Background
Methods
Data
Characteristics | AA* (n = 152) | Control** (n = 174) |
p value |
---|---|---|---|
Age, yrs†
| 36.57 ± 21.31 | 43.05 ± 20.86 | 0.003††
|
Gender | 0.021 | ||
Male | 77 (50.7%) | 66 (37.9%) | |
Female | 75 (49.3%) | 108 (62.1%) | |
Chief complaints | 0.000††
| ||
abdominal | 76 (50.0%) | 109 (62.6%) | |
left upper quadrant (LUQ) | 0 (0.0%) | 1 (0.6%) | |
periumbilical area | 4 (2.6%) | 10 (5.7%) | |
right lower quadrant (RLQ) | 60 (39.5%) | 16 (9.2%) | |
left lower quadrant (LLQ) | 0 (0.0%) | 5 (2.9%) | |
lower abdominal | 5 (3.3%) | 18 (10.3%) | |
right upper quadrant (RUQ) | 6 (3.9%) | 15 (8.6%) | |
upper abdominal | 1 (0.7%) | 0 (0.0%) | |
Urinalysis | |||
Color | 0.407 | ||
amber | 10 (6.6%) | 6 (3.4%) | |
brown | 1 (0.7%) | 1 (0.6%) | |
straw | 140 (92.1%) | 167 (96.0%) | |
yellow | 1 (0.7%) | 0 (0.0%) | |
S.G.†
| 1.02 ± 0.01 | 1.02 ± 0.01 | 0.106 |
pH†
| 6.61 ± 0.93 | 6.43 ± 0.92 | 0.086 |
Albumin | 0.412 | ||
negative | 127 (83.6%) | 151 (86.8%) | |
positive | 25 (16.4%) | 23 (13.2%) | |
Glucose | 0.000††
| ||
negative | 116 (76.3%) | 170 (97.7%) | |
positive | 36 (23.7%) | 4 (2.3%) | |
Ketone | 0.000††
| ||
negative | 98 (64.5%) | 149 (85.6%) | |
positive | 54 (35.5%) | 25 (14.4%) | |
O.B. | 0.578 | ||
negative | 104 (68.4%) | 114 (65.5%) | |
positive | 48 (31.6%) | 60 (34.5%) | |
Urobilinogen, E.U./dL†
| 0.52 ± 1.49 | 0.22 ± 0.54 | 0.020 |
Bilirubin | 0.983 | ||
negative | 139 (91.4%) | 159 (91.4%) | |
positive | 13 (8.6%) | 15 (8.6%) | |
Nitrite | 0.689 | ||
negative | 150 (98.7%) | 170 (97.7%) | |
positive | 2 (1.3%) | 4 (2.3%) | |
WBC1 | 0.345 | ||
negative | 99 (65.1%) | 122 (70.1%) | |
positive | 53 (34.9%) | 52 (29.9%) | |
RBC | 0.972 | ||
negative | 53 (34.9%) | 61 (35.1%) | |
positive | 99 (65.1%) | 113 (64.9%) | |
WBC2 | 0.936 | ||
negative | 11 (7.2%) | 13 (7.5%) | |
positive | 141 (92.8%) | 161 (92.5%) | |
Ep. Cell | 0.303 | ||
negative | 30 (19.7%) | 26 (14.9%) | |
positive | 122 (80.3%) | 148 (85.1%) | |
Cast | 0.284 | ||
negative | 151 (99.3%) | 174 (100.0%) | |
positive | 1 (0.7%) | 0 (0.0%) | |
Other | 0.184 | ||
negative | 147 (96.7%) | 172 (98.9%) | |
positive | 5 (3.3%) | 2 (1.1%) | |
Crystal | 0.383 | ||
negative | 151 (99.3%) | 171 (98.3%) | |
positive | 1 (0.7%) | 3 (1.7%) |
Statistical analysis and decision tree model
Structure of the clinical decision support model and its evaluation
Results
Characteristics | AA* (n = 152) | Control** (n = 174) |
p value |
---|---|---|---|
CBC & Differential Count†
| |||
WBC, × 103/μL | 13.47 ± 4.90 | 9.47 ± 3.91 | 0.000††
|
RBC, × 103/μL | 4.50 ± 0.55 | 4.29 ± 0.59 | 0.001††
|
HGB, g/dL | 13.51 ± 1.83 | 13.08 ± 1.83 | 0.037 |
HCT,% | 39.03 ± 4.92 | 37.93 ± 5.23 | 0.027 |
MCV, fl | 86.96 ± 5.54 | 88.58 ± 5.69 | 0.010 |
MCH, pg | 30.16 ± 2.24 | 30.62 ± 2.32 | 0.074 |
MCHC, g/dL | 34.73 ± 1.33 | 34.59 ± 1.34 | 0.343 |
PLT, × 103/μL | 268.69 ± 81.29 | 262.43 ± 78.51 | 0.480 |
