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Determination of age- and sex-specific 99th percentiles for high-sensitive troponin T from patients: an analytical imprecision- and partitioning-based approach

  • Denis Monneret EMAIL logo , Martin Gellerstedt and Dominique Bonnefont-Rousselot
Published/Copyright: November 25, 2017
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 56 Issue 5

Abstract

Background:

Detection of acute myocardial infarction (AMI) is mainly based on a rise of cardiac troponin with at least one value above the 99th percentile upper reference limit (99th URL). However, circulating high-sensitive cardiac troponin T (hs-cTnT) concentrations depend on age, sex and renal function. Using an analytical imprecision-based approach, we aimed to determine age- and sex-specific hs-cTnT 99th URLs for patients without chronic kidney disease (CKD).

Methods:

A 3.8-year retrospective analysis of a hospital laboratory database allowed the selection of adult patients with concomitant plasma hs-cTnT (<300 ng/L) and creatinine concentrations, both assayed twice within 72 h with at least 3 h between measurements. Absence of AMI was assumed when the variation between serial hs-cTnT values was below the adjusted-analytical change limit calculated according to the inverse polynomial regression of analytical imprecision. Specific URLs were determined using Clinical and Laboratory Standards Institute (CLSI) methods, and partitioning was tested using the proportion method, after adjustment for unequal prevalences.

Results:

After outlier removal (men: 8.7%; women: 6.6%), 1414 men and 1082 women with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 were assumed as non-AMI. Partitioning into age groups of 18–50, 51–70 and 71–98 years, the hs-cTnT 99th URLs adjusted on French prevalence were 18, 33, 66 and 16, 30, 84 ng/L for men and women, respectively. Age-partitioning was clearly required. However, sex-partitioning was not justified for subjects aged 18–50 and 51–70 years for whom a common hs-cTnT 99th URLs of about 17 and 31 ng/L could be used.

Conclusions:

Based on a laboratory approach, this study supports the need for age-specific hs-cTnT 99th URLs.

Keywords: 99th percentile upper reference limits (99th URL); analytical imprecision; high-sensitive cardiac troponin T (hs-cTnT); outlier removal; partitioning
Corresponding author: Denis Monneret, PharmD, PhD, Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Assistance Publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l’Hôpital, 75651 PARIS Cedex 13, France, Phone: (+33) 6 66 10 77 06

Acknowledgments

The authors thank Vincent Fitzpatrick for the English rereading.

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

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. 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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Supplemental Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0256).

Received: 2017-3-24
Accepted: 2017-10-10
Published Online: 2017-11-25
Published in Print: 2018-4-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

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  2. Editorials
  3. Scientific publishing in the “predatory” era
  4. The influence of age and other biological variables on the estimation of reference limits of cardiac troponin T
  5. Reviews
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  22. Reference Values and Biological Variations
  23. Determination of age- and sex-specific 99th percentiles for high-sensitive troponin T from patients: an analytical imprecision- and partitioning-based approach
  24. Effect of preanalytical and analytical variables on the clinical utility of mean platelet volume
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  31. Letters to the Editor
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  33. A specific abnormal scattergram of peripheral blood leukocytes that may suggest hairy cell leukemia
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https://doi.org/10.1515/cclm-2017-0256
Keywords for this article
99th percentile upper reference limits (99th URL); analytical imprecision; high-sensitive cardiac troponin T (hs-cTnT); outlier removal; partitioning

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Scientific publishing in the “predatory” era
  4. The influence of age and other biological variables on the estimation of reference limits of cardiac troponin T
  5. Reviews
  6. Prognostic and predictive value of EGFR and EGFR-ligands in blood of breast cancer patients: a systematic review
  7. GSTP1 methylation in cancer: a liquid biopsy biomarker?
  8. Opinion Paper
  9. Practical recommendations for managing hemolyzed samples in clinical chemistry testing
  10. Genetics and Molecular Diagnostics
  11. Non-invasive prenatal diagnosis of paternally inherited disorders from maternal plasma: detection of NF1 and CFTR mutations using droplet digital PCR
  12. Circulating miR-21, miR-210 and miR-146a as potential biomarkers to differentiate acute tubular necrosis from hepatorenal syndrome in patients with liver cirrhosis: a pilot study
  13. Pleiotropy of ABO gene: correlation of rs644234 with E-selectin and lipid levels
  14. General Clinical Chemistry and Laboratory Medicine
  15. Three-year customer satisfaction survey in laboratory medicine in a Chinese university hospital
  16. Measurement of sirolimus concentrations in human blood using an automated electrochemiluminescence immunoassay (ECLIA): a multicenter evaluation
  17. Precision, accuracy, cross reactivity and comparability of serum indices measurement on Abbott Architect c8000, Beckman Coulter AU5800 and Roche Cobas 6000 c501 clinical chemistry analyzers
  18. Commutability of control materials for external quality assessment of serum apolipoprotein A-I measurement
  19. Development of a new biochip array for APOE4 classification from plasma samples using immunoassay-based methods
  20. Validation of a high-performance liquid chromatography method for thiopurine S-methyltransferase activity in whole blood using 6-mercaptopurine as substrate
  21. Increased serum concentrations of soluble ST2 are associated with pulmonary complications and mortality in polytraumatized patients
  22. Reference Values and Biological Variations
  23. Determination of age- and sex-specific 99th percentiles for high-sensitive troponin T from patients: an analytical imprecision- and partitioning-based approach
  24. Effect of preanalytical and analytical variables on the clinical utility of mean platelet volume
  25. Serum prolactin levels across pregnancy and the establishment of reference intervals
  26. Gender-partitioned patient medians of serum albumin requested by general practitioners for the assessment of analytical stability
  27. Cancer Diagnostics
  28. Detection of EGFR, KRAS and BRAF mutations in metastatic cells from cerebrospinal fluid
  29. Cardiovascular Diseases
  30. No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 vs. type 2 myocardial infarction
  31. Letters to the Editor
  32. Rare inclusion bodies within monocytes at accelerated phase of Chediak-Higashi syndrome
  33. A specific abnormal scattergram of peripheral blood leukocytes that may suggest hairy cell leukemia
  34. Spuriously low lymphocyte count associated with pseudoerythroblastemia in a patient with chronic lymphocytic leukemia treated with ibrutinib
  35. Performance evaluation of a new automated fourth-generation HIV Ag/Ab combination chemiluminescence immunoassay
  36. False increase of glycated hemoglobin due to aspirin interference in Tosoh G8 analyzer
  37. Assessment of in vitro stability: a call for harmonization across studies
  38. Comparison between blood gas analyzer and central laboratory analyzer for the determination of electrolytes in patients with acute respiratory acidosis
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