| Diagnostic accuracy of blood lactate-to-pyruvate molar ratio in the differential diagnosis of congenital lactic acidosis. | |
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MedLine Citation:
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PMID: 17384007 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Although the blood lactate-to-pyruvate (L:P) molar ratio is used to distinguish between pyruvate dehydrogenase deficiency (PDH-D) and other causes of congenital lactic acidosis (CLA), its diagnostic accuracy for differentiating between these 2 types of CLA has not been evaluated formally. METHODS: We conducted a retrospective study of all patients followed for mitochondrial diseases between 1985 and 2005 in a tertiary care pediatric hospital. RESULTS: At the recommended cut point of approximately 25, individual median L:P ratio demonstrated low sensitivity and specificity (77% and 91%, respectively) for differentiating between patients with enzymatically proven PDH-D (n = 11) and those with mitochondrial disease but normal pyruvate dehydrogenase (PDH) activity (non-PDH; n = 35). We observed a strong positive association between L:P ratio and blood lactate in non-PDH CLA, whereas this association was weak in PDH-D CLA. Consequently, patient classification based on median L:P ratio showed improved diagnostic accuracy at higher lactate concentrations: for lactate <2.5 mmol/L the area under the ROC curve was not statistically different from 0.5 (P = 0.3), whereas it was statistically different for lactate >2.5 mmol/L. In the 2.5 to 5.0 mmol/L lactate category, the sensitivity and specificity at an optimal cut point of 18.4 were 93% (95% CI, 77%-99%) and 71% (95% CI, 20%-96%), respectively; for lactate >5.0 mmol/L, with an optimal cut point of 25.8, sensitivity and specificity were 96% (95% CI, 77%-99%) and 100% (95% CI, 59%-100%), respectively. CONCLUSION: Usefulness of the L:P ratio for differentiating non-PDH and PDH-D types of CLA increases at higher lactate concentrations. |
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Authors:
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François-Guillaume Debray; Grant A Mitchell; Pierre Allard; Brian H Robinson; James A Hanley; Marie Lambert |
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Publication Detail:
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Type: Journal Article Date: 2007-03-23 |
Journal Detail:
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Title: Clinical chemistry Volume: 53 ISSN: 0009-9147 ISO Abbreviation: Clin. Chem. Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-04-30 Completed Date: 2007-06-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9421549 Medline TA: Clin Chem Country: United States |
Other Details:
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Languages: eng Pagination: 916-21 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, Ste-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acidosis, Lactic
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congenital,
diagnosis* Child Diagnosis, Differential Female Hospitals, Pediatric Humans Lactic Acid / blood* Male Mitochondrial Diseases / diagnosis Pyruvate Dehydrogenase Complex Deficiency Disease / diagnosis Pyruvic Acid / blood* ROC Curve Retrospective Studies Sensitivity and Specificity |
| Chemical | |
Reg. No./Substance:
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127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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