NEUT,% | 81.48 ± 8.62 | 69.28 ± 14.14 | 0.000††
|
LYMP,% | 12.51 ± 6.95 | 22.75 ± 12.49 | 0.000††
|
MONO,% | 4.08 ± 1.91 | 4.67 ± 1.78 | 0.000††
|
EOS,% | 1.30 ± 0.91 | 2.14 ± 1.70 | 0.000††
|
BASO,% | 0.37 ± 0.27 | 0.49 ± 0.37 | 0.000††
|
LUC,% | 1.20 ± 0.73 | 1.73 ± 0.99 | 0.000††
|
MPV, fl | 7.72 ± 0.68 | 7.76 ± 0.73 | 0.633 |
Serum Electrolyte†
| |||
Na, mmol/L | 143.11 ± 2.83 | 144.01 ± 3.35 | 0.000††
|
K, mmol/L | 4.19 ± 0.44 | 4.21 ± 0.42 | 0.705 |
Cl, mmol/L | 106.12 ± 3.25 | 107.25 ± 3.83 | 0.000††
|
Routine Admission†
| |||
Calcium (T), mg/dL | 9.11 ± 0.52 | 9.10 ± 0.52 | 0.874 |
Inorganic Phosphorus, mg/dL | 3.36 ± 0.82 | 3.43 ± 0.80 | 0.490 |
Glucose, mg/dL | 127.39 ± 36.23 | 116.61 ± 40.64 | 0.001††
|
BUN, mg/dL | 13.15 ± 7.92 | 13.86 ± 6.44 | 0.376 |
Creatinine, mg/dL | 0.88 ± 0.25 | 0.94 ± 0.51 | 0.229 |
Cholesterol (T), mg/dL | 169.19 ± 37.91 | 174.44 ± 38.84 | 0.219 |
Protein (T), g/dL | 7.21 ± 0.63 | 7.18 ± 0.57 | 0.650 |
Albumin, g/dL | 4.23 ± 0.37 | 4.20 ± 0.36 | 0.404 |
Bilirubin (T), mg/dL | 1.24 ± 0.66 | 0.90 ± 0.48 | 0.000††
|
Bilirubin (D), mg/dL | 0.36 ± 0.16 | 0.26 ± 0.17 | 0.000††
|
ALP, U/L | 97.61 ± 70.85 | 88.05 ± 52.93 | 0.174 |
AST, U/L | 25.70 ± 12.84 | 31.01 ± 27.80 | 0.025 |
ALT, U/L | 22.97 ± 20.90 | 24.70 ± 19.75 | 0.444 |
APTT†, s | 29.92 ± 4.78 | 29.43 ± 12.01 | 0.007††
|
PT†, s | 1.03 ± 0.12 | 1.01 ± 0.13 | 0.028 |
Lipase†, U/L | 24.14 ± 7.70 | 31.70 ± 16.89 | 0.000††
|
Amylase (T)†, U/L | 46.86 ± 27.77 | 55.04 ± 26.90 | 0.000††
|
Variables | Coefficient (β) | Standard error | OR (95% CI) |
p value |
H statistic* |
---|---|---|---|---|---|
Complaints** | 0.000 | ||||
LUQ | -19.774 | 40192.97 | - | 1.000 | |
PA†
| -0.725 | 0.754 | 0.484 (0.111-2.121) | 0.336 | |
RLQ | 1.838 | 0.397 | 6.281 (2.883-13.687) | 0.000 | |
LLQ | -18.848 | 17365.29 | - | 0.999 | |
Lower abd. | -1.215 | 0.697 | 0.297 (0.076-1.163) | 0.081 | |
RUQ | -0.047 | 0.784 | 0.954 (0.205-4.433) | 0.952 | |
Upper abd. | 19.292 | 40192.97 | 2.390E8 (-) | 1.000 | 0.838 |
Urine glucose (positive) | 2.537 | 0.644 | 12.636 (3.575-44.658) | 0.000 | |
WBC | 0.116 | 0.043 | 1.123 (1.033-1.221) | 0.007 | |
NEUT | 0.057 | 0.017 | 1.059 (1.023-1.095) | 0.001 | |
Bilirubin (T) | 0.795 | 0.268 | 2.213 (1.308-3.746) | 0.003 | |
Lipase | -0.042 | 0.016 | 0.958 (0.928-0.989) | 0.009 | |
Intercept | -6.035 | 1.290 | - | 0.000 |
Decision support model based on multivariate analysis
Variables | OR (95% CI) |
p value |
---|---|---|
Level 0 (root node)
| ||
NEUT ≤ 73.1% or > 73.1% | 11.506 (6.244-21.202) | 0.000 |
Level 1
| ||
Urine glucose (negative) | 0.041 (0.006-0.310) | 0.002 |
Urine glucose (positive) | 24.115 (3.227-180.216) | 0.002 |
Level 2*
| ||
Abdominal pain | 2.722 (1.445-5.125) | 0.002 |
LUQ pain | 0.732 (0.014-37.307) | 0.876 |
PA or RLQ or Upper abdominal pain | 5.880 (2.727-12.681) | 0.000 |
LLQ or Lower abdominal or RUQ pain | 4.231 (1.292-13.855) | 0.017 |
