The Relationship of Serum Cobalamin to Methylmalonic Acid Concentrations and Clinical Variables in Cats

Journal of Veterinary Internal Medicine

P. Worhunsky¹  O. Toulza¹  M. Rishniw¹  N. Berghoff²  C.G. Ruaux²  J.M. Steiner² 

[1] College of Veterinary Medicine, Cornell University, Ithaca, NY;Gastrointestinal Laboratory, Texas A&M University, College Station, TX

关键词: Diagnostic accuracy;    Enteropathy;    Gastrointestinal disease;    Hepatopathy;    Sensitivity;    Specificity;    Test performance;    Vitamin B12;   

DOI  :  10.1111/jvim.12152

来源: Wiley

【 摘 要 】

Abstract

Background

Serum cobalamin concentration [CBL] suggests CBL deficiency in cats but serum methylmalonic acid concentration [MMA] more accurately indicates CBL deficiency.

Objective

To examine the ability of [CBL] to predict CBL deficiency defined by increased [MMA], and relationships of [CBL] and [MMA] with select clinical and clinicopathological variables.

Animals

One hundred sixty-three client-owned cats with [CBL] measurements, 114 cats with simultaneous [MMA] measurements; 88 cats with medical information.

Methods

Prospectively collected [CBL] and [MMA] were compared using scatter plots, receiver operating characteristic and correlative analyses with historical [CBL] thresholds and those identified in the study. [CBL] and [MMA] were compared retrospectively to specific clinical and clinicopathological variables.

Results

[CBL] correlated negatively with [MMA] (τ = −0.334, P < .0001). [MMA] ≥ 1,343 nmol/L identified CBL deficiency. [CBL] = 209 pg/mL optimized sensitivity (0.51), specificity (0.96), PPV (0.89), and NPV (0.74) for detecting [MMA] ≥ 1,343 nmol/L. Prevalence of CBL deficiency was 42% (48/114) when defined by [MMA] ≥ 1,343 nmol/L versus 23% (27/114) by [CBL] ≤ 209 pg/mL. Unexpectedly, 23 and 45% of 48 cats with [MMA] ≥ 1,343 nmol/L had [CBL] > 900 pg/mL and 290 pg/mL (historical thresholds). [CBL] correlated with mean corpuscular volume (τ = −0.199, P = .013) and [MMA] with hematocrit (τ = −0.28, P = .006).

Conclusions and Clinical Importance

Cobalamin deficiency ([MMA] ≥ 1,343 nmol/L) occurred in 42% of cats and is predicted with high specificity by [CBL] ≤ 209 pg/mL. CBL status correlates with microcytosis and anemia. Discordance between [CBL] and [MMA] cautions against relying on any single marker for determining CBL status.

【 授权许可】

Unknown   
Copyright © 2013 by the American College of Veterinary Internal Medicine