How can new diagnostic methods contribute in healthcare? What are doctors looking for? Better support in their clinical decision makings, which includes: o more accurate diagnosis o reliable prognostic estimation o tools for therapy stratification and monitoring Rapid answers to the patient in order to: o reduce the need for later reevaluation of the patient o provide 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 99 th percentile URL 99 th percentile <60 y

ULSAM-study U ppsala L ongitudinal S tudy of A dult M en All men in Uppsala born between 1920 and 1924 All 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

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 treatmentFalse 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 treatmentFalse 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) NT-proBNP, ng/L % Death

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 S-HNL Specificity Sensitivity Discrimination between acute bacterial and viral infections Hospitalized adult population Highest diagnostic accuracy in left 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 care since it provides the doctor with: Some conclusions  more accurate diagnosis  more reliable prognostic estimation  better tools for therapy stratification and monitoring All for the benefit of our patients and the society