How can new diagnostic methods contribute in healthcare? What are doctors looking for?

•Better support in their clinical decision makings, which includes:

omore accurate diagnosisoreliable prognostic estimationotools for therapy stratification and monitoring

•Rapid answers to the patient in order to:

oreduce the need for later reevaluation of the patientoprovide the patient with maximal information at the doctor´s visit

How can new diagnostic methods contribute in healthcare? What are doctors looking for?

1. More accurate diagnostic and prognostic markers in cardio-vascular disease

2. Markers for the distinction between bacterial and viral causes of acute infections

3. And more

Heart disease accounts for 49% of all deaths in Europe

The estimated cost for the society in Europe is 169 billion euros

Cardiac troponins in a healthy population –the impact of an ultra-sensitive troponin assay

35 40 45 50 55 60 65 70 75 80

Age

0,00

0,01

0,02

0,03

0,04

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cTn

I, A

ccu

Tn

I g

/L

99th percentile URL

99th percentile <60 y

ULSAM-studyUppsala Longitudinal Study of Adult Men

• All men in Uppsala born between 1920 and 1924All 50 years old men (n=2841) were invited for the investigation, 81.7% (n=2322) participated

• Remaining cohort at 70 years of age n =1673 (73%

participated n=1221)– Men without cardiovascular disease disease n = 853

– Men with cardiovascular disease n = 368

• Follow-up period 10.4 years

Outcome (Death) in 70 years old men, with or without CVD, in relation to cTroponin I (AccuTnI)

cTroponin I, g/L

>0.039 >0.02-<0.04 <0.021 >0.039 >0.02-<0.04 <0.021

Out

com

e. d

eath

%

0

20

40

60

80

Healthy Diseased

p<0.0001

p<0.0001

p=0.002

p=0.03

Thus, the development and use of ultra-sensitive troponin assays

as indicators of myocardial dysfunction and leakage

will enable us to identify many more subjects

at risk of premature death in cardio-vascular disease

Heart failure – a deadly disease and a diagnostic dilemma

Correct diagnosis – correct treatment False diagnosis – wrong treatment

Missed diagnosis – no treatment

Heart failure – the impact of assaying blood levels of natriuretic peptides (BNP and NT-proBNP)

Correct diagnosis – correct treatment False diagnosis – wrong treatment

Missed diagnosis – no treatment

NT-proBNP in healthy 70-year old men in relation to all-cause death during a 10 year follow-up, n=839 (ULSAM)

05

101520

2530

354045

<100 100 200 300 400 500 >600

NT-proBNP, ng/L

% D

eath

Should my patient be prescribed antibiotics or not?

49% of all patients visiting a primary health care unit in Sweden called the doctor because of symptoms of acute infection

The clinical diagnosis of most respiratory infections such as pneumonia, pharyngitis/tonsillitis, otitis has, when based on symptoms and physical signs only,

a diagnostic sensitivity and specificity of 55-60% in the distinction between a viral or bacterial cause of the infection

And how can we slow down the epidemics of antibiotics resistance?

Is the discovery of Human neutrophil lipocalin (HNL) the answer to our needs?

P-CRP and B-PMN in acute infections

Bacteria Virus Virus Bacteria

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CRP PMN

mg

/Lx10

9/L

HNL/NGAL in serum in acute infections

Bacteria Virus0

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g/

L

P-CRP

S-HNL

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100-Specificity

Sens

itivi

ty

Discrimination between acute bacterial and viral infectionsHospitalized adult population

Highest diagnosti

c accu

racy in le

ft corner

Internists base their clinical management to 70-80% on laboratory tests

Primary care doctors base their clinical management to 10-20% on laboratory tests

Laboratory testing is an efficient means to save money in health caresince it provides the doctor with:

Some conclusions

more accurate diagnosismore reliable prognostic estimationbetter tools for therapy stratification and monitoring

All for the benefit of our patients and the society