Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain

Autor: Lars Pieper, Jens Klotsche, Stefan Blankenberg, Stephan Baldus, David M. Leistner, Till Keller, Hans-Ulrich Wittchen, Christoph Bickel, Stergios Tzikas, Soeren L. Kleinhaus, Hendrik Lehnert, Sigmund Silber, Stefanie Dimmeler, Jes-Niels Boeckel, Tanja Zeller, Andreas M. Zeiher, Bertil Lindahl, Lars Palapies, Thomas Münzel, Günter K. Stalla, Maya F. Perret, Winfried Maerz, Beatrice von Jeinsen
Přispěvatelé: Martinson, Elizabeth
Rok vydání: 2018
Předmět:
Male
Diagnostic Techniques
Cardiovascular
Myocardial Infarction
lcsh:Medicine
030204 cardiovascular system & hematology
Chest pain
Kidney Function Tests
Cohort Studies
0302 clinical medicine
Troponin I
Cardiac and Cardiovascular Systems
030212 general & internal medicine
Myocardial infarction
lcsh:Science
education.field_of_study
Multidisciplinary
Kardiologi
Age Factors
Middle Aged
musculoskeletal system
Cardiology
cardiovascular system
Female
medicine.symptom
Glomerular Filtration Rate
Adult
Acute coronary syndrome
medicine.medical_specialty
Chest Pain
Population
Renal function
macromolecular substances
Sensitivity and Specificity
Article
03 medical and health sciences
Sex Factors
Predictive Value of Tests
Internal medicine
medicine
Humans
ddc:610
cardiovascular diseases
education
Aged
Receiver operating characteristic
business.industry
lcsh:R
medicine.disease
Heart failure
lcsh:Q
business
Biomarkers
Zdroj: Scientific Reports
SCIENTIFIC REPORTS
Scientific Reports, Vol 8, Iss 1, Pp 1-9 (2018)
ISSN: 2045-2322
Popis: 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 rage = 0.436/0.518 and with reGFR = −0.142/−0.207. For adjustment, these variables served as covariates in a linear regression model with cTnI 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.
Databáze: OpenAIRE
Externí odkaz: