Diagnostic Yield and Accuracy of Different Metabolic Syndrome Criteria in Adult Patients with Epilepsy

Abstract

Introduction: Metabolic syndrome (MetS) is an emergent problem among patients with epilepsy. Here, we evaluate and compare the diagnostic yield and accuracy of different MetS criteria among adult patients with epilepsy to further explore the best strategy for diagnosis of MetS among patients with epilepsy.

Materials and methods: Ninety-five epileptic adults from a tertiary epilepsy reference center were prospectively recruited over 22 weeks in a cross-sectional study. MetS was defined according to five international criteria used for the diagnosis of the condition [ATP3, American Association of Clinical Endocrinologists (AACE), International Diabetes Federation (IDF), AHA/NHLBI, and harmonized criteria]. Sensitivity, specificity, positive and negative predictive values (NPVs), and area under the receiver operating characteristic curve (ROC) curve were estimated for each criterion.

Results: In our sample, adult patients with epilepsy showed a high prevalence of obesity, hypertension, and diabetes. However, the prevalence of MetS was significantly different according to each criterion used, ranging from 33.7%, as defined by AACE, to 49.4%, as defined by the harmonized criteria (p < 0.005). IDF criteria showed the highest sensitivity [S = 95.5% (95% CI 84.5-99.4), p < 0.05] and AACE criteria showed the lowest sensitivity and NPV [S = 68.2% (95% CI 52.4-81.4), p < 0.05; NPV = 75.8% (95% CI 62.3-86.1), p < 0.05]. ROC curve for all criteria studied showed that area under curve (AUC) for IDF criterion was 0.966, and it was not different from AUC of harmonized criterion (p = 0.092) that was used as reference. On the other hand, the use of the other three criteria for MetS resulted in significantly lower performance, with AUC for AHA/NHLBI = 0.920 (p = 0.0147), NCEP/ATP3 = 0.898 (p = 0.0067), AACE = 0.830 (p = 0.00059).

Conclusion: Our findings suggest that MetS might be highly prevalent among adult patients with epilepsy. Despite significant variations in the yield of different criteria, the harmonized definition produced the highest prevalence rates and perhaps should be preferred. Correct evaluation of these patients might improve the rates of detection of MetS and foster primary prevention of cardiovascular events in this population.

Keywords: cardiovascular risk; comorbidities in epilepsy; general medical conditions; metabolic syndrome; risk factors.

Figure 1

Flowcharts of the selection of patients and classification according with different metabolic syndrome (MetS) criteria.

Figure 2

Tabulation and graphical plot of sensitivities and specificities.

Figure 3

Receiver operating characteristic curve for all criteria studied. Statistical analysis comparing all area under curve (AUC) with the AUC for harmonized criterion, used as reference. AUC for International Diabetes Federation (IDF) criterion was 0.966, and it was not different from AUC of harmonized criterion (p = 0.092). On the other hand, the use of the other three criteria for MetS resulted in significantly lower performance, with AUC for AHA/NHLBI = 0.920 (p = 0.0147), NCEP/ATP3 = 0.898 (p = 0.0067), American Association of Clinical Endocrinologists (AACE) = 0.830 (p = 0.00059) when compared with harmonized criterion.