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Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain

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Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain. / Boeckel, Jes-Niels; Palapies, Lars; Klotsche, Jens; Zeller, Tanja; von Jeinsen, Beatrice; Perret, Maya F; Kleinhaus, Soeren L; Pieper, Lars; Tzikas, Stergios; Leistner, David; Bickel, Christoph; Stalla, Günter K; Lehnert, Hendrik; Lindahl, Bertil; Wittchen, Hans-Ulrich; Silber, Sigmund; Baldus, Stephan; Maerz, Winfried; Dimmeler, Stefanie; Blankenberg, Stefan; Münzel, Thomas; Zeiher, Andreas M; Keller, Till.

In: SCI REP-UK, Vol. 8, No. 1, 8087, 24.05.2018.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Boeckel, J-N, Palapies, L, Klotsche, J, Zeller, T, von Jeinsen, B, Perret, MF, Kleinhaus, SL, Pieper, L, Tzikas, S, Leistner, D, Bickel, C, Stalla, GK, Lehnert, H, Lindahl, B, Wittchen, H-U, Silber, S, Baldus, S, Maerz, W, Dimmeler, S, Blankenberg, S, Münzel, T, Zeiher, AM & Keller, T 2018, 'Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain', SCI REP-UK, vol. 8, no. 1, 8087. https://doi.org/10.1038/s41598-018-26120-1

APA

Boeckel, J-N., Palapies, L., Klotsche, J., Zeller, T., von Jeinsen, B., Perret, M. F., Kleinhaus, S. L., Pieper, L., Tzikas, S., Leistner, D., Bickel, C., Stalla, G. K., Lehnert, H., Lindahl, B., Wittchen, H-U., Silber, S., Baldus, S., Maerz, W., Dimmeler, S., ... Keller, T. (2018). Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain. SCI REP-UK, 8(1), [8087]. https://doi.org/10.1038/s41598-018-26120-1

Vancouver

Boeckel J-N, Palapies L, Klotsche J, Zeller T, von Jeinsen B, Perret MF et al. Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain. SCI REP-UK. 2018 May 24;8(1). 8087. https://doi.org/10.1038/s41598-018-26120-1

Bibtex

@article{2d85644e224d49fba84bd75bc9e2bd7b,
title = "Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain",
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 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.",
keywords = "Adult, Age Factors, Aged, Biomarkers/analysis, Chest Pain/blood, Cohort Studies, Diagnostic Techniques, Cardiovascular/standards, Female, Glomerular Filtration Rate, Humans, Kidney Function Tests, Male, Middle Aged, Myocardial Infarction/blood, Predictive Value of Tests, Sensitivity and Specificity, Sex Factors, Troponin I/analysis",
author = "Jes-Niels Boeckel and Lars Palapies and Jens Klotsche and Tanja Zeller and {von Jeinsen}, Beatrice and Perret, {Maya F} and Kleinhaus, {Soeren L} and Lars Pieper and Stergios Tzikas and David Leistner and Christoph Bickel and Stalla, {G{\"u}nter K} and Hendrik Lehnert and Bertil Lindahl and Hans-Ulrich Wittchen and Sigmund Silber and Stephan Baldus and Winfried Maerz and Stefanie Dimmeler and Stefan Blankenberg and Thomas M{\"u}nzel and Zeiher, {Andreas M} and Till Keller",
year = "2018",
month = may,
day = "24",
doi = "10.1038/s41598-018-26120-1",
language = "English",
volume = "8",
journal = "SCI REP-UK",
issn = "2045-2322",
publisher = "NATURE PUBLISHING GROUP",
number = "1",

}

RIS

TY - JOUR

T1 - Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain

AU - Boeckel, Jes-Niels

AU - Palapies, Lars

AU - Klotsche, Jens

AU - Zeller, Tanja

AU - von Jeinsen, Beatrice

AU - Perret, Maya F

AU - Kleinhaus, Soeren L

AU - Pieper, Lars

AU - Tzikas, Stergios

AU - Leistner, David

AU - Bickel, Christoph

AU - Stalla, Günter K

AU - Lehnert, Hendrik

AU - Lindahl, Bertil

AU - Wittchen, Hans-Ulrich

AU - Silber, Sigmund

AU - Baldus, Stephan

AU - Maerz, Winfried

AU - Dimmeler, Stefanie

AU - Blankenberg, Stefan

AU - Münzel, Thomas

AU - Zeiher, Andreas M

AU - Keller, Till

PY - 2018/5/24

Y1 - 2018/5/24

N2 - 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.

AB - 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.

KW - Adult

KW - Age Factors

KW - Aged

KW - Biomarkers/analysis

KW - Chest Pain/blood

KW - Cohort Studies

KW - Diagnostic Techniques, Cardiovascular/standards

KW - Female

KW - Glomerular Filtration Rate

KW - Humans

KW - Kidney Function Tests

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Predictive Value of Tests

KW - Sensitivity and Specificity

KW - Sex Factors

KW - Troponin I/analysis

U2 - 10.1038/s41598-018-26120-1

DO - 10.1038/s41598-018-26120-1

M3 - SCORING: Journal article

C2 - 29799020

VL - 8

JO - SCI REP-UK

JF - SCI REP-UK

SN - 2045-2322

IS - 1

M1 - 8087

ER -