Diagnostic performance of serum cobalamin tests: a systematic review and meta-analysis

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#databases-factual #humans #predictive-value-of-tests #roc-curve #reference-standards

Diagnostic performance of serum cobalamin tests: a systematic review and meta-analysis

Willis et al., 2011 | Pathology | Meta Analysis

Citation

Willis Cameron D, Elshaug Adam G, ... Hiller Janet E. Diagnostic performance of serum cobalamin tests: a systematic review and meta-analysis. Pathology. 2011-Aug;43(5):472-81. doi:10.1097/PAT.0b013e3283486435

Abstract

AIMS: Serum cobalamin (cbl, vitamin B(12)) tests are routinely ordered for investigating conditions potentially amenable to cbl supplementation. This study aimed to systematically assess the evidence of diagnostic accuracy for serum cbl tests across patient subgroups. METHODS: Seven medical databases were searched (1990 to November 2009). Studies were included that compared serum cbl to a reference standard (all reference standards employed). Study quality was assessed using QUADAS. Summary estimates of test performance were determined using the bivariate model and hierarchical summary receiver operating characteristic curves (HSROC). RESULTS: Of 2878 identified studies, 54 were included. Studies rated poorly against QUADAS criteria. Positive (PLR) and negative likelihood ratios (NLR) were 2.72 [95% confidence interval (CI) 1.95, 3.81] and 0.59 (0.49, 0.72), respectively (studies employing methylmalonic acid as the referent). In studies employing a clinical reference standard, PLR was 3.33 (0.92, 12.10) and NLR 0.34 (0.13, 0.89). Test performance did not vary by clinical indication, test method or age. CONCLUSION: This review was limited by the quality of the evidence base and lack of a gold standard. From the available evidence, diagnosis of conditions amenable to cbl supplementation on the basis of serum cbl level alone cannot be considered a reliable approach to investigating suspected vitamin deficiency.

Key Findings

Of 2878 identified studies, 54 were included. Studies rated poorly against QUADAS criteria. Positive (PLR) and negative likelihood ratios (NLR) were 2.72 [95% confidence interval (CI) 1.95, 3.81] and 0.59 (0.49, 0.72), respectively (studies employing methylmalonic acid as the referent). In studies employing a clinical reference standard, PLR was 3.33 (0.92, 12.10) and NLR 0.34 (0.13, 0.89). Test performance did not vary by clinical indication, test method or age.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition deficiency

MeSH Terms

  • Databases, Factual
  • Humans
  • Predictive Value of Tests
  • ROC Curve
  • Reference Standards
  • Reproducibility of Results
  • Vitamin B 12
  • Vitamin B 12 Deficiency

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., Systematic Review
  • Vertical: vitamin-b12

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09