Acurácia do índice tornozelo-braquial no rastreamento da doença arterial periférica em pessoas com diabetes

Abstract

Introduction: Peripheral arterial disease (PAD) is a prevalent condition that, although it results in peripheral complications, is also characterized as a systemic condition affecting cardiovascular morbidity and mortality. The ankle-brachial index (ABI) is a tool with reasonable accuracy. Still, it may have low sensitivity, especially in screening people with diabetes, due to the occurrence of arterial calcification in this population. Evidence on the performance of the ABI in asymptomatic individuals with DM is limited and does not reflect the diversity of community populations. Objective: To evaluate the accuracy of the ankle-brachial index in screening for peripheral arterial disease in people with diabetes mellitus in a community setting. Case, Material, and Methods: An observational diagnostic accuracy study involved individuals with DM in a community setting. Primary data were obtained through structured interviews, including sociodemographic information and subsequent clinical assessments. Researchers measured the ABI and used duplex scanning as the reference standard. Descriptive analysis presented categorical variables as percentages and continuous variables as means with standard deviations or medians with interquartile ranges. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and likelihood ratios (LR+ and LR-) of ABI were analyzed. Results: Among the 105 participants, the mean age was 58.5 years, and females predominated (76.2%). A total of 75.2% had DM diagnosed less than ten years ago. Approximately 15.2% adhered to drug treatment. Intermittent claudication occurred in 7.6%. Only 1.9% had diabetic foot ulcers, and 3.8% had some amputation. Protective plantar sensitivity was present in 72.4%. In the accuracy study, 194 limbs of 99 participants were evaluated, with a prevalence of PAD of 15.98%. The 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. Conclusions: The findings suggest that a normal ABI result reduces, but does not eliminate, the possibility of PAD. Adopting additional diagnostic approaches may be essential to increase the effectiveness of PAD screening in this group. Recognizing the limitations of the ABI and discussing more accurate identification strategies is crucial for effectively managing the condition.