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Green AD, Lee GR. An appraisal of the practice of duplicate testing for the detection of irregular analytical errors. Clin Chem Lab Med 2024; 62:627-634. [PMID: 37942778 DOI: 10.1515/cclm-2022-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Our study aimed to determine the usefulness of duplicate testing in identifying irregular analytical errors and subsequent prevention of patient mismanagement. METHODS In our laboratory, all requests for Na+, Ca2+, alkaline phosphatase (ALP), and high-sensitivity cardiac-troponin-I (hs-cTnI) are run in duplicate. Data from four separate weeks for Na+ (n=21,649), Ca2+ (n=14,803) and ALP (n=19,698); and a full year for hs-cTnI (n=17,036) were gathered. For each test, pre-defined limits for differences between duplicates were used to identify erroneous results (Fliers). We further characterised a subset of such fliers as "critical errors", where duplicates fell on opposing sides of a reference/decision making threshold. The costs/benefits of running these tests in duplicate were then considered in light of increased number of tests analysed by this approach. RESULTS For Na+, 0.03 % of duplicates met our flier defining criteria, and 0.01 % of specimens were considered critical errors. For Ca2+ requests, 4.58 % of results met our flier defining criteria and 0.84 % were critical errors. For ALP, 0.22 % of results were fliers, and 0.01 % were critical errors. For hs-cTnI, 1.58 % of results were classified as fliers, whilst 0.14 % were classified as a critical error. Depending on the test in question, running all analyses in duplicate increased annual costs by as little as €1,100 (for sodium), and as much as €48,000 (for hs-cTnI). CONCLUSIONS Duplicate testing is effective at identifying and mitigating irregular laboratory errors, and is best suited for assays predisposed to such error, where costs are minimal, and clinical significance of an incorrect result can justify the practice.
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Affiliation(s)
- Alastair D Green
- Department of Clinical Biochemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Graham R Lee
- Department of Clinical Biochemistry and Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
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2
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Zhang L, Zhu J, Zhang S, Fu H. Investigating outlier rates of cardiac troponin I and troponin T assays: A systematic review. Heliyon 2024; 10:e23788. [PMID: 38205298 PMCID: PMC10776999 DOI: 10.1016/j.heliyon.2023.e23788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives This review aimed to harmoniously summarize and compare outlier rates for various cardiac troponin (cTn) assays, including high-sensitivity-cTn (hs-cTn) assays and contemporary cTn (generation of assays prior to hs-cTn ones) assays, from the published studies. Methods The PRISMA guidelines were utilized to perform this systematic review. Five databases, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, were searched using specific keywords up to June 30th, 2023. Studies reporting specifically calculated outlier rates for cTn assays when conducting in-vitro diagnosis in human samples were included. Selected studies were then further assessed using the GRADE tool. Results Thirteen studies were included. The data from the studies were summarized statistically in this review. The results showed substantial evidence of improved analytical robustness or reduced respective mean rates of outliers, critical outliers, and analytical outliers for hs-cTn assays (0.14 %, 0.18 %, and 0.18 %) compared to contemporary cTn assays (0.63 %, 0.71 %, and 0.50 %). Conclusion The findings offer promisingly provide a comprehensive reference for laboratory scientists and clinical staff in choosing the most suitable cTn assay for patient care regrading outlier rates. Besides, this review reveals the advancements of hs-cTn assays with lower outlier rates than contemporary cTn assays. The emerging challenges for continuously improving analytical robustness of cTn assays are also elaborated.
