一种用于识别维生素D缺乏症老年社区居民的临床诊断工具的推导与验证

Derivation and validation of a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D.

作者信息

Annweiler Cedric, Kabeshova Anastasiia, Legeay Mathilde, Fantino Bruno, Beauchet Olivier

机构信息

Division of Geriatric Medicine and Memory Clinic, Department of Neuroscience, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.

Division of Geriatric Medicine and Memory Clinic, Department of Neuroscience, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.

出版信息

J Am Med Dir Assoc. 2015 Jun 1;16(6):536.e8-19. doi: 10.1016/j.jamda.2015.03.008. Epub 2015 Apr 24.

DOI:10.1016/j.jamda.2015.03.008

PMID:25922119

Abstract

OBJECTIVES

Hypovitaminosis D is highly prevalent among seniors. Although evidence is insufficient to recommend routine vitamin D screening in seniors, universal vitamin D supplementation is not desirable either. To rationalize vitamin D determination, our objective was to elaborate and test a clinical diagnostic tool for the identification of seniors with hypovitaminosis D without using a blood test.

DESIGN

Derivation of a clinical diagnostic tool using artificial neural networks (multilayer perceptron; MLP) in randomized training subgroup of Prévention des Chutes, Réseau 4' cohort, and validation in randomized testing subgroup.

SETTING

Health Examination Centers of health insurance, Lyon, France.

PARTICIPANTS

A total of 1924 community-dwellers aged ≥ 65 years without vitamin D supplements, consecutively recruited between 2009 and 2012.

MEASUREMENTS

Hypovitaminosis D defined as serum 25-hydroxyvitamin (25OHD) concentration ≤ 75 nmol/L, ≤ 50 nmol/L, or ≤ 25 nmol/L. A set of clinical variables (age, gender, living alone, individual deprivation, body mass index, undernutrition, polymorbidity, number of drugs used daily, psychoactive drugs, biphosphonates, strontium, calcium supplements, falls, fear of falling, vertebral fractures, Timed Up and Go, walking aids, lower-limb proprioception, handgrip strength, visual acuity, wearing glasses, cognitive disorders, sad mood) were recorded. Several MLPs, based on varying amounts of variables according to their relative importance, were tested consecutively.

RESULTS

A total of 1729 participants (89.9%) had 25OHD ≤ 75 nmol/L, 1288 (66.9%) had 25OHD ≤ 50 nmol/L, and 525 (27.2%) had 25OHD ≤ 25 nmol/L. MLP using 16 clinical variables was able to diagnose hypovitaminosis D ≤ 75 nmol/L with accuracy = 96.3%, area under curve (AUC) = 0.938, and κ = 79.3 indicating almost perfect agreement. It was also able to diagnose hypovitaminosis D ≤ 50 nmol/L with accuracy = 81.5, AUC = 0.867, and κ = 57.8 (moderate agreement); and hypovitaminosis D ≤ 25 nmol/L with accuracy = 82.5, AUC = 0.385, and κ = 55.0 (moderate agreement).

CONCLUSIONS

We elaborated an algorithm able to identify, from 16 clinical variables, seniors with hypovitaminosis D.

摘要

目的

维生素D缺乏症在老年人中非常普遍。尽管证据不足以推荐对老年人进行常规维生素D筛查，但普遍补充维生素D也不可取。为了使维生素D检测合理化，我们的目标是精心设计并测试一种无需血液检测即可识别维生素D缺乏症老年人的临床诊断工具。

设计

在预防跌倒网络4队列的随机训练亚组中使用人工神经网络（多层感知器；MLP）推导临床诊断工具，并在随机测试亚组中进行验证。

地点

法国里昂医疗保险健康检查中心。

参与者

2009年至2012年期间连续招募的1924名年龄≥65岁且未补充维生素D的社区居民。

测量

维生素D缺乏症定义为血清25-羟基维生素（25OHD）浓度≤75 nmol/L、≤50 nmol/L或≤25 nmol/L。记录一组临床变量（年龄、性别、独居、个人贫困程度、体重指数、营养不良、多种疾病、每日用药数量、精神活性药物、双膦酸盐、锶、钙补充剂、跌倒、跌倒恐惧、椎体骨折、定时起立行走测试、助行器、下肢本体感觉、握力、视力、戴眼镜情况、认知障碍、情绪低落）。根据变量的相对重要性，连续测试了几个基于不同数量变量的MLP。

结果

共有1729名参与者（89.9%）的25OHD≤75 nmol/L，1288名（66.9%）的25OHD≤50 nmol/L，525名（27.2%）的25OHD≤25 nmol/L。使用16个临床变量的MLP能够诊断25OHD≤75 nmol/L的维生素D缺乏症，准确率=96.3%，曲线下面积（AUC）=0.938，κ=79.3，表明几乎完全一致。它还能够诊断25OHD≤50 nmol/L的维生素D缺乏症，准确率=81.5，AUC=0.867，κ=57.8（中度一致）；以及25OHD≤25 nmol/L的维生素D缺乏症，准确率=82.5，AUC=0.385，κ=55.0（中度一致）。