Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis
Aim To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort. Methods A database search of EBSCO Megafile Premier, Embase and The Co...
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| Veröffentlicht in: | Diabetic medicine 2021-02, Vol.38 (2), p.e14379-n/a |
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| creator | Chuter, V. H. Searle, A. Barwick, A. Golledge, J. Leigh, L. Oldmeadow, C. Peterson, B. Tehan, P. Twigg, S. M. |
| description | Aim
To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort.
Methods
A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta‐analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed.
Results
Thirty‐three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P |
| doi_str_mv | 10.1111/dme.14379 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2430101146</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2482083595</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-ef67e9db61b8c3f19a485f83da3cc9e76d7030a3a06e386c890716e8743ef77a3</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxi1ERbeFAy-ALHGhh7R27MQ2t6osBamIC5wjx550XfIP22HJrY-AxKvwRH2SOrulByR8sT3zm29G8yH0kpJTms6Z7eCUcibUE7SivORZwRV9ilZE8DxjRNBDdBTCDSE0V0w9Q4csF5woSVbozzpE1-no-mscN4Ct09f9kGIGa2Mmr82Mh2aX0v23Fu5uf9cpuHG6xaOHECYP2PUWfuJm8NhCBLMTG8G7cQM-cdrH9EkP6wLosPApPYwt4K2Lm6VnnerCW3yOwxwiLPMY7OGHg21qa3EHUd_d_tK9bufgwnN00Og2wIuH-xh9fb_-cvEhu_p8-fHi_CozrGAqg6YUoGxd0loa1lCluSwayaxmxigQpRWEEc00KYHJ0kiVVlWCFJxBI4Rmx-jNXnf0w_cJQqw6Fwy0re5hmEKVc0YooWnlCX39D3ozTD7Nu1AyJ5IVqkjUyZ4yfgjBQ1ONPm3fzxUl1WJllaysdlYm9tWD4lR3YB_Jv94l4GwPbF0L8_-Vqnef1nvJe00ErZY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2482083595</pqid></control><display><type>article</type><title>Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Chuter, V. H. ; Searle, A. ; Barwick, A. ; Golledge, J. ; Leigh, L. ; Oldmeadow, C. ; Peterson, B. ; Tehan, P. ; Twigg, S. M.</creator><creatorcontrib>Chuter, V. H. ; Searle, A. ; Barwick, A. ; Golledge, J. ; Leigh, L. ; Oldmeadow, C. ; Peterson, B. ; Tehan, P. ; Twigg, S. M.</creatorcontrib><description>Aim
To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort.
Methods
A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta‐analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed.
Results
Thirty‐three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72.
Conclusions
These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.14379</identifier><identifier>PMID: 32740980</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Accuracy ; Angiography ; Ankle ; Ankle Brachial Index ; Diabetes ; Diabetes Complications - diagnosis ; Diabetes Complications - etiology ; Diabetes Complications - physiopathology ; Diabetes mellitus ; Diabetes Mellitus - physiopathology ; Humans ; Medical diagnosis ; Medical imaging ; Meta-analysis ; Peripheral Arterial Disease - complications ; Peripheral Arterial Disease - diagnosis ; Peripheral Arterial Disease - physiopathology ; Sensitivity and Specificity ; Ultrasonography, Doppler, Color ; Ultrasound ; Vascular diseases</subject><ispartof>Diabetic medicine, 2021-02, Vol.38 (2), p.e14379-n/a</ispartof><rights>2020 Diabetes UK</rights><rights>2020 Diabetes UK.</rights><rights>Diabetic Medicine © 2021 Diabetes UK</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-ef67e9db61b8c3f19a485f83da3cc9e76d7030a3a06e386c890716e8743ef77a3</citedby><cites>FETCH-LOGICAL-c3539-ef67e9db61b8c3f19a485f83da3cc9e76d7030a3a06e386c890716e8743ef77a3</cites><orcidid>0000-0002-4830-288X ; 0000-0002-5779-8848 ; 0000-0002-2681-8201 ; 0000-0002-0014-3023 ; 0000-0003-4793-5340</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.14379$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.14379$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32740980$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chuter, V. H.</creatorcontrib><creatorcontrib>Searle, A.</creatorcontrib><creatorcontrib>Barwick, A.</creatorcontrib><creatorcontrib>Golledge, J.</creatorcontrib><creatorcontrib>Leigh, L.</creatorcontrib><creatorcontrib>Oldmeadow, C.</creatorcontrib><creatorcontrib>Peterson, B.</creatorcontrib><creatorcontrib>Tehan, P.</creatorcontrib><creatorcontrib>Twigg, S. M.</creatorcontrib><title>Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>Aim
To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort.
Methods
A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta‐analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed.
Results
Thirty‐three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72.