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Affiliation(s)
- Litao Zhang
- Clinical Laboratory, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430000, China
| | - Jia Zhu
- School of Intelligent Manufacturing and Smart Transportation, Suzhou City University, Suzhou, Jiangsu 215000, China
- School of Advanced Technology, Xi'an Jiaotong-Liverpool University, Suzhou, Jiangsu 215000, China
| | - Shiqiang Zhang
- School of Intelligent Manufacturing and Smart Transportation, Suzhou City University, Suzhou, Jiangsu 215000, China
| | - Hao Fu
- Mindray Medical International Ltd., Shenzhen, Guangdong 518000, China
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3
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Kleemeier S, Abildgaard A, Ladefoged SA, Thorsted Sørensen J, Stengaard C, Adelborg K. High-sensitivity troponin T and I in patients suspected of acute myocardial infarction. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:96-103. [DOI: 10.1080/00365513.2022.2033310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Steffan Kleemeier
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anders Abildgaard
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Ben Gharbia A, Rekik B, Ben Marzouk S, Maghrebi H. Prognostic value of highly-sensitive troponin in preeclampsia. LA TUNISIE MEDICALE 2022; 100:270-275. [PMID: 36005920 PMCID: PMC9387643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pre-eclampsia is a pregnancy complication leading to significant morbidity and mortality. High-sensitivity troponin (hs-cTnI ) is one of the most sensitive cardiac biomarkers, but its variation in preeclampsia remains poorly studied. AIM To assess the prognostic value of hyper-sensitive troponin in preeclampsia. METHODS It was a prospective study including patients with preeclampsia. The exclusion criteria included conditions that may cause an elevation of hs-cTnI. Preoperative laboratory assessment included the determination of the level of hs-cTnI. The discriminative value of the preoperative hs-cTnI allowing to predict the onset of complications was evaluated by the ROC curve. Group A included patients whose rate was above the calculated cutoff, and group B included the others. RESULTS Seventy seven patients were included. Complications occurred in 22% of cases. The preoperative hs-cTnI cutoff of 6.3 ng/l predicted the onset of complications (sensitivity 70.6% / specificity 86.6% / p < 0.0001). There was a higher rate of severe pre-eclampsia and complications, a higher systolic and mean arterial blood pressure values in group A with significant differences. Both groups were comparable demographically, obstetrically, clinically and biologically. CONCLUSION According to the results of our study, increased values of preoperative hs-cTnI may predict the onset of complications in pregnancies complicated by preeclampsia.
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Affiliation(s)
- Abderrahmen Ben Gharbia
- 1. Centre de maternité et de néonatologie de Tunis / université Tunis el Manar / Faculté de médecine de Tunis
| | - Bassem Rekik
- 2. Service de cardiologie de la Rabta / université Tunis el Manar / Faculté de médecine de Tunis
| | - Sofiene Ben Marzouk
- 1. Centre de maternité et de néonatologie de Tunis / université Tunis el Manar / Faculté de médecine de Tunis
| | - Hayen Maghrebi
- 1. Centre de maternité et de néonatologie de Tunis / université Tunis el Manar / Faculté de médecine de Tunis
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Yuan Z, Wang L, Chen J, Su W, Li A, Su G, Liu P, Zhou X. Electrochemical strategies for the detection of cTnI. Analyst 2021; 146:5474-5495. [PMID: 34515706 DOI: 10.1039/d1an00808k] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute myocardial infarction (AMI) is the main cause of death from cardiovascular diseases. Thus, early diagnosis of AMI is essential for the treatment of irreversible damage from myocardial infarction. Traditional electrocardiograms (ECG) cannot meet the specific detection of AMI. Cardiac troponin I (cTnI) is the main biomarker for the diagnosis of myocardial infarction, and the detection of cTnI content has become particularly important. In this review, we introduced and compared the advantages and disadvantages of various cTnI detection methods. We focused on the analysis and comparison of the main indicators and limitations of various cTnI biosensors, including the detection range, detection limit, specificity, repeatability, and stability. In particular, we pay more attention to the application and development of electrochemical biosensors in the diagnosis of cardiovascular diseases based on different biological components. The application of electrochemical microfluidic chips for cTnI was also briefly introduced in this review. Finally, this review also briefly discusses the unresolved challenges of electrochemical detection and the expectations for improvement in the detection of cTnI biosensing in the future.
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Affiliation(s)
- Zhipeng Yuan
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
| | - Li Wang
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
| | - Jun Chen
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
| | - Weiguang Su
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
| | - Anqing Li
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
| | - Guosheng Su
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
| | - Pengbo Liu
- Advanced Micro and Nano-instruments Center, School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China. .,Shandong Institute of Mechanical Design and Research, Jinan 250353, China
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Favresse J, Bayart JL, Gruson D, Bernardini S, Clerico A, Perrone M. The underestimated issue of non-reproducible cardiac troponin I and T results: case series and systematic review of the literature. Clin Chem Lab Med 2021; 59:1201-1211. [PMID: 33554552 DOI: 10.1515/cclm-2020-1564] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI). Pre-analytical or analytical issues and interferences affecting troponin T and I assays are therefore of major concern given the risk of misdiagnosis. False positive troponin results have been related to various interferences including anti-troponin antibodies, heterophilic antibodies, or elevated alkaline phosphatase level. On the other hand, false negative results have been reported in the case of a large biotin intake. These interferences are characterized with erroneous but reproducible troponin results. Of interest, non-reproducible results have also been reported in the literature. In other words, if the sample is reanalyzed a second time, a significant difference in troponin results will be observed. These interferences have been named "fliers" or "outliers". Compared to the biotin interference that received major attention in the literature, troponin outliers are also able to induce harmful clinical consequences for the patient. Moreover, the prevalence of outliers in recent studies was found to be higher (0.28-0.57%) compared to the biotin interference. The aim of this systematic review is to warn clinicians about these non-reproducible results that may alter their clinical judgment. Four case reports that occurred in the Clinique of Saint-Luc Bouge are presented to attest this point. Moreover, we aimed at identifying the nature of these non-reproducible troponin results, determining their occurrence, and describing the best way for their identification.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - Jean-Louis Bayart
