Beruflich Dokumente
Kultur Dokumente
Original Article
Abstract
Editorial Viewpoint
Introduction
Post-Graduate Trainee, Madurai Medical College, Madurai, Tamil Nadu; 2Post-Graduate Trainee, All India Institute
of Medical Sciences, New Delhi; 3Assistant Professor, Department of Community Medicine, Velammal Medical
College Hospital & Research Institute, Madurai, Tamil Nadu
Received: 25.06.2015; Revised: 21.07.2015; Accepted: 23.10.2015
39
Instruments
Information on patient
demographics, duration of diabetes
and smoking history was collected
using a semi-structured, pre-tested
questionnaire. A comprehensive
physical examination was done
along with medical record
analysis to check for presence of
comorbidities. Patients medical
r e c o r d s we r e u s e d t o c o n f i r m
the presence of Coronary Heart
Disease (CHD), Cerebrovascular
40
Patients found
eligible = 138
Refusal = 18
Total patients
included = 120
Age grp
(years)
Sex
5 (18.5)
22 (81.5)
5 (18.5)
10 (10.8)
67 (72.0)
26 (28.0)
5 (18.5)
55 (59.1)
22 (81.5)
20 (74.1)
18 (66.7)
38 (40.9)
29 (31.2)
37 (39.8)
Cerebrovascular dis.
4 (14.8)
6 (6.5)
Hypertension
22 (81.5)
55 (59.1)
Results
A total of 412 diabetic patients
were screened and 138 were found
eligible for inclusion. Eighteen
patients (13%) refused to participate
and finally a total of 120 patients
(against a calculated sample size of
122) with type 2 diabetes mellitus
were included in the study (Figure
1). Main reason for refusal was lack
of time to stay for the tests. The
prevalence of PVD in the sample
was 22.5% (95% CI: 15.9, 30.8).
Comparison of baseline parameters
showed that the PVD group, as
compared to non-PVD patients,
had a higher proportion of elderly
patients (18.5% vs. 10.8%), males
(81.5% vs. 72%), smokers (74.1%
vs. 31.2%), long-standing diabetics
(81.5% vs. 40.9%) and comorbidities
(Table 1).
The sensitivity and specificity
of pulse oximetry were 74.1% (95%
CI: 55.3, 86.8) and 95.7% (89.4,
98.3) respectively, while those
of ABI were 70.3% (51.5, 84.2)
and 87.1 (78.8, 92.5) respectively.
The PPV and NPV for pulse
oximetry were 83.3% (64.1, 93.3)
and 92.7% (85.7, 96.4) respectively
a n d t h o s e f o r A B I we r e 6 1 . 3 %
(43.8, 76.3) and 91.0% (83.3, 95.4)
41
Table 2: Sensitivity, specificity and predictive values of pulse oximetry and ABI with duplex ultrasonography as reference
standard
Index test
Pulse oximetry
Positive
Negative
20
7
4
89
Positive
Negative
19
8
12
81
Positive
Negative
Total
21
6
27
13
80
93
ABI
Combination
(parallel testing)
Sensitivity
% (95% CI)
Specificity
% (95% CI)
PPV
% (95% CI)
NPV
% (95% CI)
Table 3: Subgroup analysis of sensitivity, specificity and predictive values of pulse oximetry by selected covariates
Index
test
Validity
measure
Age
% (95% CI)
<55 years 55 years
Pulse
Sensitivity
66.6
80.0
oximetry
(35.4,
(51.3,
88.7)
94.6)
Specificity
94.9
97.0
(84.9,
(82.9,
99.8)
98.6)
PPV
72.7
92.3
(39.3,
(62.0,
92.6)
99.5)
NPV
93.3
91.6
(82.9,
(76.4,
97.8)
97.8)
Sex
Diabetes duration
% (95% CI)
% (95% CI)
Male
Female <10 years 10 years
72.7
80.0
60.0
77.2
(49.5,
(29.8,
(17.0,
(54.1,
88.3)
98.9)
92.7)
91.3)
94.7
95.5
96.1
96.3
(78.4,
(86.3,
(80.9,
(86.6,
98.8)
99.7)
99.3)
99.0)
60.0
89.4
84.2
80.0
