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Kavsak PA. Editorial commentary: High-sensitivity cardiac troponin: Like every new tool there is a learning curve. Trends Cardiovasc Med 2017; 27:48-50. [DOI: 10.1016/j.tcm.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
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Kavsak PA, Saenger AK, Hickman PE. Reality check for cardiac troponin testing - Sometimes the result is wrong. Clin Biochem 2016; 49:1107-1108. [PMID: 27645499 DOI: 10.1016/j.clinbiochem.2016.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Amy K Saenger
- University of Minnesota, Minneapolis, MN, United States
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Pethick J, Patel P, Davies T, Thompson J, Nallagonda M, Beech A, Collinson P, Lee V, Gupta P. The effect of multiple analysers on the biochemical diagnosis of myocardial infarction using a contemporary troponin-I assay. Ann Clin Biochem 2016; 53:702-705. [PMID: 27099337 DOI: 10.1177/0004563216637388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The measurement of cardiac troponin is central for the diagnosis of myocardial infarction (MI). It is recommended that a coefficient of variation of ≤10% is achieved at the diagnostic threshold and significant change between serial measurements reported. Many modern laboratories use multiple analysers linked by automation where samples are randomly assigned to an analyser. It is therefore important to consider the combined effect of all analysers on the analytical performance of troponin measurement. Method The performance of a contemporary troponin-I (cTn-I) assay run on three analysers, linked by an automated track, was undertaken across a range of cTn-I concentrations. The data for the three analysers were aggregated to obtain the combined analytical coefficient of variation (CVA) and reference change values (RCVs). Results The CVA improved with increasing concentration and calculated RCVs ranged from 67.2% (±13 ng/L) to 32% (±160 ng/L) between cTn-I values 20 ng/L and 500 ng/L. Although there were significant differences in cTn-I measurement between analysers around the diagnostic threshold ( P < 0.05), the CVA was 13.6%. Conclusions We demonstrate that there are significant differences between the performances of analysers which can impact the biochemical criteria for the diagnosis of MI. We also show that the RCV varies according to baseline cTn-I values and that reporting a single RCV across the analytical range of cTn-I may not be appropriate.
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Affiliation(s)
- James Pethick
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Prashanth Patel
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK.,2 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,3 BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK.,4 NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Timothy Davies
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - John Thompson
- 5 Department of Health Sciences, University of Leicester, Leicester, UK
| | - Madhavi Nallagonda
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Alison Beech
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Paul Collinson
- 6 Departments of Clinical Blood Sciences and Cardiology, St George's Hospital and Medical School, London, UK
| | - Virginia Lee
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Pankaj Gupta
- 1 Department of Chemical Pathology and Metabolic Medicine, University Hospitals Leicester NHS Trust, Leicester, UK.,2 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,3 BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK.,4 NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
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Belley-Côté EP, Parikh CR, Shortt CR, Coca SG, Garg AX, Eikelboom JW, Kavsak P, McArthur E, Thiessen-Philbrook H, Whitlock RP. Association of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study. J Thorac Cardiovasc Surg 2016; 152:245-251.e4. [PMID: 27045042 DOI: 10.1016/j.jtcvs.2016.02.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 12/08/2015] [Accepted: 02/13/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Acute kidney injury is common after cardiac surgery and associated with postoperative mortality. Perioperative cardiac biomarkers may predict acute kidney injury and mortality. We evaluated whether cardiac biomarkers were associated with severe acute kidney injury, defined as a doubling in serum creatinine or requiring renal replacement therapy during hospital stay after surgery, and mortality. METHODS In a prospective multicenter cohort of adults undergoing cardiac surgery, we measured the following biomarkers in preoperative and postoperative banked plasma: high-sensitivity troponin T, cardiac troponin I, creatine kinase-MB, and N-terminal prohormone of brain natriuretic peptide. RESULTS In the patients who were discharged alive, severe acute kidney injury occurred in 37 of 960 (3.9%), and 43 of 960 (4.5%) died within 1 year of follow-up. N-terminal prohormone of brain natriuretic peptide was the only preoperative biomarker that was independently associated with severe acute kidney injury (with log transformation, adjusted odds ratio, 1.4; 95% confidence interval, 1.0-1.9). Biomarkers measured within 6 hours of surgery (day 1) were all associated with severe acute kidney injury. Preoperative N-terminal prohormone of brain natriuretic peptide was also independently associated with 1-year mortality (with log transformation, adjusted odds ratio, 1.7; 95% confidence interval, 1.2-2.2). Patients in the highest tertile for N-terminal prohormone of brain natriuretic peptide preoperatively (>1006.4 ng/L) had marked increases in their risk for 1-year mortality (adjusted odds ratio, 27.2; 95% confidence interval, 3.5-213.5). Day 1 N-terminal prohormone of brain natriuretic peptide was associated with mortality independently of change in serum creatinine from preoperative baseline. CONCLUSIONS Of the studied biomarkers, N-terminal prohormone of brain natriuretic peptide was the only preoperative biomarker independently associated with severe acute kidney injury and mortality. Early increases in postoperative cardiac biomarkers were associated with severe acute kidney injury after cardiac surgery. Future research should focus on whether interventions that lower N-terminal prohormone of brain natriuretic peptide can affect postoperative outcomes.
