NR AVNG
AU Cuadrado Corrales,N.; Jimenez-Huete,A.; Albo,C.; Hortiguela,R.; Vega,L.; Cerrato,L.; Sierra-Moros,M.; Rabano,A.; de Pedro Cuesta,J.; Calero,M.
TI Impact of the clinical context on the 14-3-3 test for the diagnosis of sporadic CJD
QU BMC Neurology 2006; 6: 25
IA http://www.biomedcentral.com/1471-2377/6/25
PT journal article; research support, non-u.s. gov't
AB BACKGROUND: The 14-3-3 test appears to be a valuable aid for the clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) in selected populations. However, its usefulness in routine practice has been challenged. In this study, the influence of the clinical context on the performance of the 14-3-3 test for the diagnosis of sCJD is investigated through the analysis of a large prospective clinical series. METHODS: Six hundred seventy-two Spanish patients with clinically suspected sCJD were analyzed. Clinical classification at sample reception according to the World Health Organization's (WHO) criteria (excluding the 14-3-3 test result) was used to explore the influence of the clinical context on the pre-test probabilities, and positive (PPV) and negative (NPV) predictive values of the 14-3-3 test. RESULTS: Predictive values of the test varied greatly according to the initial clinical classification: PPV of 98.8%, 96.5% and 45.0%, and NPV of 26.1%, 66.6% and 100% for probable sCJDi (n = 115), possible sCJDi (n = 73) and non-sCJDi (n = 484) cases, respectively. According to multivariate and Bayesian analyses, these values represent an improvement of diagnostic certainty compared to clinical data alone. CONCLUSION: In three different contexts of sCJD suspicion, the 14-3-3 assay provides useful information complementary to clinical and electroencephalographic (EEG) data. The test is most useful supporting a clinical impression, whilst it may show deceptive when it is not in agreement with clinical data.
MH 14-3-3 Proteins/*cerebrospinal fluid; Adult; Aged; Aged, 80 and over; *Clinical Laboratory Techniques/methods; Creutzfeldt-Jakob Syndrome/*cerebrospinal fluid/classification/*diagnosis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies
AD Natividad Cuadrado-Corrales (ncuadrado@isciii.es), Carmen Albo (calbo@isciii.es), Rafael Hortigüela (rhortiguela@isciii.es), Luz Vega (luzvega@isciii.es), Laura Cerrato (laura.cerrato@isciii.es), Miguel Calero (mcalero@isciii.es), Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Adolfo Jiménez-Huete (ajimenez@ruberinternacional.es), Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain; Maríajosé Sierra-Moros (jsierra@msc.es), Dirección General de Salud Pública. Ministerio de Sanidad y Consumo, Madrid, Spain; Alberto Rábano (ARabano@fhalcorcon.es), Unidad de Neuropatología, Fundación Hospital Alcorcón, Alcorcón, Madrid, Spain; Jesús de Pedro-Cuesta (jpedro@isciii.es), Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
SP englisch
PO England