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This study aimed to determine significant liver fibrosis and cirrhosis with different FIB-4 cut-off points, and the need for liver biopsy (LB) by optimizing the initially established cut-off points of 1.45 and 3.25.

Materials and methods:

The study included 201 patients monoinfected with chronic HBV. METAVIR classification was used to determine the stage of fibrosis. ROC analysis and the Youden index were performed to define the optimum cut-off points.


A FIB-4 cut-off point of 1.45 and 1.62 generated Youden indexes of 0.51 and 0.55, the accuracy of 78.6% and 81.1% for significant liver fibrosis, respectively. The FIB-4 cut-off was set at 2.40 and 3.25 Youden indexes were 0.46 and 0.16, accuracies were 79.6% and 69.7% for significant liver fibrosis, respectively. A cut-off point of 1.45 and 1.62 for FIB-4 generated Youden indexes of 0.62 and 0.66, the accuracies of 81.6% and 84.1% for cirrhosis, while the FIB-4 cut-off point of 2.40 and 3.25 generated Youden indexes of 0.59 and 0.22, with the accuracies of 90% and 84.1% for cirrhosis, respectively.


The FIB-4 cut-off points of 1.62 and 2.40 have higher accuracy and may decrease the need for LB 12% more than the initially established ones in HBV monoinfected patients.



This study investigates whether a diagnostic threshold value of procalcitonin exists in Crimean-Congo hemorrhagic fever (CCHF), while also determining the correlation between serum procalcitonin and routine diagnostic laboratory markers, monitoring changes in procalcitonin levels over time during hospitalization, and exploring the effect of procalcitonin levels on survival rates.


A total of 161 patients, including 100 with laboratory-confirmed diagnosis of CCHF and 61 as a control group, were retrospectively investigated. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the contribution of procalcitonin when diagnosing the onset in CCHF patients. Procalcitonin levels were measured with Diazyme latex-enhanced immunoturbidimetric method in Roche Cobas C501 analyzer. A Mann–Whitney U-test was applied to compare the groups, a Mantel–Haenszel (log-rank) test was used to calculate for graphic of original individual patient time-to-event data, and a Kaplan–Meier survival curve was plotted.


A ROC curve analysis identified a best predictive procalcitonin level cut-off point of 0.560 μg/L, with a specificity of 97% and sensitivity of 27% for CCHF. The highest levels of procalcitonin were measured on day 2 during the follow-up throughout and on the 5th day peaked for a second time, lower than the first.


Procalcitonin may serve as prognostic indicator and an auxiliary biomarker to rule out of CCHF.