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Area under the viraemia curve versus absolute viral load: Utility for predicting symptomatic cytomegalovirus infections in kidney transplant patients
Author(s) -
Schäfer Peter,
Tenschert Werner,
Cremaschi Liana,
Schröter Matthias,
Zöllner Bernhard,
Laufs Rainer
Publication year - 2001
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.2005
Subject(s) - asymptomatic , cytomegalovirus , viral load , human cytomegalovirus , area under the curve , betaherpesvirinae , medicine , viral disease , viremia , virology , receiver operating characteristic , real time polymerase chain reaction , immunology , virus , gastroenterology , herpesviridae , biology , gene , biochemistry
A novel approach to predicting symptomatic cytomegalovirus (CMV) infections combines the level and the duration of viraemia in a single parameter. Sixty‐four kidney transplant recipients were monitored by quantitative shell vial culture, pp65 antigenaemia, and polymerase chain reaction (PCR) of leucocytes. The area under the curve (AUC) of each parameter was determined from the onset of viraemia to the beginning of antiviral treatment. The AUC values were significantly higher in symptomatic than in asymptomatic patients. For antigenaemia and PCR, optimal AUC thresholds for predicting symptomatic CMV infections were determined. They were superior to standard cutoff levels of absolute viral load in sensitivity, specificity, and positive and negative predictive value. In 8 of the 23 patients who became symptomatic, impending clinical features were indicated earlier by the AUC thresholds than by standard viral load. In conclusion, the concept of the AUC should facilitate identification of patients at risk of symptomatic CMV infection. J. Med. Virol. 65:85–89, 2001. © 2001 Wiley‐Liss, Inc.