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Affiliation(s)
- Emilie P Belley-Côté
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Chirag R Parikh
- Department of Internal Medicine, Yale University School of Medicine and the Clinical Epidemiology Research Center Veterans Affairs Connecticut Healthcare System, West Haven, Conn
| | - Colleen R Shortt
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven G Coca
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, University of Western Ontario, London, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Peter Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Heather Thiessen-Philbrook
- Department of Internal Medicine, Yale University School of Medicine and the Clinical Epidemiology Research Center Veterans Affairs Connecticut Healthcare System, West Haven, Conn
| | - Richard P Whitlock
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Kavsak PA, Beattie J, Pickersgill R, Ford L, Caruso N, Clark L. A practical approach for the validation and clinical implementation of a high-sensitivity cardiac troponin I assay across a North American city. Pract Lab Med 2015; 1:28-34. [PMID: 28932796 PMCID: PMC5597710 DOI: 10.1016/j.plabm.2015.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/20/2015] [Accepted: 02/11/2015] [Indexed: 02/03/2023] Open
Abstract
Objectives Despite several publications on the analytical performance of high-sensitivity cardiac troponin (hs-cTn) assays, there has been little information on how laboratories should validate and implement these assays into clinical service. Our study provides a practical approach for the validation and implementation of a hs-cTn assay across a large North American City. Design and methods Validation for the Abbott ARCHITECT hs-cTnI assay (across 5 analyzers) consisted of verification of limit of blank (LoB), precision (i.e., coefficient of variation; CV) testing at the reported limit of detection (LoD) and within and outside the 99th percentile, linearity testing, cTnI versus hs-cTnI patient comparison within and between analyzers (Passing and Bablok and non-parametric analyses). Education, clinical communications, and memorandums were issued in advance to inform all staff across the city as well as a selected reminder the day before live-date to important users. All hospitals switched to the hs-cTnI assay concurrently (the contemporary cTnI assay removed) with laboratory staff instructed to repeat samples previously measured with the contemporary cTnI assay with the hs-cTnI assay only by physician request. Results Across the 5 analyzers and 6 reagent packs the overall LoB was 0.6 ng/L (n=60) with a CV of 33% at an overall mean of 1.2 ng/L (n=60; reported LoD=1.0 ng/L), with linearity demonstrated from 45,005 ng/L to 1.1 ng/L. Precision testing with a normal patient-pool QC material (mean range across 5 analyzers was 3.9–4.4 ng/L) yielded a range of CVs from 7% to 10% (within-run) and CVs from 7% to 18% (between-run) with the high patient-pool QC material (mean range across 5 analyzers was 29.6–36.3 ng/L) yielding a range of CVs from 2% to 5% (within-run) and CVs from 4% to 8% (between-run). There was agreement between hs-cTnI versus cTnI with the patient samples (slope ranges: 0.89–1.03; intercept ranges: 1.9–3.8 ng/L), however, the median CV on patient samples <100 ng/L across the analyzers was 5.6% for hs-cTnI versus 18.7% for the contemporary assay (p<0.001). Following the switch to hs-cTnI testing, no requests for repeat measurements were received. Conclusions Validation and implementation of hs-cTnI testing across multiple sites requires collaboration within the laboratories and between hospital laboratories and clinical staff. City-wide analytical validation of a high-sensitivity cardiac troponin assay. Practical approach to hs-cTnI validation and clinical implementation. Clinical support and communication are important for a successful implementation. New QC practices and comparability testing for hs-cTnI monitoring.
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Affiliation(s)
- Peter A. Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton, Canada
- Hamilton Regional Laboratory Medicine Program, Canada
- Correspondence to: Juravinski Hospital and Cancer Centre, 711 Concession Street Hamilton, ON, Canada L8V 1C3. Tel.: +1 905 521 2100.
| | - John Beattie
- Hamilton Regional Laboratory Medicine Program, Canada
- Hamilton General Hospital, Hamilton, Canada
| | - Robin Pickersgill
- Hamilton Regional Laboratory Medicine Program, Canada
- St. Joseph׳s Hospital, Hamilton, Canada
| | - Lynn Ford
- Hamilton Regional Laboratory Medicine Program, Canada
- McMaster Children׳s Hospital, Hamilton, Canada
| | - Nadia Caruso
- Hamilton Regional Laboratory Medicine Program, Canada
- Hamilton General Hospital, Hamilton, Canada
| | - Lorna Clark
- Juravinski Hospital and Cancer Centre, Hamilton, Canada
- Hamilton Regional Laboratory Medicine Program, Canada
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Shortt C, Phan K, Hill SA, Worster A, Kavsak PA. An approach to rule-out an acute cardiovascular event or death in emergency department patients using outcome-based cutoffs for high-sensitivity cardiac troponin assays and glucose. Clin Biochem 2015; 48:282-7. [DOI: 10.1016/j.clinbiochem.2014.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/04/2014] [Accepted: 11/08/2014] [Indexed: 01/04/2023]
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Clinical Biochemistry year in review — The clinical “good”, the analytical “bad”, and the “ugly” laboratory practices. Clin Biochem 2014; 47:255-6. [DOI: 10.1016/j.clinbiochem.2014.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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