Boeckel, Jes-Niels, Palapies, Lars, Klotsche, Jens, Zeller, Tanja, von Jeinsen, Beatrice, Perret, Maya F., Kleinhaus, Soeren L., Pieper, Lars, Tzikas, Stergios ORCID: 0000-0002-7811-5620, Leistner, David, Bickel, Christoph, Stalla, Guenter K., Lehnert, Hendrik, Lindahl, Bertil, Wittchen, Hans-Ulrich, Silber, Sigmund, Baldus, Stephan, Maerz, Winfried, Dimmeler, Stefanie, Blankenberg, Stefan, Muenzel, Thomas, Zeiher, Andreas M. and Keller, Till (2018). Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain. Sci Rep, 8. LONDON: NATURE PUBLISHING GROUP. ISSN 2045-2322

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Abstract

The use of cardiac troponins (cTn) is the gold standard for diagnosing myocardial infarction. Independent of myocardial infarction (MI), however, sex, age and kidney function affect cTn levels. Here we developed a method to adjust cTnI levels for age, sex, and renal function, maintaining a unified cut-off value such as the 99th percentile. A total of 4587 individuals enrolled in a prospective longitudinal study were used to develop a model for adjustment of cTn. cTnI levels correlated with age and estimated glomerular filtration rate (eGFR) in males/females with r(age) = 0.436/0.518 and with (r)(eGFR) = -0.142/-0.207. For adjustment, these variables served as covariates in a linear regression model with cTnl as dependent variable. This adjustment model was then applied to a real-world cohort of 1789 patients with suspected acute MI (AMI) (N = 407). Adjusting cTnI showed no relevant loss of diagnostic information, as evidenced by comparable areas under the receiver operator characteristic curves, to identify AMI in males and females for adjusted and unadjusted cTnI. In specific patients groups such as in elderly females, adjusting cTnI improved specificity for AMI compared with unadjusted cTnI. Specificity was also improved in patients with renal dysfunction by using the adjusted cTnI values. Thus, the adjustments improved the diagnostic ability of cTnI to identify AMI in elderly patients and in patients with renal dysfunction. Interpretation of cTnI values in complex emergency cases is facilitated by our method, which maintains a single diagnostic cut-off value in all patients.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Boeckel, Jes-NielsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palapies, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Klotsche, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeller, TanjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Jeinsen, BeatriceUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Perret, Maya F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kleinhaus, Soeren L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pieper, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tzikas, StergiosUNSPECIFIEDorcid.org/0000-0002-7811-5620UNSPECIFIED
Leistner, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bickel, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stalla, Guenter K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lehnert, HendrikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lindahl, BertilUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wittchen, Hans-UlrichUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Silber, SigmundUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maerz, WinfriedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dimmeler, StefanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Blankenberg, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muenzel, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeiher, Andreas M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Keller, TillUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-186009
DOI: 10.1038/s41598-018-26120-1
Journal or Publication Title: Sci Rep
Volume: 8
Date: 2018
Publisher: NATURE PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 2045-2322
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE MYOCARDIAL-INFARCTION; EARLY-DIAGNOSIS; HEART-FAILURE; ASSAY; PREVALENCE; RISK; AGE; ELEVATION; DISEASEMultiple languages
Multidisciplinary SciencesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/18600

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