trop Med Hyg. 2004, 70 (1): 72-77.PubMed Boelaert M, Rijal S, Regmi S, Singh R, Karki B, Jacquet D, Chappuis F, Campino L, Desjeux P, Le Ray D, koirala S, Van der Stuyft P: A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis. Am J Trop Med Hyg. 2004, 70 (1): 72-77.PubMed
12.
go back to reference Pierce G, Murray PR: Current controversies in the detection of septicemia. Eur J Clin Microbiol. 1986, 5 (5): 487-491. 10.1007/BF02017688.CrossRefPubMed Pierce G, Murray PR: Current controversies in the detection of septicemia. Eur J Clin Microbiol. 1986, 5 (5): 487-491. 10.1007/BF02017688.CrossRefPubMed
13.
go back to reference Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA: Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med. 1989, 17 (5): 389-393. 10.1097/00003246-198905000-00002.CrossRefPubMed Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA: Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med. 1989, 17 (5): 389-393. 10.1097/00003246-198905000-00002.CrossRefPubMed
14.
go back to reference American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992, 20 (6): 864-874. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992, 20 (6): 864-874.
15.
go back to reference Jaimes F, Garces J, Cuervo J, Ramirez F, Ramirez J, Vargas A, Quintero C, Ochoa J, Tandioy F, Zapata L, Estrada J, Yepes M, Leal H: The systemic inflammatory response syndrome (SIRS) to identify infected patients in the emergency room. Intensive Care Med. 2003, 29 (8): 1368-1371. 10.1007/s00134-003-1874-0.CrossRefPubMed Jaimes F, Garces J, Cuervo J, Ramirez F, Ramirez J, Vargas A, Quintero C, Ochoa J, Tandioy F, Zapata L, Estrada J, Yepes M, Leal H: The systemic inflammatory response syndrome (SIRS) to identify infected patients in the emergency room. Intensive Care Med. 2003, 29 (8): 1368-1371. 10.1007/s00134-003-1874-0.CrossRefPubMed
16.
go back to reference Vincent JL: Dear SIRS, I'm sorry to say that I don't like you. Crit Care Med. 1997, 25 (2): 372-374. 10.1097/00003246-199702000-00029.CrossRefPubMed Vincent JL: Dear SIRS, I'm sorry to say that I don't like you. Crit Care Med. 1997, 25 (2): 372-374. 10.1097/00003246-199702000-00029.CrossRefPubMed
17.
go back to reference Marshall JC: SIRS and MODS: what is their relevance to the science and practice of intensive care?. Shock. 2000, 14 (6): 586-589.CrossRefPubMed Marshall JC: SIRS and MODS: what is their relevance to the science and practice of intensive care?. Shock. 2000, 14 (6): 586-589.CrossRefPubMed
18.
go back to reference Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003, 31 (4): 1250-1256. 10.1097/01.CCM.0000050454.01978.3B.CrossRefPubMed Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003, 31 (4): 1250-1256. 10.1097/01.CCM.0000050454.01978.3B.CrossRefPubMed
19.
go back to reference Marshall JC, Vincent JL, Fink MP, Cook DJ, Rubenfeld G, Foster D, Fisher CJ, Faist E, Reinhart K: Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25–26, 2000. Crit Care Med. 2003, 31 (5): 1560-1567. 10.1097/01.CCM.0000065186.67848.3A.CrossRefPubMed Marshall JC, Vincent JL, Fink MP, Cook DJ, Rubenfeld G, Foster D, Fisher CJ, Faist E, Reinhart K: Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25–26, 2000. Crit Care Med. 2003, 31 (5): 1560-1567. 10.1097/01.CCM.0000065186.67848.3A.CrossRefPubMed
20.
