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, 12, 1735-1742

Diagnostic Accuracy of Composite Autonomic Symptom Scale 31 (COMPASS-31) in Early Detection of Autonomic Dysfunction in Type 2 Diabetes Mellitus


Diagnostic Accuracy of Composite Autonomic Symptom Scale 31 (COMPASS-31) in Early Detection of Autonomic Dysfunction in Type 2 Diabetes Mellitus

Ruchi Singh et al. Diabetes Metab Syndr Obes.


Purpose: Diabetic autonomic neuropathy (DAN) is a common and disabling complication of diabetes, with cardiac autonomic neuropathy (CAN) being a major cause of mortality and morbidity. Standard autonomic function tests (AFT) are cumbersome and time consuming to conduct in OPD setting.

Objective: To evaluate the diagnostic accuracy of composite autonomic symptom scale 31 (COMPASS-31) as a screening test for DAN.

Patients and methods: A cross-sectional study which enrolled 60 type 2 diabetes individuals was conducted at a tertiary care center. Autonomic functions were evaluated by COMPASS-31 questionnaire as well as by standard Ewing's battery of tests; short-term heart rate variability; sympathetic skin response along with nerve conduction studies.

Results: Thirty males and 24 females completed the study. Forty-nine (89%) participants had CAN, of which, 9 (17%) had definite CAN. Peripheral neuropathy was present in 20 (37%). COMPASS-31 scores showed no difference between "No CAN" and "Early CAN". "Definite CAN" individuals differed significantly from "No and Early CAN" on COMPASS-31 scores and its gastrointestinal sub-domain. Receiver operating characteristic between "Definite CAN" and "No and Early CAN" showed fair accuracy with AUC of 0.731 (95% CI 0.561-0.901), sensitivity 77.8%, specificity 71.7% at a cut-off of 28.67 of COMPASS-31 score. Gastrointestinal sub-domain, at a cut-off score of 5.8, had 77.8% sensitivity, 60% specificity, and AUC was 0.748 (95% CI 0.603-0.894).

Conclusion: COMPASS-31, a self-administered tool, requiring less time, qualifies as an acceptable screening tool, especially for definite CAN. However, individuals scoring low on COMPASS-31 are still required to be evaluated by Ewing's battery to differentiate between "Early CAN" and "No CAN".

Keywords: autonomic function tests; autonomic neuropathy; cardiac autonomic neuropathy; heart rate variability.

Conflict of interest statement

The authors report no conflicts of interest in this work.


Figure 1
Figure 1
Study flow.
Figure 2
Figure 2
ROC curves for COMPASS 31 and its sub-domains. The ROC curve for COMPASS 31 scores and its 6 domains. (A) Orthostatic domain AUC (95% CI)=0.715 (0.516–0.914); (B) vasomotor domain AUC (95% CI)=0.393 (0.212–0.573); (C) secretomotor domain AUC (95% CI)=0.598 (0.374–0.821); (D) gastrointestinal domain AUC (95% CI)=0.748 (0.603–0.894); (E) bladder domain AUC (95% CI)=0.504 (0.314–0.694); (F) pupillomotor domain AUC (95% CI)=0.469 (0.271–0.668); (G) COMPASS-31 AUC (95% CI)=0.731 (0.561–0.901). The cut-off score for COMPASS 31 score was 28.67 with sensitivity of 77.8% and specificity of 71.1%. The cut-off scores were 14 and 5.8 for orthostatic domain and gastrointestinal domain with sensitivity of 77.8% for both and specificity of 57.4% and 60% respectively.

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