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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