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Published on: January 29, 2018
Diagnostic markers of metabolic bone disease of prematurity in preterm infants
Kui-Lin Lü1, Shuang-Shuang Xie2, Qi Hu3
1Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China.
Insights
New diagnostic models can help detect metabolic bone disease of prematurity (MBDP) early in preterm infants. Alkaline phosphatase (ALP) levels above 344 U/L show promise as a simple indicator for MBDP.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Biochemistry
Background:
- Metabolic bone disease of prematurity (MBDP) is common in preterm infants due to higher birth rates and improved care.
- Early diagnosis of MBDP is challenging due to a lack of clear indicators.
- This study addresses the need for simple, feasible early warning indicators for MBDP.
Purpose of the Study:
- To explore simple and feasible early warning indicators for the diagnosis of MBDP in preterm infants.
- To develop and validate diagnostic models for MBDP.
- To identify key clinical variables associated with MBDP.
Main Methods:
- Retrospective analysis of 136 preterm infants' data from two medical centers (January 2020 - February 2022).
- Correlation analysis of 14 clinical variables with MBDP occurrence.
- Least Absolute Shrinkage and Selection Operator (LASSO) regression to select predictors and establish diagnostic models.
- Receiver Operating Characteristic (ROC) curve analysis to determine optimal cutoff values and assess model performance.
Main Results:
- LASSO regression identified four predictors (height, head circumference, total serum calcium, alkaline phosphatase) for Model I.
- Alkaline phosphatase (ALP) alone was identified as a predictor for Model II.
- Model I achieved an Area Under the ROC Curve (AUROC) of 0.959, and Model II achieved an AUROC of 0.929.
- An ALP level >344 U/L was established as a simple and effective diagnostic threshold.
Conclusions:
- Two diagnostic models for MBDP were developed, showing good sensitivity and specificity for early diagnosis.
- An ALP level of 344 U/L is a promising simple threshold for MBDP diagnosis.
- Future research should focus on larger sample sizes, establishing age-specific ALP thresholds, and conducting internal/external validation.
Abstract:
Due to the higher birth rate of preterm infants and improvements in their management, metabolic bone disease of prematurity (MBDP) has a high incidence and is attracting attention. However, clear indicators for the early diagnosis of MBDP are lacking. We aimed to explore simple and feasible early warning indicators for diagnosing MBDP. Our study collected case data of premature infants from two medical centers in Chongqing from January 2020 to February 2022. According to the inclusion and exclusion criteria, data from 136 cases were collected. The correlation between 14 variables in each case and the occurrence of MBDP was analyzed. According to area under the receiver operating characteristic curve (AUROC) analysis, the best cutoff value for each variable was determined. Potential predictors were selected, and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to establish the association of two models with MBDP, whose results were used to develop a diagnostic nomogram. Furthermore, a model decision curve was analyzed. Four predictors were selected from 14 clinical variables by LASSO regression, and Model I was established, including the following characteristics: height (>36 cm), head circumference (≤29.49 cm), total serum calcium (Ca) (>2.13 mmol/L), and alkaline phosphatase (ALP) (>344 U/L) levels. A single predictor, the ALP level (>344 U/L), was used to establish Model II. The AUROC values of the two models were 0.959 for Model I and 0.929 for Model II. In conclusion, in this study, two diagnostic models of MBDP were developed using four combinations of predictors and ALP as a single predictor. Both models showed good sensitivity and specificity for the early diagnosis of metabolic bone disease (MBD), and an ALP level of 344 U/L was defined as a simple and effective diagnostic threshold. In future studies, using larger samples, diagnostic threshold values of ALP for premature infants of different ages should be established, and internal and external validations are needed to improve the adaptability of the current model.
