Determination of sex-specific 99th percentile upper reference limits for a point of care high sensitivity cardiac troponin I assay
Fred S. Apple, Karen Schulz, Christian Schmidt, Trees S. Y. van Domburg, Judith M. Fonville, Femke K. de Theije
Abstract
Abstract Objectives High sensitivity (hs) cardiac troponin (cTn) assays are defined per the IFCC Committee on Clinical Application of Cardiac Biomarker (C-CB) by the ability to measure ≥ 50% of concentrations greater than the limit of detection (LoD) with an impression of ≤10% at sex-specific 99th percentiles. Our study determined the sex-specific 99th percentile upper reference limits for males and females utilizing heparinized plasma from AACC universal sample bank for the Siemens point of care (POC) Atellica ® VTLi hs-cTnI immunoassay. Methods Apparently healthy subjects, included overall 693, males 363, and females 330, following exclusionary surrogate biomarker use of hemoglobin A 1c , NT-proBNP, and eGFR, along with statin medication. hs-cTnI was measured in a central laboratory, on multiple POC Atellica ® VTLi immunoassay analyzers. The LoD was 1.24 ng/L and the 10%CV concentration was 6.7 ng/L. 99th percentile URLs were determined by the nonparametric (NP) method. Results Histograms of the hs-cTnI concentrations (ng/L) for males and females were used to visualize the distributions and concentrations in men and women and differed significantly (pre- and post-exclusion, both p <0.001). 99th percentile URLs were: overall 23 ng/L (90% CI 20–32 ng/L); male 27 ng/L (CI 21–37 ng/L); female 18 ng/L (CI 9–78 ng/L). The percentages of subjects having a measurable concentration ≥ the LoD were: overall 83.7%, male 87.3%, female 79.7%. Conclusions Our findings show the novel POC Atellica ® VTLi hs-cTnI assay meets the designation of a ‘high-sensitivity’ assay using heparinized plasma.