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A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers

  • Yesim Ozarda EMAIL logo , Kiyoshi Ichihara , Diler Aslan , Hulya Aybek , Zeki Ari , Fatma Taneli , Canan Coker , Pinar Akan , Ali Riza Sisman , Onur Bahceci , Nurzen Sezgin , Meltem Demir , Gultekin Yucel , Halide Akbas , Sebahat Ozdem , Gurbuz Polat , Ayse Binnur Erbagci , Mustafa Orkmez , Nuriye Mete , Osman Evliyaoglu , Aysel Kiyici , Husamettin Vatansev , Bahadir Ozturk , Dogan Yucel , Damla Kayaalp , Kubra Dogan , Asli Pinar , Mehmet Gurbilek , Cigdem Damla Cetinkaya , Okhan Akin , Muhittin Serdar , Ismail Kurt , Selda Erdinc , Ozgur Kadicesme , Necip Ilhan , Dilek Sadak Atali , Ebubekir Bakan , Harun Polat , Tevfik Noyan , Murat Can , Abdulkerim Bedir , Ali Okuyucu , Orhan Deger , Suret Agac , Evin Ademoglu , Ayşem Kaya , Turkan Nogay , Nezaket Eren , Melahat Dirican , GulOzlem Tuncer , Mehmet Aykus , Yeliz Gunes , Sevda Unalli Ozmen , Reo Kawano , Sehavet Tezcan , Ozlem Demirpence and Elif Degirmen
Published/Copyright: August 15, 2014
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 52 Issue 12

Abstract

Background: A nationwide multicenter study was organized to establish reference intervals (RIs) in the Turkish population for 25 commonly tested biochemical analytes and to explore sources of variation in reference values, including regionality.

Methods: Blood samples were collected nationwide in 28 laboratories from the seven regions (≥400 samples/region, 3066 in all). The sera were collectively analyzed in Uludag University in Bursa using Abbott reagents and analyzer. Reference materials were used for standardization of test results. After secondary exclusion using the latent abnormal values exclusion method, RIs were derived by a parametric method employing the modified Box-Cox formula and compared with the RIs by the non-parametric method. Three-level nested ANOVA was used to evaluate variations among sexes, ages and regions. Associations between test results and age, body mass index (BMI) and region were determined by multiple regression analysis (MRA).

Results: By ANOVA, differences of reference values among seven regions were significant in none of the 25 analytes. Significant sex-related and age-related differences were observed for 10 and seven analytes, respectively. MRA revealed BMI-related changes in results for uric acid, glucose, triglycerides, high-density lipoprotein (HDL)-cholesterol, alanine aminotransferase, and γ-glutamyltransferase. Their RIs were thus derived by applying stricter criteria excluding individuals with BMI >28 kg/m2. Ranges of RIs by non-parametric method were wider than those by parametric method especially for those analytes affected by BMI.

Conclusions: With the lack of regional differences and the well-standardized status of test results, the RIs derived from this nationwide study can be used for the entire Turkish population.

Keywords: biochemical parameters; common reference intervals; multicenter study; regional differences; Turkey
Corresponding author: Yesim Ozarda, MD, Department of Medical Biochemistry, Uludag University School of Medicine, Bursa, Turkey, Phone: +90 224 29 53917, Fax: +90 224 29 50019, E-mail:

Acknowledgments

This study was supported by Research Fund of Uludag Universty (UAP(T)-2011/48), IFCC C-RIDL, Scientific Research Fund (No:24256003:2012-2014) provided by the Japan Society for the Promotion of Science, Abbott Diagnostics and Becton Dickinson. We had invaluable input from the IFCC C-RIDL and the Turkish National Biochemical Association. We are very grateful to Uludag University Central Laboratory, We are thankful to David Ambruster from Abbott Diagnostics for his kind cooperation to realize this study. The final manuscript was edited with generous support by Prof. A. Myron Johnson.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article. Research funding 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.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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Supplemental Material

The online version of this article (DOI 10.1515/cclm-2014-0228) offers supplementary material, available to authorized users.

Received: 2014-3-1
Accepted: 2014-5-21
Published Online: 2014-8-15
Published in Print: 2014-12-1

©2014 by De Gruyter

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https://doi.org/10.1515/cclm-2014-0228
Keywords for this article
biochemical parameters; common reference intervals; multicenter study; regional differences; Turkey

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. CCLM Award for The Most Cited Paper Recently Published
  4. Laboratory preparedness to face infectious outbreaks. Ebola and beyond
  5. Reviews
  6. Determination of reference limits: statistical concepts and tools for sample size calculation
  7. Recent advances in physiological lipoprotein metabolism
  8. New laboratory markers for the management of rheumatoid arthritis patients
  9. General Clinical Chemistry and Laboratory Medicine
  10. The impact of repeat-testing of common chemistry analytes at critical concentrations
  11. Performance of CKD-EPI equation to estimate glomerular filtration rate as compared to MDRD equation in South Brazilian individuals in each stage of renal function
  12. The serum uromodulin level is associated with kidney function
  13. Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists
  14. Performance evaluation of Sysmex XN hematology analyzer in umbilical cord blood: a comparison study with Sysmex XE-2100
  15. UF-1000i: validation of the body fluid mode for counting cells in body fluids
  16. Newborn screening for haemoglobinopathies by high performance liquid chromatography (HPLC): diagnostic utility of different approaches in resource-poor settings
  17. Progressive chromogenic anti-factor Xa assay and its use in the classification of antithrombin deficiencies
  18. Reference Values and Biological Variations
  19. Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample
  20. Reference ranges for serum β-trace protein in neonates and children younger than 1 year of age
  21. A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers
  22. Serum reference intervals of homoarginine, ADMA, and SDMA in the Study of Health in Pomerania
  23. Cancer Diagnostics
  24. Low SOX17 expression: prognostic significance in de novo acute myeloid leukemia with normal cytogenetics
  25. Results of first proficiency test for KRAS testing with formalin-fixed, paraffin-embedded cell lines in China
  26. Aberrant hypermethylation of CTNNA1 gene is associated with higher IPSS risk in patients with myelodysplastic syndrome
  27. Cardiovascular Diseases
  28. Association between SNP rs13376333 and rs1131820 in the KCNN3 gene and atrial fibrillation in the Chinese Han population
  29. Acknowledgment
  30. Acknowledgment
  31. Letters to the Editor
  32. Interference in thyroid hormones with Roche immunoassays: an unfinished story
  33. Discrepant results in plasma, but not serum in the Beckman Coulter DxI Access HYPERsensitive hTSH 3rd generation assay affect the management of differentiated thyroid cancer and hyperthyroid patients
  34. Improper serum separation on gel tubes: a trivial laboratory problem or an indicator of monoclonal gammopathy?
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