Accuracy of ankle-brachial index in screening for peripheral arterial disease in people with diabetes

• Published in: PloS one Vol. 19; no. 10; p. e0309083
• Main Authors: Cerqueira, Monique Magnavita Borba da Fonseca, Bastos, Neiva Sueli Santana Gonçalves, Silva, Dandara Almeida Reis da, Gregori, Dario, Magalhães, Lucélia Batista Neves Cunha, Pimentel, Magno Merces Weyll
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.10.2024
• Subjects: Accuracy; Aged; Aged, 80 and over; Amputation; Ankle; Ankle Brachial Index; Asymptomatic; Atherosclerosis; Biology and Life Sciences; Blood pressure; Calcification; Cardiovascular disease; Care and treatment; Diabetes; Diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - physiopathology; Diabetics; Diagnosis; Diagnostic systems; Evidence-based medicine; Female; Foot diseases; Humans; Hypertension; Infections; Ischemia; Kidney diseases; Likelihood ratio; Male; Mass Screening - methods; Measurement; Medicine and Health Sciences; Methods; Middle Aged; Morphology; Mortality; Normal distribution; Observational studies; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnosis; Peripheral neuropathy; Peripheral vascular diseases; Population; Risk factors; Risk groups; Sensitivity analysis; Sensitivity and Specificity; Ultrasonic imaging; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0309083

Although the ankle-brachial index (ABI) presents overall satisfactory accuracy, its sensitivity in the context of screening strategies does not ensure the detection of all individuals with peripheral arterial disease (PAD), especially in clinical situations where there is calcification of the arterial media layer. This study evaluated the accuracy of ABI in screening PAD among individuals with diabetes mellitus (DM) in a community setting. An observational study included only individuals with DM. ABI measurement was performed, and the lower limb duplex ultrasound (DU) was used as the reference standard for PAD diagnosis. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) of ABI were assessed. The analysis included 194 limbs from 99 participants, with a PAD prevalence identified by DU of 15.98%. ABI demonstrated an accuracy of 87.63%, with a sensitivity of 35.48%, specificity of 97.55%, PPV of 73.33%, NPV of 89.83%, LR+ of 14.46, and LR- of 0.66. ABI showed high specificity but limited sensitivity in detecting PAD among individuals with DM in a community setting. An LR- of 0.66 suggests that a normal ABI result reduces but does not eliminate the possibility of PAD, highlighting the importance of complementary diagnostic approaches to enhance accuracy in identifying PAD in high-risk patients, such as those with DM. Incorporating additional diagnostic methods may be necessary to improve the effectiveness of PAD screening in this group.