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Volume 23, Number 12—December 2017
Dispatch

Diagnostic Accuracy of Parameters for Zika and Dengue Virus Infections, Singapore

Hanley J. HoComments to Author , Joshua G.X. Wong, Win Mar Kyaw, David C. Lye, Yee Sin Leo, and Angela Chow
Author affiliations: Tan Tock Seng Hospital, Singapore

Main Article

Table 1

Diagnostic accuracy of clinical and laboratory parameters for Zika virus infection cohort. Singapore*

Parameters Sensitivity (95% CI) Specificity (95% CI) PPV (95% CI) NPV (95% CI) LRP (95% CI) LRN (95% CI)
Clinical
Documented fever >37.5°C 0.35 (0.26–0.43) 0.58 (0.50–0.66) 0.42 (0.32–0.51) 0.51 (0.43–0.58) 0.83 (0.61–1.12) 1.12 (0.93–1.35)
Headache 0.23 (0.16–0.30) 0.62 (0.54–0.69) 0.34 (0.24–0.44) 0.48 (0.41–0.55) 0.60 (0.41–0.87) 1.25 (1.07–1.46)
Myalgia 0.41 (0.33–0.49) 0.41 (0.34–0.47) 0.32 (0.25–0.39) 0.5 (0.42–0.57) 0.66 (0.52–0.84) 1.54 (1.20–1.97)
Arthralgia 0.21 (0.14–0.28) 0.79 (0.72–0.85) 0.46 (0.33–0.58) 0.54 (0.47–0.60) 0.98 (0.62–1.54) 1.01 (0.90–1.13)
Rash 0.94 (0.90–0.98) 0.59 (0.51–0.67) 0.67 (0.59–0.73) 0.92 (0.86–0.97) 2.29 (1.88–2.78) 0.10 (0.05–0.21)
Conjunctivitis 0.23 (0.16–0.3) 0.88 (0.83–0.93) 0.63 (0.49–0.76) 0.57 (0.51–0.63) 1.93 (1.13–3.31) 0.87 (0.78–0.98)
Nausea 0.04 (0.01–0.07) 0.95 (0.91–0.98) 0.38 (0.12–0.65) 0.53 (0.47–0.59) 0.73 (0.24–2.16) 1.02 (0.96–1.07)
Vomiting 0.02 (0–0.04) 0.94 (0.90–0.98) 0.18 (0–0.41) 0.53 (0.47–0.58) 0.26 (0.06–1.17) 1.04 (1.00–1.10)
Diarrhea 0.03 (0.001–0.06) 0.97 (0.94–1.00) 0.44 (0.12–0.77) 0.54 (0.48–0.60) 0.93 (0.25–3.39) 1.00 (0.96–1.05)
Abdominal pain 0.02 (0–0.04) 0.98 (0.96–1.00) 0.40 (0–0.82) 0.54 (0.48–0.60) 0.77 (0.13–.57) 1.00 (0.97–1.04)
Runny nose 0.02 (0–0.05) 0.92 (0.88–0.96) 0.20 (0–0.40) 0.52 (0.46–0.58) 0.29 (0.08–1.01) 1.06 (1.006–1.12)
Sore throat 0.18 (0.12–0.25) 0.83 (0.77–0.89) 0.48 (0.34–0.62) 0.54 (0.48–0.61) 1.07 (0.65–1.77) 0.98 (0.88–1.10)
Cough 0.12 (0.06–0.17) 0.72 (0.64–0.79) 0.26 (0.15–0.37) 0.49 (0.42–0.55) 0.41 (0.24–0.69) 1.24 (1.10–1.39)
Breathlessness 0.01 (0–0.02) 0.97 (0.95–1.00) 0.20 (0–0.55) 0.53 (0.47–0.59) 0.29 (0.03–2.56) 1.02 (0.99–1.05)
Laboratory†
Leukocytes <3.6 × 109 cells/L 0.17 (0.11–0.24) 0.9 (0.85–0.94) 0.54 (0.4–0.69) 0.6 (0.55–0.66) 2.00 (1.06–3.79) 0.90 (0.82–0.99)
Hemoglobin <13 g/dL 0.22(0.15–0.29) 0.80 (0.74–0.87) 0.50 (0.37–0.63) 0.54 (0.47–0.60) 1.13 (0.72–1.79) 0.97 (0.86–1.09)
Platelets <100 × 109/L 0.01 (0–0.02) 0.99 (0.97–1.00) 0.33 (0–0.87) 0.53 (0.47–0.59) 0.57 (0.05–6.16) 1.01 (0.98–1.03)
Neutrophils <1.4 × 109 cells/L 0.06 (0.02–0.10) 0.99 (0.97–1.00) 0.80 (0.55–1.00) 0.53 (0.47–0.59) 4.27 (0.93–19.78) 0.95 (0.91–1.00)
