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How can new diagnostic methods contribute in healthcare?
What are doctors looking for?
•
Better support in their clinical decision makings, which includes:
omore accurate diagnosis
oreliable prognostic estimation
otools for therapy stratification and monitoring
•
Rapid answers to the patient in order to:
oreduce the need for later reevaluation of the patient
oprovide the patient with maximal information at the doctor´s visit
How can new diagnostic methods contribute in healthcare?
What are doctors looking for?
1. More accurate diagnostic and prognostic markers in cardio-vascular disease
2. Markers for the distinction between bacterial and viral causes of acute infections
3. And more
Heart disease accounts for 49% of all deaths in Europe
The estimated cost for the society in Europe is 169 billion euros
Cardiac troponins in a healthy population –
the impact of an ultra-sensitive troponin assay
0,08
0,07
cTnI, AccuTnI g/L
0,06
0,05
0,04
99th percentile URL
0,03
99th percentile <60 y
0,02
0,01
0,00
35
40
45
50
55
60
Age
65
70
75
80
ULSAM-study
Uppsala Longitudinal Study of Adult Men
• All men in Uppsala born between 1920 and 1924
All 50 years old men (n=2841) were invited for the investigation, 81.7%
(n=2322) participated
• Remaining cohort at 70 years of age n =1673 (73%
participated n=1221)
– Men without cardiovascular disease disease n = 853
– Men with cardiovascular disease n = 368
• Follow-up period 10.4 years
Outcome (Death) in 70 years old men, with or without CVD,
in relation to cTroponin I (AccuTnI)
p<0.0001
80
p<0.0001
Outcome. death %
60
p=0.002
40
p=0.03
20
0
>0.039 >0.02-<0.04 <0.021
>0.039 >0.02-<0.04 <0.021
Healthy
Diseased
cTroponin I, g/L
Thus, the development and use of ultra-sensitive troponin assays
as indicators of myocardial dysfunction and leakage
will enable us to identify many more subjects
at risk of premature death in cardio-vascular disease
Heart failure – a deadly disease and a
diagnostic dilemma
Correct diagnosis – correct treatment
False diagnosis – wrong treatment
Missed diagnosis – no treatment
Heart failure – the impact of assaying blood levels
of natriuretic peptides (BNP and NT-proBNP)
Correct diagnosis – correct treatment
False diagnosis – wrong treatment
Missed diagnosis – no treatment
% Death
NT-proBNP in healthy 70-year old men in relation to allcause death during a 10 year follow-up, n=839 (ULSAM)
45
40
35
30
25
20
15
10
5
0
<100
100
200
300
400
500
NT-proBNP, ng/L
>600
Should my patient be prescribed antibiotics or not?
49% of all patients visiting a primary health care unit in Sweden
called the doctor because of symptoms of acute infection
The clinical diagnosis of most respiratory infections such as pneumonia,
pharyngitis/tonsillitis, otitis has, when based on symptoms and physical signs only,
a diagnostic sensitivity and specificity of 55-60% in the distinction between
a viral or bacterial cause of the infection
And how can we slow down the epidemics of
antibiotics resistance?
Is the discovery of Human neutrophil
lipocalin (HNL) the answer to our needs?
P-CRP and B-PMN in acute infections
CRP
PMN
mg/L
500
250
0
Bacteria
Virus
Virus
Bacteria
x109/L
20
18
16
14
12
10
8
6
4
2
0
750
HNL/NGAL in serum in acute infections
1000
 g/L
800
600
400
200
0
Bacteria
Virus
Discrimination between acute bacterial and viral infections
Hospitalized adult population
100
Sensitivity
80
60
40
P-CRP
S-HNL
20
0
0
20
40
60
100-Specificity
80
100
Some conclusions
Internists base their clinical management to 70-80% on laboratory tests
Primary care doctors base their clinical management to 10-20% on laboratory tests
Laboratory testing is an efficient means to save money in health care
since it provides the doctor with:
more accurate diagnosis
more reliable prognostic estimation
better tools for therapy stratification and monitoring
All for the benefit of our patients and the society