Conclusions
These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort.</description><subject>Accuracy</subject><subject>Angiography</subject><subject>Ankle</subject><subject>Ankle Brachial Index</subject><subject>Diabetes</subject><subject>Diabetes Complications - diagnosis</subject><subject>Diabetes Complications - etiology</subject><subject>Diabetes Complications - physiopathology</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - physiopathology</subject><subject>Humans</subject><subject>Medical diagnosis</subject><subject>Medical imaging</subject><subject>Meta-analysis</subject><subject>Peripheral Arterial Disease - complications</subject><subject>Peripheral Arterial Disease - diagnosis</subject><subject>Peripheral Arterial Disease - physiopathology</subject><subject>Sensitivity and Specificity</subject><subject>Ultrasonography, Doppler, Color</subject><subject>Ultrasound</subject><subject>Vascular diseases</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQxi1ERbeFAy-ALHGhh7R27MQ2t6osBamIC5wjx550XfIP22HJrY-AxKvwRH2SOrulByR8sT3zm29G8yH0kpJTms6Z7eCUcibUE7SivORZwRV9ilZE8DxjRNBDdBTCDSE0V0w9Q4csF5woSVbozzpE1-no-mscN4Ct09f9kGIGa2Mmr82Mh2aX0v23Fu5uf9cpuHG6xaOHECYP2PUWfuJm8NhCBLMTG8G7cQM-cdrH9EkP6wLosPApPYwt4K2Lm6VnnerCW3yOwxwiLPMY7OGHg21qa3EHUd_d_tK9bufgwnN00Og2wIuH-xh9fb_-cvEhu_p8-fHi_CozrGAqg6YUoGxd0loa1lCluSwayaxmxigQpRWEEc00KYHJ0kiVVlWCFJxBI4Rmx-jNXnf0w_cJQqw6Fwy0re5hmEKVc0YooWnlCX39D3ozTD7Nu1AyJ5IVqkjUyZ4yfgjBQ1ONPm3fzxUl1WJllaysdlYm9tWD4lR3YB_Jv94l4GwPbF0L8_-Vqnef1nvJe00ErZY</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Chuter, V. H.</creator><creator>Searle, A.</creator><creator>Barwick, A.</creator><creator>Golledge, J.</creator><creator>Leigh, L.</creator><creator>Oldmeadow, C.</creator><creator>Peterson, B.</creator><creator>Tehan, P.</creator><creator>Twigg, S. M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4830-288X</orcidid><orcidid>https://orcid.org/0000-0002-5779-8848</orcidid><orcidid>https://orcid.org/0000-0002-2681-8201</orcidid><orcidid>https://orcid.org/0000-0002-0014-3023</orcidid><orcidid>https://orcid.org/0000-0003-4793-5340</orcidid></search><sort><creationdate>202102</creationdate><title>Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis</title><author>Chuter, V. H. ; Searle, A. ; Barwick, A. ; Golledge, J. ; Leigh, L. ; Oldmeadow, C. ; Peterson, B. ; Tehan, P. ; Twigg, S. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-ef67e9db61b8c3f19a485f83da3cc9e76d7030a3a06e386c890716e8743ef77a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Accuracy</topic><topic>Angiography</topic><topic>Ankle</topic><topic>Ankle Brachial Index</topic><topic>Diabetes</topic><topic>Diabetes Complications - diagnosis</topic><topic>Diabetes Complications - etiology</topic><topic>Diabetes Complications - physiopathology</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - physiopathology</topic><topic>Humans</topic><topic>Medical diagnosis</topic><topic>Medical imaging</topic><topic>Meta-analysis</topic><topic>Peripheral Arterial Disease - complications</topic><topic>Peripheral Arterial Disease - diagnosis</topic><topic>Peripheral Arterial Disease - physiopathology</topic><topic>Sensitivity and Specificity</topic><topic>Ultrasonography, Doppler, Color</topic><topic>Ultrasound</topic><topic>Vascular diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chuter, V. H.</creatorcontrib><creatorcontrib>Searle, A.</creatorcontrib><creatorcontrib>Barwick, A.</creatorcontrib><creatorcontrib>Golledge, J.</creatorcontrib><creatorcontrib>Leigh, L.</creatorcontrib><creatorcontrib>Oldmeadow, C.</creatorcontrib><creatorcontrib>Peterson, B.</creatorcontrib><creatorcontrib>Tehan, P.</creatorcontrib><creatorcontrib>Twigg, S. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chuter, V. H.</au><au>Searle, A.</au><au>Barwick, A.</au><au>Golledge, J.</au><au>Leigh, L.</au><au>Oldmeadow, C.</au><au>Peterson, B.</au><au>Tehan, P.</au><au>Twigg, S. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2021-02</date><risdate>2021</risdate><volume>38</volume><issue>2</issue><spage>e14379</spage><epage>n/a</epage><pages>e14379-n/a</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>Aim
To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort.
Methods
A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta‐analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed.
Results
Thirty‐three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72.
Conclusions
These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32740980</pmid><doi>10.1111/dme.14379</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0002-4830-288X</orcidid><orcidid>https://orcid.org/0000-0002-5779-8848</orcidid><orcidid>https://orcid.org/0000-0002-2681-8201</orcidid><orcidid>https://orcid.org/0000-0002-0014-3023</orcidid><orcidid>https://orcid.org/0000-0003-4793-5340</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Accuracy Angiography Ankle Ankle Brachial Index Diabetes Diabetes Complications - diagnosis Diabetes Complications - etiology Diabetes Complications - physiopathology Diabetes mellitus Diabetes Mellitus - physiopathology Humans Medical diagnosis Medical imaging Meta-analysis Peripheral Arterial Disease - complications Peripheral Arterial Disease - diagnosis Peripheral Arterial Disease - physiopathology Sensitivity and Specificity Ultrasonography, Doppler, Color Ultrasound Vascular diseases |
| title | Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis |
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