Neutrophils >5.9 × 109 cells/L 0.04 (0.01–0.08) 0.66 (0.58–0.74) 0.1 (0.02–0.18) 0.42 (0.36–0.49) 0.11 (0.05–0.28) 1.45 (1.28–1.64)
Lymphocytes <0.9 × 109 cells/L 0.18 (0.12–0.25) 0.78 (0.71–0.85) 0.44 (0.31–0.57) 0.50 (0.44–0.58) 0.83 (0.51–1.33) 1.04 (0.93–1.18)
Creatinine >105 μmol/L 0.08 (0.03–0.13) 0.94 (0.91–0.98) 0.56 (0.33–0.79) 0.54 (0.47–0.60) 1.41 (0.57–3.46) 0.98 (0.91–1.04)
Urea >9.3 mmol/L 0 0.99 (0.98–1.00) 0 0.54 (0.48–0.59) 0 1.01 (0.99–1.02)
Alanine aminotransferase >54 U/L 0.08 (0.03–0.13) 0.94 (0.91–0.98) 0.56 (0.33–0.79) 0.56 (0.5–0.61) 0.72 (0.37–1.39) 1.05 (0.96–1.14)
Aspartate aminotransferase >41 U/L 0.07 (0.03–0.11) 0.83 (0.77–0.89) 0.27 (0.12–0.42) 0.50 (0.43–0.56) 0.42 (0.20–0.86) 1.12 (1.02–1.22)
Combinations
Any GI symptom (nausea, vomiting, diarrhea, abdominal pain) 0.06 (0.02–0.10) 0.89 (0.84–0.94) 0.33 (0.14–0.52) 0.53 (0.46–0.59) 0.58 (0.26–1.31) 1.04 (0.98–1.13)
Any GI symptom + lymphopenia 0.01 (0–0.03) 0.96 (0.93–0.99) 0.20 (0–0.45) 0.56 (0.5–0.61) 0.53 (0.10–2.87) 1.01 (0.98–1.05)
Rash + conjunctivitis 0.22 (0.15–0.29) 0.97 (0.94–0.99) 0.85 (0.73–0.97) 0.59 (0.53–0.65) 6.73 (2.68–16.90) 0.80 (0.73–0.89)
Documented fever + rash 0.31 (0.23–0.39) 0.86 (0.81–0.92) 0.66 (0.54–0.77) 0.59 (0.53–0.66) 2.21 (1.38–3.55) 0.80 (0.71–0.92)
Documented fever + rash + any GI symptom 0.02 (0–0.04) 0.99 (0.98–1.00) 0.75 (0.33–1.17) 0.54 (0.48–0.60) 3.48 (0.37–33.10) 0.98 (0.95–1.01)
Documented fever + rash + lymphopenia 0.07 (0.02–0.11) 0.94 (0.90–0.98) 0.50 (0.27–0.73) 0.53 (0.47–0.60) 1.14 (0.47–2.78) 0.99 (0.93–1.05)
Documented fever + lymphopenia 0.10 (0.05–0.15) 0.86 (0.80–0.91) 0.38 (0.22–0.55) 0.52 (0.46–0.58) 0.70 (0.37–1.34) 1.05 (0.96–1.15)
Documented fever + thrombocytopenia 0 0.98 (0.97–1.00) 0 0.53 (0.48–0.59) 0 1.01 (0.99–1.03)
Documented fever + lymphopenia + thrombocytopenia 0 0.99 (0.97–1.00) 0 0.53 (0.48–0.59) 0 1.01 (0.99–1.03)
Documented fever + rash, with >1 of arthralgia, myalgia, headache, conjunctivitis 0.21 (0.14–0.28) 0.89 (0.84–0.94) 0.63 (0.48–0.77) 0.57 (0.50–0.63) 1.96 (1.11–3.47) 0.90 (0.80–0.98)

*GI, gastrointestinal; LRN, negative likelihood ratio; LRP, positive likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.
†Reference values: leukocytes, 3.6–9.3 × 109 cells/L; hemoglobin, 11.0–15.0 g/dL; platelets, 170–420 × 109/L; neutrophils, 1.40–5.90 × 109 cells/L; lymphocytes, 0.90–3.30 × 109 cells/L; creatinine, 40–75 μmol/L; urea, 2.9–9.3 mmol/L; alanine aminotransferase, 14–54 U/L; aspartate aminotransferase, 15–41 U/L.

Main Article

Page created: November 16, 2017
Page updated: November 16, 2017
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