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True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study

True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study
True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study
Objective To determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital.

Design Prospective, observational cohort study.

Setting University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017.

Participants 20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons.

Main outcome measures Distribution of hs-cTnI concentrations of all study participants and specifically the 99th centile.

Results The 99th centile of hs-cTnI for the whole population was 296 ng/L compared with the manufacturer’s quoted level of 40 ng/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng/L for the remainder (n=18 171). The 99th centile was 563 ng/L for inpatients (n=4759) and 65 ng/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN.

Conclusions Of 20 000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation.

Trial registration Clinicaltrials.gov NCT03047785.
0959-8138
Mariathas, Mark
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Allan, Rick
2726ab31-1430-4275-becc-461fb4023442
Ramamoorthy, Sanjay
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Olechowski, Bartosz
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Hinton, Jonathan
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Azor, Martin
f857a719-496d-4b79-b28a-17af196a95d8
Nicholas, Zoe
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Calver, Alison
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Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Mahmoudi, Michael
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Rawlins, John
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Simpson, Iain
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Wilkinson, James
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Kwok, Chun Shing
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Cook, Paul
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Mamas, Mamas A.
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Curzen, Nick
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Mariathas, Mark
e8dbbe0d-d303-41a4-a5a2-fa8900accfe6
Allan, Rick
2726ab31-1430-4275-becc-461fb4023442
Ramamoorthy, Sanjay
b0d15032-4158-4661-8124-58071e8dc900
Olechowski, Bartosz
b58fef3a-4f2f-4970-aad5-c5e68fc932c3
Hinton, Jonathan
2e15a197-77ec-4f89-9b08-f632800837f0
Azor, Martin
f857a719-496d-4b79-b28a-17af196a95d8
Nicholas, Zoe
98403583-c418-45ad-836b-1831517dcc5f
Calver, Alison
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Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Mahmoudi, Michael
f6a55246-399e-4f81-944e-a4b169786e8a
Rawlins, John
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Simpson, Iain
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Wilkinson, James
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Kwok, Chun Shing
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Cook, Paul
538d8580-5ef0-4644-8dc4-733f5014e4c8
Mamas, Mamas A.
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Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4

Mariathas, Mark, Allan, Rick, Ramamoorthy, Sanjay, Olechowski, Bartosz, Hinton, Jonathan, Azor, Martin, Nicholas, Zoe, Calver, Alison, Corbett, Simon, Mahmoudi, Michael, Rawlins, John, Simpson, Iain, Wilkinson, James, Kwok, Chun Shing, Cook, Paul, Mamas, Mamas A. and Curzen, Nick (2019) True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study. The BMJ, 364 (8191), [l729]. (doi:10.1136/bmj.l729).

Record type: Article

Abstract

Objective To determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital.

Design Prospective, observational cohort study.

Setting University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017.

Participants 20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons.

Main outcome measures Distribution of hs-cTnI concentrations of all study participants and specifically the 99th centile.

Results The 99th centile of hs-cTnI for the whole population was 296 ng/L compared with the manufacturer’s quoted level of 40 ng/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng/L for the remainder (n=18 171). The 99th centile was 563 ng/L for inpatients (n=4759) and 65 ng/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN.

Conclusions Of 20 000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation.

Trial registration Clinicaltrials.gov NCT03047785.

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More information

Accepted/In Press date: 8 February 2019
e-pub ahead of print date: 13 March 2019
Published date: 16 March 2019

Identifiers

Local EPrints ID: 428331
URI: http://eprints.soton.ac.uk/id/eprint/428331
ISSN: 0959-8138
PURE UUID: ee05190a-f326-4bf0-b19b-416e0baae7ab
ORCID for Michael Mahmoudi: ORCID iD orcid.org/0000-0003-1293-8461
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 21 Feb 2019 17:30
Last modified: 06 Jun 2024 04:03

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Contributors

Author: Mark Mariathas
Author: Rick Allan
Author: Sanjay Ramamoorthy
Author: Bartosz Olechowski
Author: Jonathan Hinton
Author: Martin Azor
Author: Zoe Nicholas
Author: Alison Calver
Author: Simon Corbett
Author: John Rawlins
Author: Iain Simpson
Author: James Wilkinson
Author: Chun Shing Kwok
Author: Paul Cook
Author: Mamas A. Mamas
Author: Nick Curzen ORCID iD

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