{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T04:43:58Z","timestamp":1783053838254,"version":"3.54.6"},"reference-count":20,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Biochem"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Assessing the pre- and post-test probability of disease in the context of routine health care is challenging. We wished to study how test performance parameters relating to clinical utility vary by clinical indication in a \u2018real-world\u2019 setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The diagnostic accuracy of serum total B\n                      <jats:sub>12<\/jats:sub>\n                      and Active-B\n                      <jats:sub>12<\/jats:sub>\n                      \u00ae (holotranscobalamin) was evaluated in a primary care population, using serum methylmalonic acid as the reference standard. We used electronic requesting to establish the clinical indication for each request. Routine requests from primary care for serum total B\n                      <jats:sub>12<\/jats:sub>\n                      were included if creatinine was also measured and estimated glomerular filtration rate was at least 60\u2009mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Clinical indications included peripheral neuropathy ( n\u2009=\u2009168), anaemia ( n\u2009=\u2009168), cognitive decline ( n\u2009=\u2009125), suspected dietary deficiency ( n\u2009=\u200976), other ( n\u2009=\u2009362). For peripheral neuropathy, the area under the receiver operator curve\u2009\u00b1\u200995% confidence interval (AUC\u2009\u00b1\u2009CI) was 0.63 (0.54\u20130.71) ( P\u2009=\u20090.002) for total B\n                      <jats:sub>12<\/jats:sub>\n                      and 0.68 (0.60\u20130.77) ( P\u2009&lt;\u20090.0001) for Active-B\n                      <jats:sub>12<\/jats:sub>\n                      \u00ae. For anaemia, AUC\u2009\u00b1\u2009CI was 0.56 (0.47\u20130.66) ( P\u2009=\u20090.10) for total B\n                      <jats:sub>12<\/jats:sub>\n                      and 0.69 (0.59\u20130.78) ( P\u2009&lt;\u20090.0001) for Active-B\n                      <jats:sub>12<\/jats:sub>\n                      \u00ae. For cognitive decline, AUC\u2009\u00b1\u2009CI was 0.54 (0.43\u20130.65) ( P\u2009=\u20090.26) for total B\n                      <jats:sub>12<\/jats:sub>\n                      and 0.69 (0.58\u20130.80) ( P\u2009=\u20090.0002) for Active-B\n                      <jats:sub>12<\/jats:sub>\n                      \u00ae. The pre\u2013post-test change in probability of disease varied by clinical indication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Combining diagnostic accuracy studies and electronic testing in a \u2018real-world\u2019 setting allows clinical utility to be assessed by clinical indication. Wider application of this would permit more personalised laboratory medicine. In this study, diagnostic performance of total B\n                      <jats:sub>12<\/jats:sub>\n                      and Active-B\n                      <jats:sub>12<\/jats:sub>\n                      \u00ae varied across all indications. Active-B\n                      <jats:sub>12<\/jats:sub>\n                      \u00ae provided better discrimination, but this may have reflected the cut-offs used.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00045632211003605","type":"journal-article","created":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T00:01:43Z","timestamp":1615334503000},"page":"445-451","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Personalising laboratory medicine in the \u2018real world\u2019: Assessing clinical utility, by clinical indication, of serum total B\n                    <sub>12<\/sub>\n                    and Active-B\n                    <sub>12<\/sub>\n                    \u00ae (holotranscobalamin) in the diagnosis of vitamin B\n                    <sub>12<\/sub>\n                    deficiency"],"prefix":"10.1177","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6735-125X","authenticated-orcid":false,"given":"Michael J","family":"Murphy","sequence":"first","affiliation":[{"name":"Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Brandie","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mildred","family":"Ebare","sequence":"additional","affiliation":[{"name":"General Practice Training, NHS Education Scotland, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Haematology, Ninewells Hospital & Medical School, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellie","family":"Dow","sequence":"additional","affiliation":[{"name":"Department of Biochemical Medicine, Ninewells Hospital & Medical School, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A","family":"Bartlett","sequence":"additional","affiliation":[{"name":"NHS National Services Scotland, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Craig","sequence":"additional","affiliation":[{"name":"Axis Shield Diagnostics Ltd, Dundee, UK*"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"key":"bibr1-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1177\/0004563217747907"},{"key":"bibr2-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2010.158154"},{"key":"bibr3-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2014-0818"},{"key":"bibr4-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-015-0060-x"},{"key":"bibr5-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2006.080382"},{"key":"bibr6-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1515\/CCLM.2007.361"},{"key":"bibr7-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-010-5764-4"},{"key":"bibr8-00045632211003605","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2011.011039"},{"key":"bibr9-00045632211003605","first-page":"20","volume":"3","author":"Green 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