Background and aims: We recently validated the questionnaire Composite Autonomic Symptom Score (COMPASS) 31 for autonomic symptoms of diabetic neuropathy. In a wider population from the same diabetes centre, we aimed to further investigate the diagnostic performance of different autonomic symptoms (i.e., orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor domains of COMPASS 31) for diabetic cardiovascular autonomic neuropathy (CAN) and diabetic polyneuropathy (DPN). Materials and methods: A total of 93 participants with diabetes (age 54±14 years, diabetes duration 13±10 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular reflex tests and assessment of neuropathic symptoms (using the Michigan Neuropathy Screening Instrument Questionnaire), signs (using the Michigan Diabetic Neuropathy Score), vibration, and thermal thresholds. Results: As expected, the COMPASS 31 total weighted score was higher in the presence of CAN (26.7±19.5 Vs. 12.5±14.3; P=0.0044) and DPN (26.9±17.8 Vs. 12.5±11.3; P=0.0000). Among the 6 domains of COMPASS 31, the highest differences were seen in gastrointestinal (P=0.0004) and orthostatic intolerance weighted scores (P=0.0188) according to the presence of CAN, and in secretomotor (P=0.0000), gastrointestinal (P=0.0000), pupillomotor (P=0.0001), and orthostatic intolerance weighted scores (P=0.0005) according to the presence of DPN. Receiver-operating curve analysis confirmed a fair diagnostic accuracy of total weighted score for CAN [area under the curve (AUC) 0.685±0.067, 95% CI 0.583-0.782] and DPN (AUC: 0.755±0.050, 95% CI 0.652-0.836). Among the six COMPASS 31 domains, a fair diagnostic accuracy for CAN was reached only by gastrointestinal domain (AUC: 0.728±0.066, 95% CI 0.630-0.821), whereas it was achieved for DPN by secretomotor (AUC: 0.758±0.050, 95% CI 0.652-0.836), gastrointestinal (AUC: 0.728±0.066, 95% CI 0.630-0.821) and pupillomotor domains (AUC: 0.705±0.056, 95% CI 0.606-0.799). Secretomotor weighted score at the cut-off of 4.28 had a sensitivity of 61.5% (95% CI 46.3-76.8) and a specificity of 81.5% (95% CI 71.1-91.8) for DPN. Vasomotor and bladder domains showed the worst diagnostic performance. Conclusion: Among autonomic symptoms as assessed using COMPASS 31, the best diagnostic performances were provided by the secremotor domain (exploring sweating changes, dry eyes and dry mouth) for DPN and by the gastrointestinal domain for both CAN and DPN. These findings expand previous observations, give insights into the relationship between autonomic and sensorimotor neuropathy, and further support the inclusion of COMPASS 31 in a comprehensive evaluation of diabetic neuropathy.
Greco, C., D'Amato, C., Di Gennaro, F., Sun, A., Lombardo, G., Campo, M., et al. (2017). Diagnostic value of different autonomic symptoms assessed by COMPASS 31 for cardiovascular autonomic neuropathy and diabetic polyneuropathy. ??????? it.cilea.surplus.oa.citation.tipologie.CitationProceedings.prensentedAt ??????? 53rd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Lisbon, Portugal.
Diagnostic value of different autonomic symptoms assessed by COMPASS 31 for cardiovascular autonomic neuropathy and diabetic polyneuropathy
D'AMATO, CINZIA;LAURO, DAVIDE;SPALLONE, VINCENZA
2017-09-01
Abstract
Background and aims: We recently validated the questionnaire Composite Autonomic Symptom Score (COMPASS) 31 for autonomic symptoms of diabetic neuropathy. In a wider population from the same diabetes centre, we aimed to further investigate the diagnostic performance of different autonomic symptoms (i.e., orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor domains of COMPASS 31) for diabetic cardiovascular autonomic neuropathy (CAN) and diabetic polyneuropathy (DPN). Materials and methods: A total of 93 participants with diabetes (age 54±14 years, diabetes duration 13±10 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular reflex tests and assessment of neuropathic symptoms (using the Michigan Neuropathy Screening Instrument Questionnaire), signs (using the Michigan Diabetic Neuropathy Score), vibration, and thermal thresholds. Results: As expected, the COMPASS 31 total weighted score was higher in the presence of CAN (26.7±19.5 Vs. 12.5±14.3; P=0.0044) and DPN (26.9±17.8 Vs. 12.5±11.3; P=0.0000). Among the 6 domains of COMPASS 31, the highest differences were seen in gastrointestinal (P=0.0004) and orthostatic intolerance weighted scores (P=0.0188) according to the presence of CAN, and in secretomotor (P=0.0000), gastrointestinal (P=0.0000), pupillomotor (P=0.0001), and orthostatic intolerance weighted scores (P=0.0005) according to the presence of DPN. Receiver-operating curve analysis confirmed a fair diagnostic accuracy of total weighted score for CAN [area under the curve (AUC) 0.685±0.067, 95% CI 0.583-0.782] and DPN (AUC: 0.755±0.050, 95% CI 0.652-0.836). Among the six COMPASS 31 domains, a fair diagnostic accuracy for CAN was reached only by gastrointestinal domain (AUC: 0.728±0.066, 95% CI 0.630-0.821), whereas it was achieved for DPN by secretomotor (AUC: 0.758±0.050, 95% CI 0.652-0.836), gastrointestinal (AUC: 0.728±0.066, 95% CI 0.630-0.821) and pupillomotor domains (AUC: 0.705±0.056, 95% CI 0.606-0.799). Secretomotor weighted score at the cut-off of 4.28 had a sensitivity of 61.5% (95% CI 46.3-76.8) and a specificity of 81.5% (95% CI 71.1-91.8) for DPN. Vasomotor and bladder domains showed the worst diagnostic performance. Conclusion: Among autonomic symptoms as assessed using COMPASS 31, the best diagnostic performances were provided by the secremotor domain (exploring sweating changes, dry eyes and dry mouth) for DPN and by the gastrointestinal domain for both CAN and DPN. These findings expand previous observations, give insights into the relationship between autonomic and sensorimotor neuropathy, and further support the inclusion of COMPASS 31 in a comprehensive evaluation of diabetic neuropathy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