21.
go back to reference Aird WC: The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood. 2003, 101 (10): 3765-3777. 10.1182/blood-2002-06-1887.CrossRefPubMed Aird WC: The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood. 2003, 101 (10): 3765-3777. 10.1182/blood-2002-06-1887.CrossRefPubMed
22.
go back to reference Mavrommatis AC, Theodoridis T, Orfanidou A, Roussos C, Christopoulou-Kokkinou V, Zakynthinos S: Coagulation system and platelets are fully activated in uncomplicated sepsis. Crit Care Med. 2000, 28 (2): 451-457. 10.1097/00003246-200002000-00027.CrossRefPubMed Mavrommatis AC, Theodoridis T, Orfanidou A, Roussos C, Christopoulou-Kokkinou V, Zakynthinos S: Coagulation system and platelets are fully activated in uncomplicated sepsis. Crit Care Med. 2000, 28 (2): 451-457. 10.1097/00003246-200002000-00027.CrossRefPubMed
23.
go back to reference ten Cate H: Pathophysiology of disseminated intravascular coagulation in sepsis. Crit Care Med. 2000, 28 (9 Suppl): S9-11. 10.1097/00003246-200009001-00003.CrossRefPubMed ten Cate H: Pathophysiology of disseminated intravascular coagulation in sepsis. Crit Care Med. 2000, 28 (9 Suppl): S9-11. 10.1097/00003246-200009001-00003.CrossRefPubMed
24.
go back to reference Opal SM, Kessler CM, Roemisch J, Knaub S: Antithrombin, heparin, and heparan sulfate. Crit Care Med. 2002, 30 (5 Suppl): S325-331. 10.1097/00003246-200205001-00024.CrossRefPubMed Opal SM, Kessler CM, Roemisch J, Knaub S: Antithrombin, heparin, and heparan sulfate. Crit Care Med. 2002, 30 (5 Suppl): S325-331. 10.1097/00003246-200205001-00024.CrossRefPubMed
25.
go back to reference Opal SM, Garber GE, LaRosa SP, Maki DG, Freebairn RC, Kinasewitz GT, Dhainaut JF, Yan SB, Williams MD, Graham DE, Nelson DR, Levy H, Bernard Gr: Systemic host responses in severe sepsis analyzed by causative microorganism and treatment effects of drotrecogin alfa (activated). Clin Infect Dis. 2003, 37 (1): 50-58. 10.1086/375593.CrossRefPubMed Opal SM, Garber GE, LaRosa SP, Maki DG, Freebairn RC, Kinasewitz GT, Dhainaut JF, Yan SB, Williams MD, Graham DE, Nelson DR, Levy H, Bernard Gr: Systemic host responses in severe sepsis analyzed by causative microorganism and treatment effects of drotrecogin alfa (activated). Clin Infect Dis. 2003, 37 (1): 50-58. 10.1086/375593.CrossRefPubMed
26.
go back to reference Opal SM, Esmon CT: Bench-to-bedside review: functional relationships between coagulation and the innate immune response and their respective roles in the pathogenesis of sepsis. Crit Care. 2003, 7 (1): 23-38. 10.1186/cc1854.CrossRefPubMed Opal SM, Esmon CT: Bench-to-bedside review: functional relationships between coagulation and the innate immune response and their respective roles in the pathogenesis of sepsis. Crit Care. 2003, 7 (1): 23-38. 10.1186/cc1854.CrossRefPubMed
27.
go back to reference Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med. 2003, 348 (2): 138-150. 10.1056/NEJMra021333.CrossRefPubMed Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med. 2003, 348 (2): 138-150. 10.1056/NEJMra021333.CrossRefPubMed
28.
go back to reference Amaral A, Opal SM, Vincent JL: Coagulation in sepsis. Intensive Care Med. 2004, 30 (6): 1032-1040. 10.1007/s00134-004-2291-8.CrossRefPubMed Amaral A, Opal SM, Vincent JL: Coagulation in sepsis. Intensive Care Med. 2004, 30 (6): 1032-1040. 10.1007/s00134-004-2291-8.CrossRefPubMed
29.
