Bronchoalveolar Wash: Proposal of a Cutting Point for Lactate Dehydrogenase in the Differential Diagnosis of Pulmonary Diseases
Bibliographic record
Abstract
Background: The analysis of bronchoalveolar lavage (BAL) is of great clinical utility in the diagnosis of pulmonary diseases (PDs). The cytological study (total and differential cell count) performed routinely in these samples, has a high orientative power and is diagnostic in some cases. The study of soluble substances has provided little information. This study aimed to determine the cut-off point of lactate dehydrogenase (LDH) activity in the diagnosis of different lung diseases. Methods: Two hundred forty-three BALs were selected from a total of 306 patients with a single respiratory disease: acute pneumonia due to common germs (NCG, n = 126), tuberculosis (TB, n = 20), mycotic pneumonia (MN, n = 12, N = 37) and interstitial diseases (IDs, n = 48). Cytological study and measurement of LDH activity were performed. The mean, standard deviation, sensitivity (S), specificity (Sp) and Youden index (YI) of this enzyme were determined. Student’s parametric and non-parametric Mann-Whitney tests were done (P < 0.05: significant). Results: Comparing the means and standard deviations of LDH in the different PDs, a significant increase of this parameter was observed in the NCG compared to the other PDs: NCG vs. TB (P = 0.003); MN, MD and ID (P < 0.0001). Based on these significant differences observed, the cut-off point for LDH in NCG was evaluated. Different values were analyzed: LDH: ≥ 150 IU/L with S: 70%, Sp: 85% and YI: 0.55; ≥ 130 IU/L with S: 77%, Sp: 80% and YI: 0.57; ≥ 120 IU/L with S: 80%, Sp: 77% and YI: 0.57 and ≥ 100 IU/L with S: 86%, Sp: 74% and YI: 0.60. Conclusions: It is proposed to perform the measurement of LDH activity for the differential diagnosis of NCG in the PD, since its mean value was significantly higher than the rest of the PD, using a cut-off point of LDH ≥ 100 IU/L; it showed a higher S and YI for the diagnosis of NCG screening. Increased LDH activity in NCG could be associated with the high number of leukocytes present in this pathology, superior to the rest of the PD. Measurement of LDH activity along with cell count would contribute to the diagnosis of PD. Clin Infect Immun. 2017;2(1):1-4 doi: https://doi.org/10.14740/cii60e
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".