Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study

Abstract Background The diagnosis of neurosyphilis is challenging due to the requirement of a lumbar puncture and cerebrospinal fluid (CSF) laboratory tests. Therefore, a convenient diagnostic nomogram for neurosyphilis is warranted. This study aimed to construct diagnostic models for diagnosing neu...

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Autores principales:	Wenjing Ge, Yang Zhang, Chao Peng, Dongdong Li, Lijie Gao, Jiajia Bao, Changling Li, Ning Chen, Dong Zhou, Li He
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Neurosyphilis Diagnostic model HIV-negative patient Serum TRUST Psychiatric behaviour disorders Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/37ad7f88cfc44b4d9569912bede2c416
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spelling	oai:doaj.org-article:37ad7f88cfc44b4d9569912bede2c4162021-11-21T12:09:39ZDevelopment and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study10.1186/s12883-021-02454-81471-2377https://doaj.org/article/37ad7f88cfc44b4d9569912bede2c4162021-11-01T00:00:00Zhttps://doi.org/10.1186/s12883-021-02454-8https://doaj.org/toc/1471-2377Abstract Background The diagnosis of neurosyphilis is challenging due to the requirement of a lumbar puncture and cerebrospinal fluid (CSF) laboratory tests. Therefore, a convenient diagnostic nomogram for neurosyphilis is warranted. This study aimed to construct diagnostic models for diagnosing neurosyphilis. Methods This cross-sectional study included data of two patient cohorts from Western China Hospital of Sichuan University between September 2015 and April 2021 and Shangjin Hospital between September 2019 and April 2021 as the development cohort and the external validation cohort, respectively. A diagnostic model using logistic regression analysis was constructed to readily provide the probability of diagnosis at point of care and presented as a nomogram. The clinical usefulness of the diagnostic models was assessed using a receiver operating characteristic (ROC) and Harrell concordance (Harrell C) index for discrimination and calibration plots for accuracy, which adopted bootstrap resampling 500 times. Results One hundred forty-eight and 67 patients were included in the development and validation cohorts, respectively. Of those, 131 were diagnosed as having reactive neurosyphilis under the criteria of positive results in both CSF treponemal and non-treponemal tests. In the development cohort, male, psychiatric behaviour disorders, and serum toluidine red unheated serum test were selected as diagnostic indicators applying a stepwise procedure in multivariable logistic model. The model reached 80% specificity, 79% sensitivity, and 0·85 area under the curves (AUC) (95% confidence interval, 0·76–0·91). In the validation cohorts, the Harrell C index for the diagnostic possibility of reactive neurosyphilis was 0·71. Conclusions A convenient model using gender, presence of psychiatric behaviour disorders, and serum TRUST titre was developed and validated to indicate diagnostic results in patients suspected of neurosyphilis. Checking the model value of factors on nomogram is a feasible way to assist clinicians and primary health servers in updating patients’ medical charts and making a quantitatively informed decision on neurosyphilis diagnosis. Trial registration This research was retrospectively registered in the Ethics committee on biomedical research, West China Hospital of Sichuan University. The research registration and committee’s reference number was 1163 in 2020 approval.Wenjing GeYang ZhangChao PengDongdong LiLijie GaoJiajia BaoChangling LiNing ChenDong ZhouLi HeBMCarticleNeurosyphilisDiagnostic modelHIV-negative patientSerum TRUSTPsychiatric behaviour disordersNeurology. Diseases of the nervous systemRC346-429ENBMC Neurology, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosyphilis Diagnostic model HIV-negative patient Serum TRUST Psychiatric behaviour disorders Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosyphilis Diagnostic model HIV-negative patient Serum TRUST Psychiatric behaviour disorders Neurology. Diseases of the nervous system RC346-429 Wenjing Ge Yang Zhang Chao Peng Dongdong Li Lijie Gao Jiajia Bao Changling Li Ning Chen Dong Zhou Li He Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
description	Abstract Background The diagnosis of neurosyphilis is challenging due to the requirement of a lumbar puncture and cerebrospinal fluid (CSF) laboratory tests. Therefore, a convenient diagnostic nomogram for neurosyphilis is warranted. This study aimed to construct diagnostic models for diagnosing neurosyphilis. Methods This cross-sectional study included data of two patient cohorts from Western China Hospital of Sichuan University between September 2015 and April 2021 and Shangjin Hospital between September 2019 and April 2021 as the development cohort and the external validation cohort, respectively. A diagnostic model using logistic regression analysis was constructed to readily provide the probability of diagnosis at point of care and presented as a nomogram. The clinical usefulness of the diagnostic models was assessed using a receiver operating characteristic (ROC) and Harrell concordance (Harrell C) index for discrimination and calibration plots for accuracy, which adopted bootstrap resampling 500 times. Results One hundred forty-eight and 67 patients were included in the development and validation cohorts, respectively. Of those, 131 were diagnosed as having reactive neurosyphilis under the criteria of positive results in both CSF treponemal and non-treponemal tests. In the development cohort, male, psychiatric behaviour disorders, and serum toluidine red unheated serum test were selected as diagnostic indicators applying a stepwise procedure in multivariable logistic model. The model reached 80% specificity, 79% sensitivity, and 0·85 area under the curves (AUC) (95% confidence interval, 0·76–0·91). In the validation cohorts, the Harrell C index for the diagnostic possibility of reactive neurosyphilis was 0·71. Conclusions A convenient model using gender, presence of psychiatric behaviour disorders, and serum TRUST titre was developed and validated to indicate diagnostic results in patients suspected of neurosyphilis. Checking the model value of factors on nomogram is a feasible way to assist clinicians and primary health servers in updating patients’ medical charts and making a quantitatively informed decision on neurosyphilis diagnosis. Trial registration This research was retrospectively registered in the Ethics committee on biomedical research, West China Hospital of Sichuan University. The research registration and committee’s reference number was 1163 in 2020 approval.
format	article
author	Wenjing Ge Yang Zhang Chao Peng Dongdong Li Lijie Gao Jiajia Bao Changling Li Ning Chen Dong Zhou Li He
author_facet	Wenjing Ge Yang Zhang Chao Peng Dongdong Li Lijie Gao Jiajia Bao Changling Li Ning Chen Dong Zhou Li He
author_sort	Wenjing Ge
title	Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
title_short	Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
title_full	Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
title_fullStr	Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
title_full_unstemmed	Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
title_sort	development and external validation of a nomogram for neurosyphilis diagnosis among non-hiv patients: a cross-sectional study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/37ad7f88cfc44b4d9569912bede2c416
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Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study

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