go back to reference Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001, 344 (10): 699-709. 10.1056/NEJM200103083441001.CrossRefPubMed Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001, 344 (10): 699-709. 10.1056/NEJM200103083441001.CrossRefPubMed
30.
go back to reference Povoa P: C-reactive protein: a valuable marker of sepsis. Intensive Care Med. 2002, 28 (3): 235-243. 10.1007/s00134-002-1209-6.CrossRefPubMed Povoa P: C-reactive protein: a valuable marker of sepsis. Intensive Care Med. 2002, 28 (3): 235-243. 10.1007/s00134-002-1209-6.CrossRefPubMed
31.
go back to reference Becker KL, Nylen ES, White JC, Muller B, Snider RH: Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004, 89 (4): 1512-1525. 10.1210/jc.2002-021444.CrossRefPubMed Becker KL, Nylen ES, White JC, Muller B, Snider RH: Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004, 89 (4): 1512-1525. 10.1210/jc.2002-021444.CrossRefPubMed
32.
go back to reference Povoa P, Almeida E, Moreira P, Fernandes A, Mealha R, Aragao A, Sabino H: C-reactive protein as an indicator of sepsis. Intensive Care Med. 1998, 24 (10): 1052-1056. 10.1007/s001340050715.CrossRefPubMed Povoa P, Almeida E, Moreira P, Fernandes A, Mealha R, Aragao A, Sabino H: C-reactive protein as an indicator of sepsis. Intensive Care Med. 1998, 24 (10): 1052-1056. 10.1007/s001340050715.CrossRefPubMed
33.
go back to reference Pettila V, Pentti J, Pettila M, Takkunen O, Jousela I: Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med. 2002, 30 (2): 271-275. 10.1097/00003246-200202000-00001.CrossRefPubMed Pettila V, Pentti J, Pettila M, Takkunen O, Jousela I: Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med. 2002, 30 (2): 271-275. 10.1097/00003246-200202000-00001.CrossRefPubMed
34.
go back to reference Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A: Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003, 31 (6): 1737-1741. 10.1097/01.CCM.0000063440.19188.ED.CrossRefPubMed Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A: Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003, 31 (6): 1737-1741. 10.1097/01.CCM.0000063440.19188.ED.CrossRefPubMed
35.
go back to reference Toh CH, Samis J, Downey C, Walker J, Becker L, Brufatto N, Tejidor L, Jones G, Houdijk W, Giles A, Koschinsky M, Ticknor LO, Paton R, Wenstone R, Nesheim M: Biphasic transmittance waveform in the APTT coagulation assay is due to the formation of a Ca(++)-dependent complex of C-reactive protein with very-low-density lipoprotein and is a novel marker of impending disseminated intravascular coagulation. Blood. 2002, 100 (7): 2522-2529. 10.1182/blood.V100.7.2522.CrossRefPubMed Toh CH, Samis J, Downey C, Walker J, Becker L, Brufatto N, Tejidor L, Jones G, Houdijk W, Giles A, Koschinsky M, Ticknor LO, Paton R, Wenstone R, Nesheim M: Biphasic transmittance waveform in the APTT coagulation assay is due to the formation of a Ca(++)-dependent complex of C-reactive protein with very-low-density lipoprotein and is a novel marker of impending disseminated intravascular coagulation. Blood. 2002, 100 (7): 2522-2529. 10.1182/blood.V100.7.2522.CrossRefPubMed
36.
go back to reference Toh CH, Ticknor LO, Downey C, Giles AR, Paton RC, Wenstone R: Early identification of sepsis and mortality risks through simple, rapid clot-waveform analysis. Implications of lipoprotein-complexed C reactive protein formation. Intensive Care Med. 2003, 29 (1): 55-61.CrossRefPubMed Toh CH, Ticknor LO, Downey C, Giles AR, Paton RC, Wenstone R: Early identification of sepsis and mortality risks through simple, rapid clot-waveform analysis. Implications of lipoprotein-complexed C reactive protein formation. Intensive Care Med. 2003, 29 (1): 55-61.CrossRefPubMed
37.
