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[Likelihood ratio and ROC curve in evaluation of iron parameters for diagnosing iron deficiency]
1Department of Hematology, Huashan Hospital, Shanghai Medical University, Shanghai 200040.
Insights
Soluble transferrin receptor (sTfR) is the most effective biomarker for diagnosing iron deficiency (ID) in patients with chronic diseases. This study highlights sTfR
Area of Science:
- Hematology
- Clinical Chemistry
Context:
- Iron deficiency (ID) diagnosis can be challenging, particularly in patients with anemia of chronic diseases (ACD).
- Accurate diagnosis of ID is crucial for effective treatment and management of anemia.
- Bone marrow iron staining serves as the gold standard for assessing iron stores.
Purpose:
- To evaluate the diagnostic performance of various iron parameters for identifying iron deficiency.
- To compare the efficacy of soluble transferrin receptor (sTfR) against serum ferritin (SF) and other markers in diagnosing ID.
- To assess the utility of Receiver Operating Characteristic (ROC) curves and Likelihood Ratios (LR) in evaluating diagnostic tests.
Summary:
- A cross-sectional study compared diagnostic tests for iron deficiency in 90 anemic patients, including those with and without chronic diseases.
- Soluble transferrin receptor (sTfR) demonstrated superior diagnostic accuracy (AUCROC 0.90-0.96) compared to serum ferritin (SF) (AUCROC 0.77-0.94) and other iron parameters (AUCROC < 0.70) in identifying iron deficiency, especially in chronic disease settings.
- ROC analysis and LR were confirmed as valuable tools for assessing iron parameters.
Impact:
- Identifies sTfR as a superior biomarker for diagnosing iron deficiency in complex patient populations with chronic diseases.
- Provides evidence-based recommendations for selecting optimal diagnostic tools in clinical practice.
- Contributes to improved diagnostic strategies for iron deficiency anemia, potentially leading to better patient outcomes.
Objective:
To evaluate the value of iron parameters in diagnosing iron deficiency (ID).
Methods:
Cross-sectional study was performed for diagnostic tests. Ninety consecutive patients with anemia including iron deficiency anemia without chronic diseases (36 cases), chronic diseases (54) were divided into chronic diseases without ID(ACD) (23 cases) and chronic diseases with ID(CDID) (31) by bone marrow iron staining. The exclusion criteria included hemolytic anemia, deficiency of Vitamin B12 or folic acid, blood transfusion, taking iron preparations within one month and hematological malignancies. By using absence of bone marrow iron as gold standard of ID, we compared the diagnostic powers in the diagnosis of iron deficiency for sTfR, serum iron, total iron binding capacity, serum ferritin (SF), transferrin saturation and the presence of hypochromic red cells by analyzing the likelihood ratio, the area under ROC(AUCROC).
Results:
AUCROC for sTfR in determining ID in groups IDA + CDID vs. ACD, IDA vs. ACD and CDID vs. ACD were 0.9 (95% CI: 0.82-0.98), 0.96(0.9-0.99) and 0.84 (0.72-0.96) respectively, AUCROC for SF in above groups 0.87 (95% CI: 0.77-0.87), 0.94(0.86-0.99) and 0.77(0.63-0.91) respectively. AUCROC for other iron parameters in determining iron deficiency in chronic diseases was lower than 70%.
Conclusion:
ROC and LR are useful tools for evaluating iron parameters in diagnosing iron deficiency. TfR is a best parameter in determining iron deficiency in chronic diseases than SF and other iron parameters.