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Generation of reference values for cardiac enzymes from hospital admission laboratory data
V Kairisto1, K P Hänninen, A Leino
1Department of Clinical Chemistry, University of Turku, Finland.
Insights
Hospital patient databases can establish reliable reference values for cardiac enzymes like creatine kinase and lactate dehydrogenase. This method provides health-related reference values for emergency admission patients, aiding in accurate cardiac diagnostics.
Area of Science:
- Biochemistry
- Clinical Chemistry
- Medical Informatics
Background:
- Establishing accurate reference values for cardiac enzymes is crucial for diagnosing myocardial damage.
- Traditional methods for determining reference values may not always reflect real-world patient populations.
- Hospital information systems offer a vast source of patient data for research.
Purpose of the Study:
- To evaluate the feasibility of using hospital patient databases to derive reference values for cardiac enzymes.
- To establish health-related reference values for creatine kinase, creatine kinase isoenzyme MB, lactate dehydrogenase, and lactate dehydrogenase isoenzyme 1.
- To compare reference values derived from patient databases with those obtained from a conventional healthy subject group.
Main Methods:
- Retrospective analysis of cardiac enzyme data from 2029 emergency admission patients.
- Selection of 538 "healthy" patients based on discharge diagnoses and stable enzyme levels.
- Calculation of upper reference limits (97.5th percentile) at 37°C, with age-dependent values for specific enzymes.
- Comparison with reference values derived from 246 conventionally selected healthy subjects.
Main Results:
- Patient databases yielded suitable health-related reference values for cardiac enzymes.
- Age-dependent reference limits were established for creatine kinase and lactate dehydrogenase.
- Reference limits for creatine kinase-MB and lactate dehydrogenase isoenzyme 1 were similar between the two groups.
- Reference limits for total creatine kinase and lactate dehydrogenase showed more variability.
Conclusions:
- Hospital patient databases are a viable source for establishing cardiac enzyme reference values.
- This approach can provide relevant reference ranges reflecting diverse patient populations.
- The findings support the use of HIS data for deriving clinically applicable enzyme reference limits.
Abstract:
An approach is described for using patient databases of a hospital information system as a source of reference values for cardiac enzymes. Of a total of 2029 emergency admission patients with serial cardiac enzyme data, 538 patients were considered "healthy" (having no damage in myocardium) because their discharge diagnoses suggested neither myocardial damage nor any other condition that could lead to elevated enzyme activities, and because their serially collected cardiac enzyme activities remained stable. Enzyme activities of creatine kinase (EC 2.7.3.2), creatine kinase isoenzyme MB, lactate dehydrogenase (EC 1.1.1.28), and lactate dehydrogenase isoenzyme 1 of these patients at admission to hospital were considered as suitable health related reference values. The upper (97.5%) reference limits of activities, measured at 37 degrees C according to Scandinavian recommendations, were as follows (age dependent limits given at 25 and at 75 years of age, U/l): creatine kinase men 268, 192; creatine kinase women 200 (no age effect); creatine kinase-MB 16, 24; lactate dehydrogenase 497, 603; lactate dehydrogenase isoenzyme 1 103, 140. For comparison, reference values were also produced conventionally from a group of 246 healthy subjects. Observed effects of age on enzyme activities were quite similar to those in the selected patient group. Calculated reference limits for isoenzymes creatine kinase-MB and lactate dehydrogenase isoenzyme 1 were also similar but reference limits for less cardiospecific total enzyme activities, creatine kinase and lactate dehydrogenase, were more variable between these two groups.(ABSTRACT TRUNCATED AT 250 WORDS)