go back to reference Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J: Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001, 164 (3): 396-402.CrossRefPubMed Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J: Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001, 164 (3): 396-402.CrossRefPubMed
38.
go back to reference Giamarellos-Bourboulis EJ, Mega A, Grecka P, Scarpa N, Koratzanis G, Thomopoulos G, Giamarellou H: Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient?. Intensive Care Med. 2002, 28 (9): 1351-1356. 10.1007/s00134-002-1398-z.CrossRefPubMed Giamarellos-Bourboulis EJ, Mega A, Grecka P, Scarpa N, Koratzanis G, Thomopoulos G, Giamarellou H: Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient?. Intensive Care Med. 2002, 28 (9): 1351-1356. 10.1007/s00134-002-1398-z.CrossRefPubMed
39.
go back to reference Pettila V, Hynninen M, Takkunen O, Kuusela P, Valtonen M: Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med. 2002, 28 (9): 1220-1225. 10.1007/s00134-002-1416-1.CrossRefPubMed Pettila V, Hynninen M, Takkunen O, Kuusela P, Valtonen M: Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med. 2002, 28 (9): 1220-1225. 10.1007/s00134-002-1416-1.CrossRefPubMed
40.
go back to reference Balc IC, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B: Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care. 2003, 7 (1): 85-90. 10.1186/cc1843.CrossRef Balc IC, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B: Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care. 2003, 7 (1): 85-90. 10.1186/cc1843.CrossRef
41.
go back to reference Meisner M, Tschaikowsky K, Palmaers T, Schmidt J: Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999, 3 (1): 45-50. 10.1186/cc306.CrossRefPubMedPubMedCentral Meisner M, Tschaikowsky K, Palmaers T, Schmidt J: Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999, 3 (1): 45-50. 10.1186/cc306.CrossRefPubMedPubMedCentral
42.
go back to reference Levi M, Ten Cate H: Disseminated intravascular coagulation. N Engl J Med. 1999, 341 (8): 586-592. 10.1056/NEJM199908193410807.CrossRefPubMed Levi M, Ten Cate H: Disseminated intravascular coagulation. N Engl J Med. 1999, 341 (8): 586-592. 10.1056/NEJM199908193410807.CrossRefPubMed
43.
go back to reference Carrigan SD, Scott G, Tabrizian M: Toward resolving the challenges of sepsis diagnosis. Clin Chem. 2004, 50 (8): 1301-1314. 10.1373/clinchem.2004.032144.CrossRefPubMed Carrigan SD, Scott G, Tabrizian M: Toward resolving the challenges of sepsis diagnosis. Clin Chem. 2004, 50 (8): 1301-1314. 10.1373/clinchem.2004.032144.CrossRefPubMed
44.
go back to reference Yang I, Becker MP: Latent variable modeling of diagnostic accuracy. Biometrics. 1997, 53 (3): 948-958. 10.2307/2533555.CrossRefPubMed Yang I, Becker MP: Latent variable modeling of diagnostic accuracy. Biometrics. 1997, 53 (3): 948-958. 10.2307/2533555.CrossRefPubMed
45.
go back to reference Walter SD, Irwig L, Glasziou PP: Meta-analysis of diagnostic tests with imperfect reference standards. J Clin Epidemiol. 1999, 52 (10): 943-951. 10.1016/S0895-4356(99)00086-4.CrossRefPubMed Walter SD, Irwig L, Glasziou PP: Meta-analysis of diagnostic tests with imperfect reference standards. J Clin Epidemiol. 1999, 52 (10): 943-951. 10.1016/S0895-4356(99)00086-4.CrossRefPubMed
46.
go back to reference Goetghebeur E, Liinev J, Boelaert M, Van der Stuyft P: Diagnostic test analyses in search of their gold standard: latent class analyses with random effects. Stat Methods Med Res. 2000, 9 (3): 231-248. 10.1191/096228000701555127.CrossRefPubMed Goetghebeur E, Liinev J, Boelaert M, Van der Stuyft P: Diagnostic test analyses in search of their gold standard: latent class analyses with random effects. Stat Methods Med Res. 2000, 9 (3): 231-248. 10.1191/096228000701555127.CrossRefPubMed
47.
