Assessment of the 99th or 97.5th Percentile for Cardiac Troponin I in a Healthy Pediatric Cohort

[摘要] To the Editor:Recent publications on high-sensitivity cardiac troponin in Clinical Chemistry have detailed how to derive an appropriate 99th percentile cutoff (1), highlighted its impact on health outcomes (2), and even questioned the 99th percentile in the diagnosis of acute coronary syndrome (3). Much attention has focused on the selection of a “healthy population,” with differences in high-sensitivity cardiac troponin T (hs-cTnT)1 and hs-cTnI concentrations being evident between sexes in the adult population (1). Accordingly, it is plausible that biological differences in high-sensitivity cardiac troponin concentrations between ethnic groups may also be apparent. This issue has recently been addressed via the study by Gaggin and colleagues, who found no significant difference in hs-cTnT concentrations in a US population (i.e., 98.8% with concentrations <14.0 ng/L) vs a Vietnamese population (98.1% with concentrations <14.0 ng/L) (4). Unfortunately, it is not clear why the derived 99th percentile in the Vietnamese population (19.0 ng/L) was higher than in the US population (15.1 ng/L). The authors noted that there were 3 additional Vietnamese participants with concentrations above the 99th percentile, yet it is unclear whether common statistical techniques were used to remove potential outliers. Although there are publications emphasizing additional laboratory and imaging tests required to define a healthy population (1, 3), there have been no recommendations made regarding what statistical tests to use …

[学科分类] 过敏症与临床免疫学