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Cai Q, Liu M, Xie Z, Wu M, Zhao L, Tuo W, Xie S, Xiang Y, Sun H, Yuan C, Yao C, Wang J. Specific reference interval for high-sensitivity cardiac troponin I among healthy children in Wuhan, China. Transl Pediatr 2024; 13:908-920. [PMID: 38984031 PMCID: PMC11228900 DOI: 10.21037/tp-24-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
Background Troponin (Tn) is of an important biomarker for the diagnosis and prognosis of myocardial injury and for evaluating the severity of cardiac involvement due to other systemic diseases in children. Unfortunately, high-sensitivity cardiac troponin I (hs-cTnI) specific reference intervals (RIs) are extremely limited. This study aimed to establish a preliminary pediatric hs-cTnI RI for newborns, children, and adolescents in Wuhan, China. Methods A total of 1,355 healthy participants (1 day to 19 years) were recruited from a cross-sectional study implemented in Wuhan Children's Hospital from September 2022 to August 2023. Serum hs-cTnI levels were detected via the Mindray automated chemiluminescence immunoassay analyzer (CL-6000i). Specific serum hs-cTnI RIs were established according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The RIs were defined by the nonparametric median (P50), and 2.5th, 97.5th [P50 (P2.5-P97.5)] intervals. Results Of the 1,355 pediatric participants, serum hs-cTnI concentrations of 1,332 children were measured. The serum overall P50 and 95% interval range (P2.5-P97.5) of serum hs-cTnI was 0.41 (0.00, 44.31) ng/L. This was higher in males of 0.47 (0.00, 44.90) ng/L than in females of 0.36 (0.00, 44.17) ng/L (P<0.01). Age- and sex-specific differences in hs-cTnI levels were observed. The levels were highly variable in children under 1 year of age (especially in newborns), deriving a P50 (P2.5-P97.5) of 22.06 (1.04, 154.22) ng/L, and gradually narrowed and decreased with increasing age, with a markedly lower established P50 (P2.5-P97.5) of 0.36 (0.00, 2.16) ng/L. However, the levels began to increase slightly at the age of 9-12 years and reached a small peak at the age range of 15 to 18 years in males with 0.71 (0.03, 3.29) ng/L, while females were less affected by puberty. Sex- and age-specific RIs for hs-cTnI were established: 5 age-specific RIs in males, 1 day-1 month: 30.16 (8.67, 171.81) ng/L; >1-12 months: 13.20 (0.63, 61.91) ng/L; >1-15 years: 0.36 (0.00, 1.86) ng/L; >15-18 years: 0.71 (0.03, 3.29) ng/L; >18-19 years: 0.52 (0.00, 1.92) ng/L; and 4 age-specific RIs in females, 1 day-1 month: 43.93 (18.82, 146.38) ng/L; >1-12 months: 5.22 (0.92, 42.54) ng/L; >1-6 years: 0.54 (0.00, 2.74) ng/L; >6-19 years: 0.23 (0.00, 1.56) ng/L. Conclusions This study preliminarily established age- and sex-specific serum hs-cTnI RIs using the Mindray CL-6000i system in healthy children in Wuhan, China.
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Affiliation(s)
- Qinzhen Cai
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Mei Liu
- Department of Laboratory Medicine, Wuhan Hankou Hospital, Wuhan, China
| | - Zhen Xie
- Department of Laboratory Medicine, the Fifth Hospital of Wuhan, Wuhan, China
| | - Mo Wu
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lun Zhao
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Wenbin Tuo
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Si Xie
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yun Xiang
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hong Sun
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Chunhui Yuan
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Cong Yao
- Health Care Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Jun Wang
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Tiwari D, Aw TC. Optimizing the Clinical Use of High-Sensitivity Troponin Assays: A Review. Diagnostics (Basel) 2023; 14:87. [PMID: 38201396 PMCID: PMC10795745 DOI: 10.3390/diagnostics14010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Ischemic heart diseases (IHDs) remain a global health concern. Many IHD cases go undiagnosed due to challenges in the initial diagnostic process, particularly in cases of acute myocardial infarction (AMI). High-sensitivity cardiac troponin (hs-cTn) assays have revolutionized myocardial injury assessment, but variations in diagnostic cut-off values and population differences have raised challenges. This review addresses essential laboratory and clinical considerations for hs-cTn assays. Laboratory guidelines discuss the importance of establishing standardized 99th-percentile upper reference limits (URLs) considering factors such as age, sex, health status, and analytical precision. The reference population should exclude individuals with comorbidities like diabetes and renal disease, and rigorous selection is crucial. Some clinical guidelines emphasize the significance of sex-specific URL limits while others do not. They highlight the use of serial troponin assays for AMI diagnosis. In addition, timely reporting of accurate hs-cTn results is essential for effective clinical use. This review aims to provide a clearer understanding among laboratory professionals and clinicians on how to optimize the use of hs-cTn assays in clinical settings in order to ensure accurate AMI diagnosis and thus improve patient care and outcomes.
