Dijagnostička točnost UK-NEQAS smjernica za određivanje hematogenih pigmenata u cerebrospinalnoj tekućini kod sumnje na subarahnoidalno krvarenje

master's thesis

• Title (english): Diagnostic accuracy of UK-NEQAS guidelines for cerebrospinal fluid pigment analysis in suspected subarachnoid haemorrhage
• Author: Iva Klišanin
• Mentor: Dunja Rogić (mentor)
• Committee member: Dunja Rogić (predsjednik povjerenstva)
• Committee member: Saša Kralik-Oguić (član povjerenstva)
• Committee member: Anita Somborac Bačura (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of medical biochemistry and haematology); Zagreb
• Defense date and country: 2022-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Medical Biochemistry

Abstract

Određivanje hematogenih pigmenata u likvoru važno je za detekciju subarahnoidalnog krvarenja (SAH) kod paci-jenata s visokom kliničkom sumnjom i negativnim nalazima dobivenim slikovnim tehnikama. Cilj ovog istraživa-nja bio je ispitati dijagnostičku točnost UK-NEQAS metode i računskih formula za određivanje hematogenih pig-menata u likvoru pri sumnji na SAH i usporediti ih s vizualnom metodom očitavanja hematogenih pigmenata iz spektra. Istraživanje je provedeno u Kliničkom zavodu za laboratorijsku dijagnostiku KBC-a Zagreb na 37 uzas-topnih pacijenata sa sumnjom na SAH kojima je analiziran likvor dobiven lumbalnom punkcijom. Izmjeren je apsorpcijski spektar supernatanta centrifugiranog likvora u području 250-600 nm te je interpretiran trima meto-dama: vizualnom metodom, izračunom ukupne apsorbancije bilirubina (NBA) i oksihemoglobina (NOA) prema UK-NEQAS-u, te u slučaju pozitivnog NBA UK-NEQAS metodom uz korekciju NBA. SAH je dijagnosticiran referentnom metodom digitalnom subtrakcijskom angiografijom (DSA). Kod 3/37 pacijenata je potvrđen SAH i svim trima metodama detektiran bilirubin u likvoru s jednakom osjetljivosti, a računska metoda prema UK-NEQAS-u pokazala je statistički značajno veću specifičnost od vizualne metode. Lažno pozitivni nalazi posljedica su drugih uzroka krvarenja (prethodne traumatske punkcije, operacija, tromboza). Nije bilo lažno negativnih re-zultata. Cohenovim kappa testom pokazano je snažno podudaranje rezultata između metoda. Računska metoda prema UK-NEQAS smjernicama ima izvrsne dijagnostičke karakteristike za dijagnozu SAH-a i standardizira po-stupak interpretacije apsorpcijskih spektara. Najbolje karakteristike testa za dijagnozu SAH-a ima metoda korigi-ranog NBA. U usporedbi sa vizualnom metodom, daje manje lažno pozitivnih rezultata i pokazuje veću specifič-nost za SAH.

Abstract (english)

Cerebrospinal fluid (CSF) pigment analysis is important for detection of subarachnoid haemorrhage (SAH) in patients with high clinical suspicion and negative findings with imaging techniques. The aim was to exa-mine the diagnostic accuracy of UK-NEQAS method for CSF pigment analysis in suspected SAH and to compare it with the visual assessment of bilirubin from the absorption spectrum. The study included 37 conse-cutive patients with suspected SAH who underwent lumbar puncture to obtain CSF for analysis in Department of Laboratory Diagnostics, UHC Zagreb. UV-VIS spectrophotometric scan of supernatant of centrifuged CSF was performed in the 250-600 nm range. Three methods were used for interpreting absorption curves: visual assessment, net bilirubin (NBA) and oxyhaemoglobin (NOA) absorbance calculation according to UK-NEQAS and NBA correction in case of a positive NBA by UK-NEQAS method. SAH was diagnosed using digital subtraction angiography. Bilirubin was detected by all three methods in 3/37 patients with SAH with equal sensitivity. UK-NEQAS method displayed significantly higher specificity than visual method. False positives were the result of other causes of bleeding (prior traumatic puncture, operation, thrombosis). There were no false-negative results. A strong agreement between the methods was shown using the Cohen kappa test. UK-NEQAS method has great diagnostic characteristics for SAH and standardizes the process of abs-orption curve interpretation. NBA correction method has shown the best diagnostic characteristics for SAH. Compared to the visual method it produces less false-positive results and displays higher specificity for SAH.

• Keywords: cerebrospinalna tekućina; hematogeni pigmenti; bilirubin; spektrofotometrija; subarahnoidalno krvarenje
• Keywords (english): cerebrospinal fluid; blood pigments; bilirubin; spectrophotometry; subarachnoid haemorrhage
• Language: croatian
• URN:NBN: urn:nbn:hr:163:877220
• Study programme: Title: Medical biochemistry; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra medicinske biokemije (magistar/magistra medicinske biokemije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-07-25 14:14:45