Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department.
Early diagnosis of myocardial infarction (MI) with cardiac troponin (cTn) assays at the point-of-care (POC) is suggested to shorten turn-around-time in the emergency department (ED). The present study aimed at comparing the diagnostic performance of two POC cTn assays with that of a central laborato...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2017-01-01
|
Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC5705122?pdf=render |
id |
doaj-922717d945d74b188cf0a6e6b1c9d36a |
---|---|
record_format |
Article |
spelling |
doaj-922717d945d74b188cf0a6e6b1c9d36a2020-11-24T22:07:25ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-011211e018870610.1371/journal.pone.0188706Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department.Petra WilkeAnnette MasuchOliver FahronStephanie ZyllaTobias LeipoldAstrid PetersmannEarly diagnosis of myocardial infarction (MI) with cardiac troponin (cTn) assays at the point-of-care (POC) is suggested to shorten turn-around-time in the emergency department (ED). The present study aimed at comparing the diagnostic performance of two POC cTn assays with that of a central laboratory high-sensitivity (hs) method, under routine ED conditions. In 2,163 non-selected ED patients suspected for MI, the diagnostic performance of the POC troponin I (TnI), troponin T (TnT), and hs-TnT assay for the prediction of MI was evaluated based on receiver operating characteristic (ROC) analyses and compared with the performance based on the manufacturers' cut-offs. Due to an observed association between renal function as determined by estimated glomerular filtration rate (eGFR) and cTn concentrations, all analyses were stratified by renal function. In patients with normal renal function (eGFR > 60 mL/min/1.73m2), POC and hs assays showed a comparable diagnostic performance as quantified by the area under the ROC curve (AUC) of about 0.88. The ROC-derived optimal cut-off (OCO) levels for the different cTn assays clearly changed with decreasing kidney function. Impaired kidney function required OCO to be three to five times higher to achieve a comparable performance. Particularly cTnT concentrations were strongly associated with renal function. The three cTn assays demonstrated equivalent diagnostic performance in ED-patients admitted with suspected ACS in relation to the release diagnosis, supporting the use of POC testing in this setting. The present results implicate that application of eGFR-specific OCOs may decrease false-positives among patients with impaired renal function. Providing individual cut-offs depending on patients' eGFR might be an appropriate add-on tool to improve specificity in the diagnosis of MI.http://europepmc.org/articles/PMC5705122?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Petra Wilke Annette Masuch Oliver Fahron Stephanie Zylla Tobias Leipold Astrid Petersmann |
spellingShingle |
Petra Wilke Annette Masuch Oliver Fahron Stephanie Zylla Tobias Leipold Astrid Petersmann Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. PLoS ONE |
author_facet |
Petra Wilke Annette Masuch Oliver Fahron Stephanie Zylla Tobias Leipold Astrid Petersmann |
author_sort |
Petra Wilke |
title |
Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. |
title_short |
Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. |
title_full |
Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. |
title_fullStr |
Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. |
title_full_unstemmed |
Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. |
title_sort |
diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2017-01-01 |
description |
Early diagnosis of myocardial infarction (MI) with cardiac troponin (cTn) assays at the point-of-care (POC) is suggested to shorten turn-around-time in the emergency department (ED). The present study aimed at comparing the diagnostic performance of two POC cTn assays with that of a central laboratory high-sensitivity (hs) method, under routine ED conditions. In 2,163 non-selected ED patients suspected for MI, the diagnostic performance of the POC troponin I (TnI), troponin T (TnT), and hs-TnT assay for the prediction of MI was evaluated based on receiver operating characteristic (ROC) analyses and compared with the performance based on the manufacturers' cut-offs. Due to an observed association between renal function as determined by estimated glomerular filtration rate (eGFR) and cTn concentrations, all analyses were stratified by renal function. In patients with normal renal function (eGFR > 60 mL/min/1.73m2), POC and hs assays showed a comparable diagnostic performance as quantified by the area under the ROC curve (AUC) of about 0.88. The ROC-derived optimal cut-off (OCO) levels for the different cTn assays clearly changed with decreasing kidney function. Impaired kidney function required OCO to be three to five times higher to achieve a comparable performance. Particularly cTnT concentrations were strongly associated with renal function. The three cTn assays demonstrated equivalent diagnostic performance in ED-patients admitted with suspected ACS in relation to the release diagnosis, supporting the use of POC testing in this setting. The present results implicate that application of eGFR-specific OCOs may decrease false-positives among patients with impaired renal function. Providing individual cut-offs depending on patients' eGFR might be an appropriate add-on tool to improve specificity in the diagnosis of MI. |
url |
http://europepmc.org/articles/PMC5705122?pdf=render |
work_keys_str_mv |
AT petrawilke diagnosticperformanceofpointofcareandcentrallaboratorycardiactroponinassaysinanemergencydepartment AT annettemasuch diagnosticperformanceofpointofcareandcentrallaboratorycardiactroponinassaysinanemergencydepartment AT oliverfahron diagnosticperformanceofpointofcareandcentrallaboratorycardiactroponinassaysinanemergencydepartment AT stephaniezylla diagnosticperformanceofpointofcareandcentrallaboratorycardiactroponinassaysinanemergencydepartment AT tobiasleipold diagnosticperformanceofpointofcareandcentrallaboratorycardiactroponinassaysinanemergencydepartment AT astridpetersmann diagnosticperformanceofpointofcareandcentrallaboratorycardiactroponinassaysinanemergencydepartment |
_version_ |
1725820575436242944 |