Level 3
| ||
Bilirubin (T) ≤ 1.0 mg/dL or > 1.0 mg/dL | 6.200 (2.604-14.762) | 0.000 |
Level 4
| ||
Lipase ≤ 46 U/L or > 46 U/L | 37.800 (1.829-781.085) | 0.019 |
Decision support model based on univariate analysis
Variables | OR (95% CI) |
p value |
---|---|---|
Level 0 (root node)
| ||
LYMP ≤ 20.2% or > 20.2% | 12.527 (6.335-24.770) | 0.000 |
Level 1
| ||
Urine glucose (negative) | 0.036 (0.005-0.270) | 0.001 |
Urine glucose (positive) | 27.645 (3.709-206.043) | 0.001 |
BASO ≤ 1.1% | 9.333 (1.169-74.489) | 0.035 |
BASO > 1.1% | 0.107 (0.013-0.8555) | 0.035 |
Level 2*
| ||
Abdominal pain | 4.487 (2.556-7.878) | 0.000 |
LUQ or LLQ or RUQ pain | 4.594 (0.929-22.712) | 0.062 |
APA pain | 1.087 (0.237-4.994) | 0.914 |
RLQ pain | 7.447 (3.274-16.938) | 0.000 |
Lower abdominal pain | 6.058 (1.273-28.826) | 0.024 |
Upper abdominal pain | 2.465 (0.099-61.267) | 0.582 |
WBC ≤ 6.2 × 103/μL or > 6.2 × 103/μL | 25.000 (0.341-1831.738) | 0.142 |
Level 3
| ||
Bilirubin (T) ≤ 1.0 mg/dL or > 1.0 mg/dL | 6.576 (2.791-15.493) | 0.000 |
WBC ≤ 14.37 × 103/μL or > 14.37 × 103/μL | 63.000 (0.982-4042.374) | 0.051 |
Cl ≤ 104 mmol/L | 9.197 (0.499-169.573) | 0.136 |
Cl > 104 mmol/L | 0.109 (0.006-2.005) | 0.136 |
Bilirubin (D) ≤ 0.4 mg/dL or > 0.4 mg/dL | 95.000 (1.482-6088.126) | 0.032 |
Level 4
| ||
Amylase (T) ≤ 58 U/L | 0.033 (0.002-0.584) | 0.020 |
Amylase (T) > 58 U/L | 29.881 (1.1711-521.765) | 0.020 |
APTT ≤ 22.6 s or > 22.6 s | 37.800 (1.829-781.085) | 0.019 |
Urine ketone (negative) | 0.667 (0.113-3.919) | 0.654 |
Urine ketone (positive) | 1.500 (0.255-8.817) | 0.654 |
Level 5
| ||
MONO ≤ 2.4% or > 2.4% | 19.667 (1.022-378.446) | 0.048 |
NEUT ≤ 84% | 0.055 (0.003-1.051) | 0.054 |
NEUT > 84% | 18.103 (0.951-344.559) | 0.054 |
MONO ≤ 3.6% or > 3.6% | 29.000 (1.413-595.209) | 0.029 |
Level 6
| ||
EOS ≤ 2.4% | 0.077 (0.004-1.426) | 0.085 |
EOS > 2.4% | 13.047 (0.701-242.739) | 0.085 |
LYMP ≤ 13.8% or > 13.8% | 49.286 (2.214-1097.056) | 0.014 |
EOS ≤ 1.5% or > 1.5% | 47.667 (1.597-1422.784) | 0.026 |
Level 7
| ||
Urine ketone (negative or positive) | 1.932 (0.423-8.814) | 0.395 |
Bilirubin (D) ≤ 0.3 mg/dL or > 0.3 mg/dL | 25.000 (0.750-832.997) | 0.072 |
Level 8
| ||
Glucose ≤ 124 mg/dL or > 124 mg/dL | 25.706 (1.307-505.514) | 0.033 |
BASO ≤ 0.4% or > 0.4% | 12.600 (0.446-356.388) | 0.137 |
Level 9
| ||
Cl ≤ 107 mmol/L or > 107 mmol/L | 18.667 (1.563-222.937) | 0.021 |
Level 10
| ||
RBC ≤ 4.14 × 103/μL or > 4.14 × 103/μL | 25.000 (0.750-832.997) | 0.072 |
Variables | Fold 1 | Fold 2 | Fold 3 | Fold 4 | Fold 5 | Fold 6 | Fold 7 | Fold 8 | Fold 9 | Fold 10 | ||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | |
Age | O | O | O | O | O | O | ||||||||||||||||||||||||
Complaints | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | ||
Urine pH | O | O | ||||||||||||||||||||||||||||
Urine glucose | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | ||