- Department of Laboratory Medicine, Cliniques Saint-Pierre, Ottignies, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc et Université Catholique de Louvain, Woluwé-Saint-Lambert, Bruxelles, Belgium
| | - Sergio Bernardini
- Department of Clinical Biochemistry and Clinical Molecular Biology, University of Rome Tor Vergata, Rome, Italy
| | - Aldo Clerico
- CNR-Regione Toscana G. Monasterio Foundation, Heart Hospital, Massa, Italy
- Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Perrone
- Department of Cardiology, University of Rome Tor Vergata, Rome, Italy
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Adamson PD, McAllister D, Pilbrow A, Pickering JW, Poppe K, Shah A, Whalley G, Ellis C, Mills NL, Newby DE, Pemberton C, Troughton RW, Doughty RN, Richards AM. Convalescent troponin and cardiovascular death following acute coronary syndrome. Heart 2019; 105:1717-1724. [PMID: 31337669 PMCID: PMC6855795 DOI: 10.1136/heartjnl-2019-315084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES High-sensitivity cardiac troponin testing is used in the diagnosis of acute coronary syndromes but its role during convalescence is unknown. We investigated the long-term prognostic significance of serial convalescent high-sensitivity cardiac troponin concentrations following acute coronary syndrome. METHODS In a prospective multicentre observational cohort study of 2140 patients with acute coronary syndrome, cardiac troponin I concentrations were measured in 1776 patients at 4 and 12 months following the index event. Patients were stratified into three groups according to the troponin concentration at 4 months using the 99th centile (women>16 ng/L, men>34 ng/L) and median concentration of those within the reference range. The primary outcome was cardiovascular death. RESULTS Troponin concentrations at 4 months were measurable in 99.0% (1759/1776) of patients (67±12 years, 72% male), and were ≤5 ng/L (median) and >99th centile in 44.8% (795) and 9.3% (166), respectively. There were 202 (11.4%) cardiovascular deaths after a median of 4.8 years. After adjusting for the Global Registry of Acute Coronary Events score, troponin remained an independent predictor of cardiovascular death (HR 1.4, 95% CI 1.3 to 1.5 per doubling) with the highest risk observed in those with increasing concentrations at 12 months. Patients with 4-month troponin concentrations >99th centile were at increased risk of cardiovascular death compared with those ≤5 ng/L (29.5% (49/166) vs 4.3% (34/795); adjusted HR 4.9, 95% CI 3.8 to 23.7). CONCLUSIONS Convalescent cardiac troponin concentrations predict long-term cardiovascular death following acute coronary syndrome. Recognising this risk by monitoring troponin may improve targeting of therapeutic interventions. TRIAL REGISTRATION NUMBER ACTRN12605000431628;Results.
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Affiliation(s)
- Philip D Adamson
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Anna Pilbrow
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Katrina Poppe
- Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
| | - Anoop Shah
- BHF/University Centre for Cardiovascular Science, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gillian Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Chris Ellis
- Cardiology, Greenlane CVS Services, Auckland City Hospital, Auckland, New Zealand
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Sciences, The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Chris Pemberton
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard W Troughton
- Cardiology, Christchurch Hospital, Christchurch, New Zealand
- Medicine, University of Otago, Christchurch, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
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Zhelev Z, Ohtake H, Iwata M, Terasawa T, Rogers M, Peters JL, Hyde C. Diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to triage patients suspected of acute non-ST-segment elevation myocardial infarction: a systematic review protocol. BMJ Open 2019; 9:e026012. [PMID: 30928947 PMCID: PMC6475186 DOI: 10.1136/bmjopen-2018-026012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Although the new generation of cardiac troponin assays have revolutionised the diagnosis of myocardial infarction (MI), their application in triaging patients with suspected acute coronary syndrome requires further investigation. The objectives of the current systematic review are to evaluate the diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to identify patients with non-ST-segment-elevation MI in the emergency department. METHODS AND ANALYSIS We will conduct systematic searches of MEDLINE, EMBASE, Science Citation Index, the Cochrane Database of Systematic Reviews and the CENTRAL database covering the period from 1 January 2006 to present, with no restrictions on language or publication status. Two review authors will independently screen studies for inclusion, extract data from eligible studies and assess their methodological quality using Quality Assessment of Diagnostic Accuracy Studies version 2. Studies will be included if they evaluate contemporary or high-sensitivity cardiac troponin assays used in serial testing, in patients presenting to the ED with suspicion of MI. Estimates of sensitivity and specificity from each study will be presented in forest plots and in the receiver-operating characteristics space. If appropriate, we will pool the results using Bayesian hierarchical models that allow correction for imperfect reference standard. We will obtain summary estimates of sensitivity and specificity of alternative testing protocols and compare their accuracy. We will also investigate the impact of prespecified sources of heterogeneity and methodological quality items. If pooling of results is considered inappropriate, we will present our findings in tables and diagrams and will describe them narratively. ETHICS AND DISSEMINATION No formal ethical approval will be sought, but we will report on the ethical approval of the included studies. Dissemination of findings will be through publications in peer-reviewed journals, presentations at conferences and the websites of the universities. PROSPERO REGISTRATION NUMBER CRD42018106379.
