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Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly

  • Nils Kuster , Karine Monnier , Gregory Baptista , Anne-Marie Dupuy , Stéphanie Badiou , Anne-Sophie Bargnoux , Claude Jeandel and Jean-Paul Cristol EMAIL logo
Published/Copyright: August 7, 2014
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue 5

Abstract

Background: Cardiac troponin level measured by high-sensitivity assays (hs-cTn) in the elderly is frequently found higher than the 99th percentile upper reference limit, making the diagnosis of acute coronary syndromes (ACS) difficult. This study aimed at: 1) identifying determinants of hs-cTnT levels in an unselected population of elderly subjects; and 2) assessing the prognosis value of increased hs-cTnT in elderly people free of ACS.

Methods: Hs-cTnT was measured in 591 individuals aged over 65 years without suspicion of ACS. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). C-reactive protein, α1-acid glycoprotein, albumin and creatinine were measured. Factors influencing hs-cTnT levels were assessed through linear regression and quantile regression was used to model percentiles of hs-cTnT. Risk of mortality was assessed through Cox regression.

Results: Age, gender, cardiac CIRS-G, estimated glomerular filtration rate (p<0.001 for all), albumin (p<0.028) and α1-acid glycoprotein (p=0.002) were independent predictors of hs-cTnT. After exclusion of outliers, the median was 15 ng/L and 99th percentile was 64 ng/L. After controlling for comorbidities, the 99th percentile increased from 24 ng/L at age 65 to 53 ng/L at age 90 in females and from 33 ng/L to 75 ng/L in males. In multivariate analysis, hs-cTnT level was significantly related to mortality.

Conclusions: Hs-cTnT level is associated with inflammation and renal function in the elderly. Independently of comorbidities, hs-cTnT concentration increases exponentially with age after 65 years. Decision limits adapted to age and sex may be useful to patient management.

Keywords: elderly people; high-sensitivity cardiac troponin T; mortality; 99th percentile
Corresponding author: Jean-Paul Cristol, Department of Biochemistry, Lapeyronie Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France, Phone: +33 4 67338314, Fax: + 33 4 67338393, E-mail:

Author contributions

All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Financial support: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2014-2-5
Accepted: 2014-7-1
Published Online: 2014-8-7
Published in Print: 2015-4-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. High-sensitivity assays for cardiac troponins
  4. Reviews
  5. High sensitivity cardiac troponin assays in the clinical laboratories
  6. Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm
  7. Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction
  8. Cardiovascular Diseases
  9. Evaluation of standardization capability of current cardiac troponin I assays by a correlation study: results of an IFCC pilot project
  10. Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly
  11. High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study
  12. Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction
  13. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
  14. Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T
  15. General Clinical Chemistry and Laboratory Medicine
  16. Active intervention in hospital test request panels pays
  17. An approach to establish the uncertainty budget of catalytic activity concentration measurements in a reference laboratory
  18. Uric acid: a potential biomarker of multiple sclerosis and of its disability
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  21. Quantification of piperacillin, tazobactam, cefepime, meropenem, ciprofloxacin and linezolid in serum using an isotope dilution UHPLC-MS/MS method with semi-automated sample preparation
  22. Plasma visfatin/nicotinamide phosphoribosyltransferase (visfatin/NAMPT) concentration is not related to kidney function in elderly subjects
  23. Diagnostic performance study of an antigen microarray for the detection of antiphospholipid antibodies in human serum
  24. Dry ice exposure of plasma samples influences pH and lupus anticoagulant analysis
  25. Reference Values and Biological Variations
  26. A new robust statistical model for interpretation of differences in serial test results from an individual
  27. Cancer Diagnostics
  28. The value of red blood cell distribution width in endometrial cancer
  29. Letters to the Editors
  30. Serum high-sensitivity troponin concentrations in a multi-ethnic Asian population of stable chronic kidney disease patients
  31. Comparison between BNP values measured in capillary blood samples with a POCT method and those measured in plasma venous samples with an automated platform
  32. Reply to the article entitled “Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D” by Farrell et al., Clin Chem Lab Med 2014;52:1579–87
  33. Reply. Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D. Authors’ response to the Letter to the Editor by Donnelly et al.
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https://doi.org/10.1515/cclm-2014-0121
Keywords for this article
elderly people; high-sensitivity cardiac troponin T; mortality; 99th percentile

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. High-sensitivity assays for cardiac troponins
  4. Reviews
  5. High sensitivity cardiac troponin assays in the clinical laboratories
  6. Laboratory medicine as the science that underpins medicine: the “high-sensitivity” troponin paradigm
  7. Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction
  8. Cardiovascular Diseases
  9. Evaluation of standardization capability of current cardiac troponin I assays by a correlation study: results of an IFCC pilot project
  10. Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly
  11. High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study
  12. Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction
  13. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
  14. Diagnosis of acute myocardial infarction in patients with renal insufficiency using high-sensitivity troponin T
  15. General Clinical Chemistry and Laboratory Medicine
  16. Active intervention in hospital test request panels pays
  17. An approach to establish the uncertainty budget of catalytic activity concentration measurements in a reference laboratory
  18. Uric acid: a potential biomarker of multiple sclerosis and of its disability
  19. Experience with the first fully automated chemiluminescence immunoassay for the quantification of 1α, 25-dihydroxy-vitamin D
  20. I-FABP and L-FABP are early markers for abdominal injury with limited prognostic value for secondary organ failures in the post-traumatic course
  21. Quantification of piperacillin, tazobactam, cefepime, meropenem, ciprofloxacin and linezolid in serum using an isotope dilution UHPLC-MS/MS method with semi-automated sample preparation
  22. Plasma visfatin/nicotinamide phosphoribosyltransferase (visfatin/NAMPT) concentration is not related to kidney function in elderly subjects
  23. Diagnostic performance study of an antigen microarray for the detection of antiphospholipid antibodies in human serum
  24. Dry ice exposure of plasma samples influences pH and lupus anticoagulant analysis
  25. Reference Values and Biological Variations
  26. A new robust statistical model for interpretation of differences in serial test results from an individual
  27. Cancer Diagnostics
  28. The value of red blood cell distribution width in endometrial cancer
  29. Letters to the Editors
  30. Serum high-sensitivity troponin concentrations in a multi-ethnic Asian population of stable chronic kidney disease patients
  31. Comparison between BNP values measured in capillary blood samples with a POCT method and those measured in plasma venous samples with an automated platform
  32. Reply to the article entitled “Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D” by Farrell et al., Clin Chem Lab Med 2014;52:1579–87
  33. Reply. Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D. Authors’ response to the Letter to the Editor by Donnelly et al.
  34. Therapeutic drug monitoring of voriconazole: validation of a novel ARK™ immunoassay and comparison with ultra-high performance liquid chromatography
  35. Interference of C-reactive protein with clotting times
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