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Affiliation(s)
- Dipti Tiwari
- Independent Researcher, Singapore 069046, Singapore;
| | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore 119228, Singapore
- Pathology Academic Clinical Program, Duke-NUS Graduate School of Medicine, Singapore 169857, Singapore
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Liu C, Deng Z, Wu W, Li Y, Yang F, Ge R, Ge M, Niu S, Liu H, Ji L, Li X, Huang X, Yusufu D, Zhang X. Ethnicity and sex-specific 99th percentile upper reference limits of high-sensitivity cardiac troponin I among adults in Xinjiang, China. Clin Biochem 2023; 116:94-99. [PMID: 37084997 DOI: 10.1016/j.clinbiochem.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES To determine the 99th percentile upper reference limit (URL) of high-sensitivity cardiac troponin I (hs-cTnI) in a healthy population in Xinjiang, China, and investigate the impact of ethnicity, sex, and age on this limit. DESIGN AND METHODS From September 2018 to March 2022, 5,090 Han and Uyghur adults aged 20-79 years were recruited. After questionnaire screening, 2,970 participants with physical and/or laboratory normality were enrolled. Participants recruited between September 2018 and October 2021 (2,109/2,970) were evaluated by ARCHITECTi2000 to determine the 99th percentile URL of hs-cTnI. The results were then validated in 861/2,970 participants recruited from November 2021 to March 2022. A criterion of ≤10% of test results falling outside the original determined value was used to determine whether the newly established reference intervals were valid. RESULTS The hs-cTnI concentration was higher among Uyghurs than among Han participants (p<0.001). The 99th percentile URLs were 17.52 ng/L for all participants, 18.96 ng/L for Uyghur, and 16.93 ng/L for Han. Hs-cTnI concentration was also correlated with sex and age. In the Han and Uyghur groups, male participants had a higher hs-cTnI concentration than female participants (p<0.001); the 99th percentile URLs of hs-cTnI among male and female participants were 17.80 vs. 13.67 ng/L and 19.47 vs. 16.52 ng/L, respectively. Stratified by age, hs-cTnI concentrations were higher in participants aged >60 years than in those of other age categories (p<0.001), in both the Han and Uyghur groups. Finally, <2% of these test results exceeded the newly established reference, validating the results. CONCLUSIONS This study established the 99th percentile URLs of hs-cTnI in the Xinjiang. Ethnicity and sex influence the value and should be considered.
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Affiliation(s)
- Chunyan Liu
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Zhaohui Deng
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Wenli Wu
- Department of Clinical Laboratory, Fourth Division Hospital of Xinjiang Production and Construction Corps, No. 56, Xinhua West Road, Yining, Xinjiang, China.
| | - Yan Li
- Department of Clinical Laboratory, Fourth Division Hospital of Xinjiang Production and Construction Corps, No. 56, Xinhua West Road, Yining, Xinjiang, China.
| | - Fang Yang
- Department of Clinical Laboratory, Tumushuke General Hospital of the Third Division of Xinjiang Production and Construction Corps, No. 13, Qianhai East Street, Tumushuke, Xinjiang, China.
| | - Ruoqing Ge
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Min Ge
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Shumin Niu
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Huimin Liu
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Linlin Ji
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Xin Li
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
| | - Xibei Huang
- Department of Clinical Laboratory, Fourth Division Hospital of Xinjiang Production and Construction Corps, No. 56, Xinhua West Road, Yining, Xinjiang, China.
| | - Dilibaier Yusufu
- Department of Clinical Laboratory, Tumushuke General Hospital of the Third Division of Xinjiang Production and Construction Corps, No. 13, Qianhai East Street, Tumushuke, Xinjiang, China.
| | - Xin Zhang
- Department of Clinical Laboratory, Hospital of Xinjiang Production and Construction Corps, No. 232, Qingnian Road, Tianshan District, Urumqi, Xinjiang, China.
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