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A Clinical Decision Rule to Aid Ordering of Serum and Urine Protein Electrophoresis for Case-Finding of Paraproteins in Hospitalized Inpatients

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Abstract

Objective

To develop a simple clinical decision rule that could increase the yield of serum and urine protein electrophoresis (SPE/UPE) without loss of sensitivity.

Design

A cross-sectional study of inpatients with a SPE/UPE performed over a 5-year period (2001–2006) with complete data on electrolytes, globulins, full blood count, creatinine, age, and gender.

Setting

A tertiary-care general teaching hospital serving the Hunter Valley in New South Wales, with a referral population of over 1 million.

Participants

A total of 14,374 adult patients admitted between January 2001–November 2006.

Main outcome measures

Paraprotein on serum and/or urine protein electrophoresis (SPE/UPE).

Results

Five points were assigned for globulin >41 g/l, 3 points for age ≥60, 2 points for each of hemoglobin <121 and male gender, and 1 point for estimated glomerular filtration rate (eGFR) <60. Total scores of 0–5, 6–10, and ≥11 corresponded to positive likelihood ratios of an abnormal SPE/UPE of 1, 2.5, and 6.6, respectively. The predictive ability of this model was strong, with an area under the curve of ∼0.8. Results in the validation set were almost identical.

Conclusion

A clinical decision rule using simple clinical variables has the potential to improve the yield of SPE/UPE. This rule however needs to be verified prospectively.

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Acknowledgement

The authors declare that there was no conflict of interest, and there was no financial support.

Author information

Authors and Affiliations

  1. Clinical Epidemiology Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Ammarin Thakkinstian PhD

  2. Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia

    Ammarin Thakkinstian PhD & John Attia PhD, FRCPC, FRACP

  3. HRMC, Locked Bag 1, Hunter Area Pathology Service, Newcastle, New South Wales, Australia

    Huy Tran MB BS, FRACP & Glenn Reeves MB BS, FRACP

  4. Division of Medicine, HRMC, Locked Bag 1, John Hunter Hospital, Newcastle, New South Wales, Australia

    Stuart Murch B Med & John Attia PhD, FRCPC, FRACP

Authors
  1. Ammarin Thakkinstian PhD
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  2. Huy Tran MB BS, FRACP
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  3. Glenn Reeves MB BS, FRACP
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  4. Stuart Murch B Med
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  5. John Attia PhD, FRCPC, FRACP
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Corresponding author

Correspondence to John Attia PhD, FRCPC, FRACP.

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Thakkinstian, A., Tran, H., Reeves, G. et al. A Clinical Decision Rule to Aid Ordering of Serum and Urine Protein Electrophoresis for Case-Finding of Paraproteins in Hospitalized Inpatients. J GEN INTERN MED 23, 1688–1692 (2008). https://doi.org/10.1007/s11606-008-0712-z

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  • DOI: https://doi.org/10.1007/s11606-008-0712-z

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