(65.4,
(59.5,
(29.8,
(17.0,
98.9)
92.7)
98.1)
95.8)
91.4
96.1
96.3
87.8
(81.6,
(78.4,
(86.3,
(72.9,
96.4)
99.7)
99.3)
95.4)
Current smoker
% (95% CI)
Yes
No
70.0
85.7
(45.6,
(42.0,
87.1)
99.2)
96.5
95.3
(80.3,
(86.0,
99.8)
98.7)
66.6
93.3
(66.0,
(30.9,
99.6)
90.9)
82.3
98.3
(64.8,
(90.1,
92.6)
99.9)
CHD
% (95% CI)
Present Absent
77.7
66.6
(51.9,
(30.9,
92.6)
90.0)
97.2
94.6
(84.1,
(84.1,
98.6)
99.8)
93.3
66.6
(66.0,
(30.9,
99.6)
90.0)
90.0
94.6
(75.4,
(84.1,
96.7)
98.6)
Hypertension
% (95% CI)
Present Absent
72.7
80.0
(49.5,
(29.8,
88.3)
98.9)
98.1
92.1
(77.5,
(89.0,
99.9)
97.9)
94.1
57.1
(69.2,
(20.2,
88.1)
99.6)
90.0
97.2
(78.8,
(83.7,
95.8)
99.8)
Table 4: Subgroup analysis of sensitivity, specificity and predictive values of ABI by selected covariates
Index
test
ABI
Validity
measure
Age
% (95% CI)
<55 years 55 years
Sensitivity
66.6
73.3
(35.4,
(44.8,
88.7)
91.0)
Specificity
84.7
91.1
(72.5,
(75.1,
92.3)
97.6)
PPV
47.0
78.5
(23.8,
(48.8,
71.4)
94.2)
NPV
92.5
88.5
(81.2,
(72.3,
97.6)
96.2)
Sex
Diabetes duration
% (95% CI)
% (95% CI)
Male
Female <10 years 10 years
68.1
80.0
60.0
72.7
(45.1,
(29.8,
(17.0,
(49.5,
85.2)
98.9)
92.7)
88.3)
78.9
89.5
80.7
92.7
(60.0,
(81.5,
(62.2,
(79.0,
95.3)
92.6)
97.6)
89.8)
42.8
66.6
68.1
44.4
(44.6,
(45.1,
(15.3,
(11.8,
85.2)
77.3)
79.7)
83.5)
89.5
95.4
96.2
83.3
(79.0,
(75.1,
(85.9,
(66.5,
95.3)
99.7)
99.3)
93.0)
Current smoker
% (95% CI)
Yes
No
65.0
85.7
(40.9,
(42.0,
83.6)
99.2)
75.8
92.1
(56.0,
(81.9,
88.9)
97.0)
65.0
54.5
(40.9,
(24.5,
83.6)
81.8)
75.8
98.3
(56.0,
(89.8,
88.9)
99.9)
CHD
% (95% CI)
Present Absent
72.2
66.6
(46.4,
(30.9,
89.2)
90.9)
81.0
91.0
(64.2,
(79.6,
96.9)
91.4)
65.0
54.5
(40.9,
(24.5,
83.6)
81.8)
85.7
94.4
(68.9,
(83.6,
94.6)
98.5)
Hypertension
% (95% CI)
Present Absent
68.1
80.0
(45.1,
(29.8,
85.2)
98.9)
90.9
81.5
(79.2,
(65.1,
96.6)
91.6)
75.0
36.3
(50.5,
(12.3
,68.3)
90.4)
87.7
96.8
(75.7,
(82.0,
94.5)
99.8)
Discussion
We found that PVD was fairly
prevalent among the diabetics
included in this study. A few
community-based studies have
reported a lower prevalence
ranging from about 6% to 8%. 4,5
This could be due to the fact that
the study sample came from a
42
Table 5: Subgroup analysis of sensitivity, specificity and predictive values of combination of pulse oximetry and ABI by selected
covariates
Index test
Validity
measure
Age
% (95% CI)
<55 years 55 years
Combination Sensitivity
88.8
94.7
(parallel
(82.1,
(89.4,
testing)
94.1)
98.1)
Specificity
80.4
88.4
(71.7,
(81.2,
86.7)
93.4)
Sex
Diabetes duration
% (95% CI)
% (95% CI)
Male
Female <10 years 10 years
91.2
96.0
84.0
93.8
(84.1,
(90.5,
(76.3,
(88.3,
95.3)
98.6)
90.1)
97.6)
77.6
89.3
74.7
85.5
(78.2,
(68.9,
(82.1,
(66.0,
91.5)
84.6)
94.1)
82.4)
Current smoker
% (95% CI)
Yes
No
89.5
98.0
(82.1,
(94.1,
94.1)
99.7)
73.2
87.8
(64.4,
(80.2,
80.9)
92.8)
CHD
% (95% CI)
Present Absent
93.8
88.8
(88.3,
(82.1,
97.6)
94.1)
78.7
86.1
(78.2,
(69.8,
85.3)
91.5)
Hypertension
% (95% CI)
Present Absent
91.2
96.0
(84.1,
(90.5,
95.3)
98.6)
89.2
75.1
(82.1,
(66.2,
94.1)
82.4)
References
2.
Research Ethics
5.
6.
Conclusion
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1988; 17:248254.
8.
9.
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