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Affiliation(s)
- Zhivko Zhelev
- Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Hirotaka Ohtake
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mitsunaga Iwata
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Teruhiko Terasawa
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Morwenna Rogers
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jaime L Peters
- Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Exeter Test Group, University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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9
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Morton A, Morton A. High sensitivity cardiac troponin I levels in preeclampsia. Pregnancy Hypertens 2018; 13:79-82. [DOI: 10.1016/j.preghy.2018.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/15/2022]
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10
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Kozinski M, Krintus M, Kubica J, Sypniewska G. High-sensitivity cardiac troponin assays: From improved analytical performance to enhanced risk stratification. Crit Rev Clin Lab Sci 2017; 54:143-172. [DOI: 10.1080/10408363.2017.1285268] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Marek Kozinski
- Department of Principles of Clinical Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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Love SA, Sandoval Y, Smith SW, Nicholson J, Cao J, Ler R, Schulz K, Apple FS. Incidence of Undetectable, Measurable, and Increased Cardiac Troponin I Concentrations Above the 99th Percentile Using a High-Sensitivity vs a Contemporary Assay in Patients Presenting to the Emergency Department. Clin Chem 2016; 62:1115-9. [PMID: 27324737 DOI: 10.1373/clinchem.2016.256305] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/05/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We compared the incidence of undetectable [below the limit of detection (LoD)], measurable (LoD to 99th percentile), and increased cardiac troponin I (cTnI) concentrations above the 99th percentile between Abbott high-sensitivity cTnI (hs-cTnI) and contemporary cTnI assays in a US emergency department population. METHODS Patients (n = 2100) presenting to the emergency department who had serial cTnI (0, 3, 6, 9 h) measurements ordered on clinical indication were enrolled. Contemporary cTnI [Abbott Architect used clinically; 99th percentile: 0.030 μg/L (30 ng/L)] and hs-cTnI [Abbott investigational; sex-specific 99th percentiles: female (F) 16 ng/L, male (M) 34 ng/L] assays simultaneously measured fresh EDTA plasma. RESULTS The hs-cTnI assay measured fewer undetectable cTnI concentrations compared to the contemporary cTnI assay across baseline (F: 31% vs 47%, M: 22% vs 40%) and serial (F: 21% vs 46%; M: 19% vs 54%) measurements. Conversely, the proportion of measurable cTnI concentrations was higher using hs-cTnI compared to contemporary cTnI assay across both baseline (F: 46% vs 31%; M: 60% vs 33%) and serial (F: 48% vs 28%; M: 83% vs 40%) measurements. The overall proportion of patients with increased cTnI concentrations above the 99th percentile was not significantly different between the contemporary (31%) and hs-cTnI (26%) assays (P = 0.09). CONCLUSIONS In patients presenting to the emergency department, the use of the Abbott hs-cTnI assay provides clinicians with more numeric cTnI concentrations. This occurs via a shift from results below the LoD to those between the LoD and the 99th percentile and does not increase in the number of cTnI concentrations above the 99th percentile.
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Affiliation(s)
- Sara A Love
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, and University of Minnesota, Minneapolis, MN;
| | - Yader Sandoval
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and Minneapolis Heart Institute, Abbott-Northwestern Hospital, Minneapolis, MN
| | - Stephen W Smith
- Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN
| | - Jennifer Nicholson
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, MN
| | - Jing Cao
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Ranka Ler
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Karen Schulz
- Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, and University of Minnesota, Minneapolis, MN; Cardiac Biomarkers Trials Laboratory (CBTL), Minneapolis Medical Research Foundation, Minneapolis, MN
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