go back to reference Qu Y, Tan M, Kutner MH: Random effects models in latent class analysis for evaluating accuracy of diagnostic tests. Biometrics. 1996, 52 (3): 797-810. 10.2307/2533043.CrossRefPubMed Qu Y, Tan M, Kutner MH: Random effects models in latent class analysis for evaluating accuracy of diagnostic tests. Biometrics. 1996, 52 (3): 797-810. 10.2307/2533043.CrossRefPubMed
48.
go back to reference Engels EA, Sinclair MD, Biggar RJ, Whitby D, Ebbesen P, Goedert JJ, Gastwirth JL: Latent class analysis of human herpesvirus 8 assay performance and infection prevalence in sub-saharan Africa and Malta. Int J Cancer. 2000, 88 (6): 1003-1008. 10.1002/1097-0215(20001215)88:6<1003::AID-IJC26>3.0.CO;2-9.CrossRefPubMed Engels EA, Sinclair MD, Biggar RJ, Whitby D, Ebbesen P, Goedert JJ, Gastwirth JL: Latent class analysis of human herpesvirus 8 assay performance and infection prevalence in sub-saharan Africa and Malta. Int J Cancer. 2000, 88 (6): 1003-1008. 10.1002/1097-0215(20001215)88:6<1003::AID-IJC26>3.0.CO;2-9.CrossRefPubMed
49.
go back to reference Langhi DM, Bordin JO, Castelo A, Walter SD, Moraes-Souza H, Stumpf RJ: The application of latent class analysis for diagnostic test validation of chronic Trypanosoma cruzi infection in blood donors. Braz J Infect Dis. 2002, 6 (4): 181-187. 10.1590/S1413-86702002000400005.CrossRefPubMed Langhi DM, Bordin JO, Castelo A, Walter SD, Moraes-Souza H, Stumpf RJ: The application of latent class analysis for diagnostic test validation of chronic Trypanosoma cruzi infection in blood donors. Braz J Infect Dis. 2002, 6 (4): 181-187. 10.1590/S1413-86702002000400005.CrossRefPubMed
50.
go back to reference Benjamin DK, DeLong E, Steinbach WJ: Latent class analysis: an illustrative application for education in the assessment of resident otoscopic skills. Ambul Pediatr. 2004, 4 (1): 13-17. 10.1367/1539-4409(2004)004<0013:LCAAIA>2.0.CO;2.CrossRefPubMed Benjamin DK, DeLong E, Steinbach WJ: Latent class analysis: an illustrative application for education in the assessment of resident otoscopic skills. Ambul Pediatr. 2004, 4 (1): 13-17. 10.1367/1539-4409(2004)004<0013:LCAAIA>2.0.CO;2.CrossRefPubMed
51.
go back to reference Buderer NM: Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med. 1996, 3 (9): 895-900.CrossRefPubMed Buderer NM: Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med. 1996, 3 (9): 895-900.CrossRefPubMed
52.
go back to reference Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982, 143 (1): 29-36.CrossRefPubMed Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982, 143 (1): 29-36.CrossRefPubMed
53.
go back to reference Rosner: Fundamentals of biostatistics. Fundamentals of biostatistics. Belmont. Edited by: press D. 1995, 346-358. Fourth Rosner: Fundamentals of biostatistics. Fundamentals of biostatistics. Belmont. Edited by: press D. 1995, 346-358. Fourth
Metadata
Title
Toward an operative diagnosis in sepsis: a latent class approach
Authors
Gisela D De La Rosa
Marta L Valencia
Clara M Arango
Carlos I Gomez
Alex Garcia
Sigifredo Ospina
Susana Osorno
Adriana Henao
Fabián A Jaimes
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2008
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-8-18

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