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The applied statistical approach highly influences the 99th percentile of cardiac troponin I
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. (Bertil Lindahl)
Hennepin Cty Med Ctr, Dept Lab Med & Pathol, Minneapolis, MN 55415 USA;Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN USA .
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
2016 (English)In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 49, no 15, 1109-1112 p.Article in journal (Refereed) Published
Abstract [en]

Background

Cardiac troponin (cTn) is the biomarker of choice for assessment of patients with acute coronary syndromes. Guidelines recommend the cTn 99th percentile derived from a cardiovascular healthy reference population as decision threshold. The importance of standardized criteria for the composition of such a reference population is well acknowledged. In this analysis, we investigated to which extent different statistical methods might have bearing on the calculated cTnI 99th percentile.

Methods

cTnI (Abbott) 99th percentiles were determined in 521 cardiovascular healthy community-dwelling subjects using the nonparametric method, the Harrell-Davis bootstrap method and the robust method together with different tests to identify potential outliers (Dixon, Tukey, Reed) and different statistical softwares.

Results

The cTnI 99th percentiles (nonparametric method) were 37 ng/L (total population), 42 ng/L (men) and 25 ng/L (women). These estimates differed by − 7.4% to + 5.7% using the Harrell-Davis bootstrap method and were up to 64.1% lower using the robust method. For the robust method, cTnI 99th percentiles varied by 44.2% depending on the applied software. The method of Tukey classified nine subjects as outliers while no outlier was detected using the other methods. Excluding these nine subjects resulted in up to 60.2% lower cTnI 99th percentiles.

Conclusions

Our results emphasize the need of a standardized statistical approach to calculate cTnI 99th percentiles. Our findings support the use of the nonparametric method and a conservative approach to detect outliers. This requires that the assessed population is sufficiently large and well selected on the basis of stringently applied clinical criteria.

Place, publisher, year, edition, pages
2016. Vol. 49, no 15, 1109-1112 p.
Keyword [en]
Cardiac troponin; Upper reference level; 99th percentile; Statistics
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:uu:diva-307339DOI: 10.1016/j.clinbiochem.2016.08.012ISI: 000385329700003PubMedID: 27556285OAI: oai:DiVA.org:uu-307339DiVA: diva2:1046223
Funder
Swedish Heart Lung Foundation, 20100947The Swedish Medical Association, SLS-248691 SLS-407281
Available from: 2016-11-12 Created: 2016-11-12 Last updated: 2016-11-22Bibliographically approved

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