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Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population.
Dis Markers. 2020; 2020:7468506.DM

Abstract

Four biomarkers are commonly employed to diagnose B12 deficiency: vitamin B12 (B12), holotranscobalamin (HoloTC), methylmalonic acid (MMA), and homocysteine (Hcy). 4cB12, a combined index of the B12 status, has been suggested to improve the recognition of B12 deficiency. We aimed to evaluate the four different markers for detecting B12 deficiency, as determined by 4cB12. Within a large, mixed patient population, 11,833 samples had concurrent measurements of B12, HoloTC, MMA, and Hcy. 4cB12 was calculated according to the methods described by Fedosov. Diagnostic cutoffs as well as diagnostic accuracy for the detection of B12 deficiency were assessed with receiver operating characteristic (ROC) analysis. The median age was 56 years, and women accounted for 58.8% of the samples. Overall, the area under the curve (AUC) for the detection of subclinical B12 deficiency was highest for HoloTC (0.92), followed by MMA (0.91), B12 (0.9) and Hcy (0.78). The difference between HoloTC and B12 was driven by a significantly higher AUC for HoloTC (0.93) than for B12 (0.89), MMA (0.91), and Hcy in women 50 years and older (0.79; p < 0.05 for all). In the detection of subclinical B12 deficiency, there were no significant differences in the AUCs of HoloTC, B12, and MMA among men and women <50 years. In conclusion, in women < 50 years and in men, HoloTC, MMA, or Hcy do not appear superior to B12 for the detection of B12 deficiency. For women 50 years and older, HoloTC seems to be the preferred first-line marker for the detection of subclinical B12 deficiency.

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Authors+Show Affiliations

Jarquin Campos A
Universidad Autonòma de Guadalajara, Faculdad de Medicina, Zapopan, Jalisco, Mexico. Labormedizinisches zentrum Dr. Risch, Vaduz, Liechtenstein.
Risch L
Labormedizinisches zentrum Dr. Risch, Vaduz, Liechtenstein. Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland. Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.
Nydegger U
Labormedizinisches zentrum Dr. Risch, Vaduz, Liechtenstein.
Wiesner J
Universidad Autonòma de Guadalajara, Faculdad de Medicina, Zapopan, Jalisco, Mexico.
Vazquez Van Dyck M
Universidad Autonòma de Guadalajara, Faculdad de Medicina, Zapopan, Jalisco, Mexico.
Renz H
Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany.
Stanga Z
Department for Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland. Competence Centre of Military Disaster Medicine, Swiss Armed Forces, Ittigen, Switzerland.
Risch M
Labormedizinisches zentrum Dr. Risch, Vaduz, Liechtenstein. Zentrallabor, Kantonsspital Graubünden, Chur, Switzerland.

MeSH

AdultAgedBiomarkersCohort StudiesFemaleHomocysteineHumansMaleMethylmalonic AcidMiddle AgedROC CurveRetrospective StudiesSensitivity and SpecificityTranscobalaminsVitamin B 12Vitamin B 12 Deficiency

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32089757

Citation

Jarquin Campos, Araceli, et al. "Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population." Disease Markers, vol. 2020, 2020, p. 7468506.
Jarquin Campos A, Risch L, Nydegger U, et al. Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population. Dis Markers. 2020;2020:7468506.
Jarquin Campos, A., Risch, L., Nydegger, U., Wiesner, J., Vazquez Van Dyck, M., Renz, H., Stanga, Z., & Risch, M. (2020). Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population. Disease Markers, 2020, 7468506. https://doi.org/10.1155/2020/7468506
Jarquin Campos A, et al. Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population. Dis Markers. 2020;2020:7468506. PubMed PMID: 32089757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population. AU - Jarquin Campos,Araceli, AU - Risch,Lorenz, AU - Nydegger,Urs, AU - Wiesner,Jacobo, AU - Vazquez Van Dyck,Maclovia, AU - Renz,Harald, AU - Stanga,Zeno, AU - Risch,Martin, Y1 - 2020/02/07/ PY - 2019/09/27/received PY - 2019/11/26/revised PY - 2019/12/23/accepted PY - 2020/2/25/entrez PY - 2020/2/25/pubmed PY - 2020/10/31/medline SP - 7468506 EP - 7468506 JF - Disease markers JO - Dis Markers VL - 2020 N2 - Four biomarkers are commonly employed to diagnose B12 deficiency: vitamin B12 (B12), holotranscobalamin (HoloTC), methylmalonic acid (MMA), and homocysteine (Hcy). 4cB12, a combined index of the B12 status, has been suggested to improve the recognition of B12 deficiency. We aimed to evaluate the four different markers for detecting B12 deficiency, as determined by 4cB12. Within a large, mixed patient population, 11,833 samples had concurrent measurements of B12, HoloTC, MMA, and Hcy. 4cB12 was calculated according to the methods described by Fedosov. Diagnostic cutoffs as well as diagnostic accuracy for the detection of B12 deficiency were assessed with receiver operating characteristic (ROC) analysis. The median age was 56 years, and women accounted for 58.8% of the samples. Overall, the area under the curve (AUC) for the detection of subclinical B12 deficiency was highest for HoloTC (0.92), followed by MMA (0.91), B12 (0.9) and Hcy (0.78). The difference between HoloTC and B12 was driven by a significantly higher AUC for HoloTC (0.93) than for B12 (0.89), MMA (0.91), and Hcy in women 50 years and older (0.79; p < 0.05 for all). In the detection of subclinical B12 deficiency, there were no significant differences in the AUCs of HoloTC, B12, and MMA among men and women <50 years. In conclusion, in women < 50 years and in men, HoloTC, MMA, or Hcy do not appear superior to B12 for the detection of B12 deficiency. For women 50 years and older, HoloTC seems to be the preferred first-line marker for the detection of subclinical B12 deficiency. SN - 1875-8630 UR - https://www.unboundmedicine.com/medline/citation/32089757/Diagnostic_Accuracy_of_Holotranscobalamin_Vitamin_B12_Methylmalonic_Acid_and_Homocysteine_in_Detecting_B12_Deficiency_in_a_Large_Mixed_Patient_Population_ DB - PRIME DP - Unbound Medicine ER -