Diagnostic Accuracy of Morning Salivary Cortisol in the Assessment of the Hypothalamic-Pituitary-Adrenal Axis Recovery after Prolonged Corticosteroid Therapy in Children
Authors' conclusion
The present study supports that mSAF ≥5.0 nmol/L by ECLIA is a non-invasive biomarker for the assessment of HPA recovery after prolonged glucocorticoid therapy in paediatric patients, with a positive predictive value of 97%. This proposed cut-off should be further validated using gold standard techniques for steroid quantification such as liquid chromatography-tandem mass spectrometry.
Study context
- Population
- Paediatric patients (mean ± SD age 13.0 ± 4.4 years) who received glucocorticoids for >4 weeks (median 11 [7–14] months), referred for therapy withdrawal; samples 8–9 a.m., 48 h after cessation
- Participants
- 171 patients
- Comparison
- mSAF vs serum cortisol ≥193 nmol/L
- Outcome
- Diagnostic accuracy of mSAF to determine HPA recovery after prolonged corticosteroid therapy
Methodological detailsprospective, validation study
- Prospective
- Validation study
Performance
As reported in the abstract
Diagnostic accuracy of mSAF for HPA recovery vs serum cortisol reference · 48 h after cessation of glucocorticoid therapy
- ROC cut-off for mSAF
- ≥5.0 nmol/L
- True positives
- 85/171
- True negatives
- 40/171
- False positives
- 3/171, 1.7%
- False negatives
- 43/171 (25%)
- AUC
- 0.98 (0.96-0.99) (95% CI)
- Sensitivity
- 0.66 (0.57-0.75) (95% CI)
- Specificity
- 0.93 (0.81-0.99) (95% CI)
- PPV
- 0.97 (0.90-0.99) (95% CI)
- NPV
- 0.48 (0.37-0.59) (95% CI)
- LR+
- 9.5
- Diagnostic accuracy
- 73.1%
Original publication
Diagnostic Accuracy of Morning Salivary Cortisol in the Assessment of the Hypothalamic-Pituitary-Adrenal Axis Recovery after Prolonged Corticosteroid Therapy in Children. Horm Res Paediatr. Published 3 May 2023. doi:10.
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