Urine ketone | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
Urine Urobilinogen | O | O | O | |||||||||||||||||||||||||||
WBC | O | O | O | O | O | O | O | O | O | O | O | O | O | |||||||||||||||||
RBC | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
NEUT | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O |
LYMP | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
MONO | O | O | O | O | O | |||||||||||||||||||||||||
EOS | O | O | O | O | O | O | O | O | O | O | O | |||||||||||||||||||
BASO | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
LUC | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
Bilirubin (T) | O | O | O | O | O | O | O | O | O | O | O | |||||||||||||||||||
Bilirubin (D) | O | O | O | O | O | O | O | O | O | O | O | O | O | |||||||||||||||||
Lipase | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | ||||||||||
Amylase (T) | O | O |
Variables | Fold 1 | Fold 2 | Fold 3 | Fold 4 | Fold 5 | Fold 6 | Fold 7 | Fold 8 | Fold 9 | Fold 10 | ||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | M1 | M2 | M3 | |
Age | O | O | O | O | ||||||||||||||||||||||||||
Complaints | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | |||
Urine pH | O | O | ||||||||||||||||||||||||||||
Urine glucose | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | |||||
Urine ketone | O | O | O | O | O | O | ||||||||||||||||||||||||
WBC | O | O | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||
RBC | O | O | O | O | O | O | O | |||||||||||||||||||||||
NEUT | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | |||||
LYMP | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
MONO | O | |||||||||||||||||||||||||||||
EOS | O | O | O | O | O | O | O | O | ||||||||||||||||||||||
BASO | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
LUC | O | O | O | O | O | O | O | O | O | |||||||||||||||||||||
Bilirubin (T) | O | O | O | O | O | O | O | O | O | O | ||||||||||||||||||||
Bilirubin (D) | O | O | O | O | O | O | O | O | O | O | O | |||||||||||||||||||
Lipase | O | O | O | O | O | O | O | O | O | O | O | O | O | O | O | |||||||||||||||
Amylase (T) | O | O |
Performance | ACC | SENS | SPEC | PPV | NPV | AUC |
---|---|---|---|---|---|---|
Based on univariate
analysis*
| 80.2 | 82.4 | 78.3 | 76.8 | 83.5 | 80.3 |
Based on multivariate
analysis**
| 71.6 | 69.3 | 73.7 | 69.7 | 73.3 | 71.5 |
Based on multivariate
analysis
†
| 73.5 | 66.0 | 80.0 | 74.3 | 72.9 | 73.0 |
Pairwise comparison of ROC curves | Based on univariate analysis* | Based on multivariate analysis** | Based on multivariate analysis†
|
---|---|---|---|
Based on univariate analysis* | - |
p < 0.01 (95% CI: 3.13-14.5) |
p < 0.05 (95% CI, 1.54-13.1) |
Based on multivariate analysis** |
p < 0.01 (95% CI, 3.13-14.5) | - |
p = 0.400 (95% CI, -2.0-5.02) |
Based on multivariate analysis†
|
p < 0.05 (95% CI, 1.54-13.1) |
p = 0.400 (95% CI, -2.0-5.02) | - |