Clinical Prediction of Iron Deficiency at Age 2 Years: A National Cross-sectional Study in France - 22/07/21
, Anne-Sylvia Sacri, MD, PhD 1, 2, Corinne Levy, MD 3, 4, 5, Alain Bocquet, MD 3, 6, Nathanaël Lapidus, MD, PhD 7, Serge Hercberg, MD, PhD 8, 9, Pascale Hebel, PhD 10, Anne Chevé, MD 11, Christian Copin, MD 12, Morched Zouari, MD 13, Laurent Gouya, MD, PhD 14, Mariane de Montalembert, MD, PhD 1, 2, Jérémie F. Cohen, MD, PhD 1, 2, Martin Chalumeau, MD, PhD 1, 2Abstract |
Objective |
To assess the diagnostic accuracy of existing clinical criteria and to develop prediction tools for iron deficiency in 2-year-old children.
Study design |
In a national cross-sectional study conducted in primary care pediatricians' practices throughout France, 2-year-old children were consecutively included (2016-2017). Multivariable logistic regression modeling and bootstrapping were used to develop several clinical models to predict iron deficiency (serum ferritin <12 μg/L). These models used the best criteria and combinations among the American Academy of Pediatrics’ (AAP) criteria adapted to the European context (n = 10), then all potential predictors (n = 19). One model was then simplified into a simple prediction tool.
Results |
Among 568 included infants, 38 had iron deficiency (6.7%). In univariable analyses, no significant association with iron deficiency was observed for 8 of the 10 adapted AAP criteria. Three criteria (both parents born outside the European Union, low weight at 1 year old, and weaning to cow's milk without supplemental iron) were retained in the AAP model, which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.62 (95% CI, 0.58-0.67), 30% (95% CI, 22%-39%), and 95% (95% CI, 92%-97%), respectively. Four criteria were retained in a newly derived simple prediction tool (≥1 criterion among the 3 previous plus duration of iron-rich formula consumption <12 months), which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72 (95% CI, 0.65-0.79), 63% (95% CI, 47%-80%), and 81% (95% CI, 70%-91%), respectively.
Conclusions |
All prediction tools achieved acceptable diagnostic accuracy. The newly derived simple prediction tool offered potential ease of use.
Trial registration |
ClinicalTrials.gov NCT02484274.
Le texte complet de cet article est disponible en PDF.Keywords : screening, prediction tools, nationwide cohort study
Abbreviations : AAP, AUROC, CRP, EU, LR–, TRIPOD
Plan
| Supported by the Secteur Français des Aliments de l’Enfance and the French Ministry of Health “DGOS PHRC régional 2014 no. AOR14053.” The sponsor was Assistance Publique – Hôpitaux de Paris, France (Délégation à la Recherche Clinique et à l’Innovation [DRCI]). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest. |
|
| Deidentified individual participant data (including data dictionaries) will be made available, in addition to study protocols, the statistical analysis plan, and the informed consent form. The data will be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to martin.chalumeau@inserm.fr |
Vol 235
P. 212-219 - août 2021 Retour au numéro
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