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In a recent prospective study in Germany, the sensitivity and specificity were 31% and 98%, respectively, when the cut-off was less than 15, and they suggested 23 as a cut-off to increase sensitivity [335]

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Prior to metabolism in the mitochondria, the acetyl group is transferred to coenzyme A (CoA) to form acetyl-CoA, which enters the TCA cycle to generate ATP through oxidative phosphorylation