title: Validation of the Composite Autonomic Symptom Score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes.
abstract: To validate the Composite Autonomic Symptom Score (COMPASS) 31, in its Italian version, for the diagnosis of diabetic cardiovascular autonomic neuropathy in a clinic-based, single-centre study.
  
  
  
  A total of 73 participants with diabetes (age 55 ± 14 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular autonomic neuropathy and diabetic polyneuropathy assessment according to cardiovascular reflex tests, neuropathic symptoms and signs, and vibration and thermal thresholds.
  
  
  
  The COMPASS 31 total weighted score differed between participants with and without cardiovascular autonomic neuropathy (29.9 ± 19.5 vs 16.1 ± 14.7; P = 0.003) and with and without diabetic polyneuropathy (28.9 ± 19.1 vs 12.7 ± 11.3; P < 0.0001). It was related to cardiovascular reflex tests score (rho = 0.38, P = 0.0013) as well as diabetic polyneuropathy symptoms (rho=0.61, P < 0.0001) and signs scores (rho = 0.49, P < 0.0001). Receiver-operating curve analysis showed a fair diagnostic accuracy of total score for cardiovascular autonomic neuropathy (area under the curve 0.748 ± 0.068, 95% CI 0.599-0.861) and diabetic polyneuropathy (area under the curve 0.742 ± 0.061, 95% CI 0.611-0.845). The best score thresholds were 16 for early cardiovascular autonomic neuropathy (sensitivity 75.0%, specificity 64.9%, positive predictive value 37.5% and negative predictive value 90.2%), and 17 for both confirmed cardiovascular autonomic neuropathy and diabetic polyneuropathy (sensitivity 70.0% and 65.5%, respectively; specificity 66.7% and 79.5%, respectively; positive predictive value 25.0% and 67.9%, respectively; and negative predictive value 93.0% and 77.8%, respectively). COMPASS 31 had a good internal consistency according to Cronbach's α coefficient of 0.73.
  
  
  
  COMPASS 31 can represent a valid, easy-to-use, quantitative assessment tool for autonomic symptoms in diabetic neuropathy, with a fair diagnostic accuracy for both cardiovascular autonomic neuropathy and diabetic polyneuropathy.
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Greco
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Di Gennaro
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: D'Amato
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Morganti
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Corradini
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sun
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Longo
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lauro
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.|Neurology, DIBINEM, University of Bologna Alma Mater Studiorum, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pierangeli
authors.affiliation: IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.|Neurology, DIBINEM, University of Bologna Alma Mater Studiorum, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cortelli
authors.affiliation: Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Spallone
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000134:cerebrospinal fluid*; D003929:Diabetic Neuropathies / Q000175:diagnosis*; D003940:Diagnostic Techniques, Endocrine; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012107:Research Design; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index