Plasma Phosphorylated Tau 217 Cutoffs for Amyloid Pathology and Kidney Function, Body Mass Index, and Anemia

For plasma phosphorylated tau 217–based amyloid-β detection, does the strategy of using biological subgroup–specific optimal single cutoffs or a double cutoff better optimize diagnostic accuracy and cost efficiency?This cohort study found that subgroup-specific optimal cutoffs improved accuracy over the standard single cutoff, especially in chronic kidney disease (CKD) and anemia. Compared with a double cutoff, the optimal cutoff had similar or better accuracy in CKD with lower cost, whereas a double cutoff was slightly better in underweight and anemia but created intermediates; in obesity, a double cutoff remained superior.Biologically optimized cutoffs offer a balanced, cost-efficient default, particularly in CKD and anemia, while a double cutoff retains advantages in obesity.

Corresponding Authors: Hyemin Jang, MD, PhD, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (hmjang57@amc.seoul.kr; hmjang57@gmail.com); Sang Won Seo, MD, PhD, Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (sangwonseo@empal.com).

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