Diagnostic accuracy of composite autonomic symptom scale 31 (COMPASS-31) in early detection of autonomic dysfunction in type 2 diabetes mellitus

Abstract

Purpose

Diabetic autonomic neuropathy (DAN) is a common and disabling complication of diabetes, with cardiac autonomic neuropathy (CAN) being a major cause of mortality and morbidity. Standard autonomic function tests (AFT) are cumbersome and time consuming to conduct in OPD setting.

Objective

To evaluate the diagnostic accuracy of composite autonomic symptom scale 31 (COMPASS-31) as a screening test for DAN.

Patients and methods

A cross-sectional study which enrolled 60 type 2 diabetes individuals was conducted at a tertiary care center. Autonomic functions were evaluated by COMPASS-31 questionnaire as well as by standard Ewing’s battery of tests; short-term heart rate variability; sympathetic skin response along with nerve conduction studies.

Results

Thirty males and 24 females completed the study. Forty-nine (89%) participants had CAN, of which, 9 (17%) had definite CAN. Peripheral neuropathy was present in 20 (37%). COMPASS-31 scores showed no difference between “No CAN” and “Early CAN”. “Definite CAN” individuals differed significantly from “No and Early CAN” on COMPASS-31 scores and its gastrointestinal sub-domain. Receiver operating characteristic between “Definite CAN” and “No and Early CAN” showed fair accuracy with AUC of 0.731 (95% CI 0.561–0.901), sensitivity 77.8%, specificity 71.7% at a cut-off of 28.67 of COMPASS-31 score. Gastrointestinal sub-domain, at a cut-off score of 5.8, had 77.8% sensitivity, 60% specificity, and AUC was 0.748 (95% CI 0.603–0.894).

Conclusion

COMPASS-31, a self-administered tool, requiring less time, qualifies as an acceptable screening tool, especially for definite CAN. However, individuals scoring low on COMPASS-31 are still required to be evaluated by Ewing’s battery to differentiate between “Early CAN” and “No CAN”.

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Keywords:

• autonomic neuropathy
• cardiac autonomic neuropathy
• autonomic function tests
• heart rate variability

Acknowledgment

The study was a non-funded Indian council of medical research – STS fellowship project selected in the year 2017. This paper was presented at Washington DC (1-6th May) in 31st International Congress of Clinical Neurophysiology (ICCN 2018) as a poster presentation. The poster’s abstract was published in “Poster Abstract” in Clinical Neurophysiology doi:10.1016/j.clinph.2018.04.321.

Abbreviations

AFT, autonomic function tests; ANS, autonomic nervous system; AUC, area under the curve; CAN, cardiac autonomic neuropathy; CMAP, compound motor action potential; COMPASS-31, Composite autonomic symptom scale 31; CV, conduction velocity; SNAP, sensory nerve action potential; DAN, diabetic autonomic neuropathy; DL, distal latencies; DM, diabetes mellitus; HbA1c, hemoglobin A1c; HF nu, high frequency component normalized unit; HRV, heart rate variability; LF nu, low frequency component normalized unit; LL, lower limb; NCS, nerve conduction studies; NPV, negative predictive value, LR+, positive likelihood; LR-, negative likelihood; MNCV, motor nerve conduction velocities; PL, peak latencies; PPV, positive predictive value; ROC, receiver operating characteristic; SDNN, standard deviations of the normal mean RR interval; SNCV, sensory nerve conduction velocities; SSR, sympathetic skin response; RMSSD, root-mean square of difference of successive RR intervals; pRR50, frequency of two consecutive RR intervals differing by more than 50 ms; T2DM, type 2 DM; TP, total power; UL, upper limb; VM, Valsalva maneuver.

Disclosure

The authors report no conflicts of interest in this work.