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Establishment of reference intervals for 41 serum biochemical analytes in healthy Chinese children
Qinlan Liu1, Xiufa Zhang1, Ling Zhuang1
1Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, No.56, Yulv Road, Bao'an District, Shenzhen, 518100, China.
Insights
This study established age-specific pediatric reference intervals for 41 serum biochemical analytes in Chinese children. Twenty-one analytes showed age-dependent changes, aiding accurate clinical interpretation for pediatric health.
Area of Science:
- Clinical Biochemistry
- Pediatric Laboratory Medicine
- Reference Interval Establishment
Background:
- Pediatric reference intervals (RIs) are crucial for accurate diagnosis and monitoring in children.
- Existing RIs are often limited or unavailable for specific pediatric populations, leading to potential misinterpretation.
- This study addresses the need for validated, age-specific RIs in healthy Chinese children.
Purpose of the Study:
- To establish comprehensive, age-specific reference intervals for 41 serum biochemical analytes in healthy Chinese children.
- To identify analytes with significant age-dependent variations.
- To evaluate pediatric patterns of estimated glomerular filtration rate (eGFR).
Main Methods:
- Serum samples from 2627 healthy children (28 days to 17 years) were analyzed.
- Forty-one biochemical analytes were measured using a Mindray BS-2800M analyzer.
- Reference intervals were established following Clinical and Laboratory Standards Institute (CLSI) EP28 guidelines, with age-dependent trajectories visualized.
Main Results:
- Twenty-one analytes demonstrated distinct age-dependent dynamics, including liver enzymes, prealbumin, bilirubin, immunoglobulins, renal and cardiac biomarkers, ferritin, and anti-streptolysin O.
- Electrolytes, proteins, glucose, and anemia markers showed stable levels across age groups.
- Established RIs for 36 analytes largely agreed with comparative studies, with noted discrepancies for triglyceride and anti-streptolysin O. eGFR increased rapidly in the first two years, with the European Kidney Function Consortium equation showing the closest pattern to measured ranges.
Conclusions:
- Comprehensive pediatric biochemical RIs for 41 serum analytes were established, with 21 showing significant age-dependent changes.
- Good agreement was observed for 36 analytes when compared to landmark studies.
- Caution is advised in selecting eGFR equations for young children, and these RIs support cross-regional harmonization and reduce inappropriate reference use in pediatrics.
Purpose:
Owing to the absence of appropriate pediatric reference intervals (RIs), this study aimed to establish age-specific RIs for serum biochemical analytes in healthy Chinese children.
Methods:
A total of 2627 residual serum samples were collected from children aged 28 days to 17 years at Shenzhen Baoan Women's and Children's Hospital. Forty-one analytes, including enzymes, proteins, lipids, electrolytes, and others, were measured using the Mindray BS-2800M analyzer. Outlier removal and RIs establishment were performed according to Clinical and Laboratory Standards Institute (CLSI) EP28 guideline. Age-dependent trajectories were visualized, and RIs were compared with multicenter studies. Additionally, the pediatric patterns of estimated glomerular filtration rate (eGFR) were also evaluated by equations.
Results:
Twenty-one analytes showed distinct age-dependent dynamics, including liver enzymes, prealbumin, bilirubin, immunoglobulins, renal biomarkers, cardiac enzymes, ferritin, and anti-streptolysin O. Meanwhile, electrolytes, proteins, glucose, and other anemia markers remained stable across ages. RIs for thirty-six analytes were largely consistent with comparative studies, although quantitative discrepancies were noted for triglyceride and anti-streptolysin O. In 806 children, eGFR increased rapidly during the first two years of life, with inter-formula variability. The European Kidney Function Consortium equation produced distribution pattern closest to measured ranges from the comparative study.
Conclusions:
This study established comprehensive pediatric biochemical RIs for forty-one serum analytes, with twenty-one exhibiting distinct age-dependent dynamics. Comparisons with landmark studies showed good agreement for thirty-six analytes. The eGFR equation selection requires caution, particularly in young children. These RIs provide reliable evidence to support cross-regional harmonization and help reduce inappropriate use of references in children.
