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Effect of age and serum creatinine on endogenous digoxin-like substances in infants and children
Insights
Digoxin-like immunoreactive substances (DLIS) were found in 27% of pediatric patients not on digoxin. DLIS presence is age-related, appearing in a broader pediatric age range than previously understood.
Area of Science:
- Pediatric Endocrinology
- Clinical Chemistry
- Pharmacology
Background:
- Digoxin-like immunoreactive substances (DLIS) are endogenous compounds that can interfere with digoxin assays.
- Previous studies suggested DLIS is primarily found in neonates and infants.
Purpose of the Study:
- To investigate the prevalence and characteristics of DLIS in a pediatric population not receiving digoxin.
- To determine the relationship between DLIS and patient demographics (age, weight, gender, race) and serum creatinine.
Main Methods:
- Radioimmunoassay was used to measure DLIS concentrations in 374 pediatric patients (0-72 months) not on digoxin.
- Statistical analyses were performed to assess correlations between DLIS and various clinical parameters.
Main Results:
- Twenty-seven percent of patients exhibited detectable DLIS (≥0.2 ng/ml).
- DLIS-positive patients were significantly younger (P<0.01).
- A weak positive correlation was observed between DLIS and serum creatinine (r=0.22, P<0.03), but not with elevated creatinine levels.
Conclusions:
- The presence of DLIS is associated with younger age in pediatric patients.
- DLIS is present in a larger and older pediatric population than previously reported.
- DLIS prevalence is not significantly related to race or gender.
Abstract:
An apparent digoxin-like immunoreactive substance(s) (DLIS) was evaluated in 374 pediatric patients, 0 to 72 months of age, not receiving digoxin. The relationship between DLIS presence or concentration and age, weight, gender, race, and serum creatinine was investigated. Twenty-seven percent of patients had a positive apparent DLIS concentration (greater than or equal to 0.2 ng/ml). The mean +/- SD concentration of DLIS in the positive group was 0.39 +/- 0.18 ng/ml (range 0.2 to 1.37 ng/ml). Patients in the DLIS-positive group were younger than those in the negative group (P less than 0.01). Although a greater percentage of infants younger than 6 months of age had measurable DLIS, the mean DLIS concentrations, when present, were not significantly different for all age groups (P greater than 0.05). No significant relationship was found between race or gender and DLIS. A weakly positive correlation between serum creatinine concentration and DLIS was noted (r = 0.22, P less than 0.03), but elevated serum creatinine measurements (greater than 0.6 mg/dL) did not correlate with DLIS concentration. These results support the hypothesis that the presence of DLIS is age related, but DLIS appears to be present in a much larger and older population of pediatric patients than previously reported.