Age- and Sex-Specific Reference Intervals for Myocardial Enzyme Activity in Healthy Chinese Han Population Aged 1∼<18 years

Value of cardiac enzyme spectrum for the risk assessment of mortality in critically ill children: a single-centre retrospective study

OBJECTIVES

Identifying high-risk paediatric patients with a poor prognosis and providing timely and adequate treatment are critical. This study aimed to evaluate the effects of different types of cardiac enzyme spectrum within 24 hours of admission on the short-term prognosis of patients in paediatric intensive care units.

DESIGN

A retrospective study.

SETTING

A single-centre, tertiary care hospital in China, with patient data from 2010 to 2018.

PARTICIPANTS

A total of 4343 critically ill children were enrolled.

INTERVENTION

None.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcome measure was in-hospital mortality, which was defined as death from any cause during hospitalisation. The secondary outcome was 30-day mortality, intensive care unit (ICU) length of stay (LOS) and total LOS.

RESULTS

Using the local polynomial regression fitting method, an approximately linear increase in in-hospital mortality was detected for creatine kinase (CK), creatine kinase MB (CK-MB), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH). Among the different types of cardiac enzyme spectrum, LDH had the highest area under the curve value (0.729), followed by AST (0.701), CK-MB (0.613) and CK (0.557). The Kaplan‒Meier analysis showed that the patients in the high LDH group had higher 30-day mortality. The multivariate logistic regression revealed that high LDH was independently associated with in-hospital mortality (OR 2.45, 95% CI 1.84 to 3.24). After propensity score matching (PSM) and sensitivity analysis, the results remained consistent.

CONCLUSIONS

LDH is a reliable outcome predictor in critically ill children, including those with various comorbidities.

Case-control study on risk factors for in-hospital mortality in patients with severe COVID-19

Objective

The purpose of this study was to identify independent risk factors affecting patient survival and explore predictors of severe cases of coronavirus disease 2019 (COVID-19).

Methods

We conducted a retrospective, observational, case-control study on adult patients with severe COVID-19 who were admitted to affiliated hospitals in Tianjin between December 18, 2022, and January 31, 2023. We used univariate and multifactorial logistic regression analyses to analyze demographic indicators, comorbidity profiles, and laboratory parameters in two groups of patients (deceased and surviving) to identify independent risk factors for death in patients with severe COVID-19.

Results

Patients in the deceased group were older than those in the survival group (p = 0.018), and there were more cases of coexisting respiratory insufficiency in the deceased group (p = 0.002). Additionally, laboratory test results for white blood cell count (WBC) and creatine kinase (CK) showed significantly higher values in the deceased group (p = 0.047 and p = 0.029, respectively), while arterial oxygen partial pressure (PAO2) showed significantly lower values compared to the survival group (p = 0.021). Age, respiratory insufficiency, WBCH (highest WBC value), CKH (highest CK value), and PAO2F (first PAO2 value) had area under curve (AUC) values of 0.698, 0.838, 0.721, 0.744, and 0.633, respectively.

Conclusion

The main risk factors for mortality in patients with severe COVID-19 that we identified in this study were the advanced age of patients, coexisting respiratory insufficiency, elevated levels of WBC and CK, and decreased levels of PAO2. Elevated WBC and CK laboratory parameters, in particular, demonstrated good predictive value for in-hospital mortality risk.

Creatine kinase serum levels in children revisited: New reference intervals from a large cohort of healthy children and adolescents

BACKGROUND

Creatine Kinase (CK) has become increasingly important in pediatrics as a commonly used laboratory screening parameter for neuromuscular diseases. Recent research suggests that hyperCKemia in children is not always associated with pathology and can occur due to several reasons. Little is known of various clinical factors that may influence CK throughout child development.

OBJECTIVE

This study aimed to establish reliable age- and sex-specific reference ranges for serum CK levels in healthy infants, children, and adolescents. In addition, the effect of puberty, oral contraceptive (OC) use as well as steroid hormones on CK was examined.

MATERIALS AND METHODS

The data was collected from subjects of the longitudinal population-based "LIFE Child"-cohort between 2011 and 2016 in Leipzig, Germany. 5238 blood samples of 2707 healthy children, aged between 0.14 months and 18 years, were analyzed.

RESULTS

Serum CK levels raised during the first year of life, peaking shortly after age one (P50girls = 2.7 µkat/L, P50boys = 2.90 µkat/L). There was a pronounced difference in the 97.5th percentile between boys and girls during adolescence with its maximum at age 18 (P97.5girls = 5.74 µkat/L, P97.5boys= 14.48 µkat/L). Also, mean CK serum levels were significantly higher in boys (bboys = 0.29, pboys < 0.001). Intake of oral contraceptives (OC), extreme underweight, underweight and obesity revealed a significant inverse correlation with CK serum levels.

CONCLUSION

Age, sex, OC intake and weight status affect serum CK levels, particularly during infancy and puberty. We recommend the use of age- and sex-specific reference values for CK serum levels to assess the clinical relevance of measurements.

Effect of age and sex on hematological and biochemical parameters in Chinese rhesus monkeys (Macaca mulatta) anesthetized with ketamine

OBJECTIVE

Rhesus monkeys are increasingly used in biomedical research, which makes their hematological and biochemical parameters increasingly important in preclinical research. Since age and sex can influence blood parameters, establishing reference intervals for such parameters based on age and sex becomes along with identifying the effect of age and sex on those parameters.

METHODS

A total of 1385 healthy Chinese rhesus monkeys (548 males and 837 females) anesthetized with ketamine were selected and segregated by age (six groups) and sex. A total of 21 hematological and 26 biochemical parameters were measured, and the effects of age and sex were analyzed.

RESULTS

We established baseline indices for hematological and biochemical parameters based on age and sex, separately, and observed significant impacts of age, sex, and age-sex interactions on blood parameters. Among different age groups, significant differences were found in WBC, NEUT%, LYM%, EO%, LYM#, EO#, MCV, RDW-CV, PLT, MPV, PDW, PCT, TP, Alb, GLB, A/G, ALT, AST, ALP, TBIL, GGT, BUN, Cre, GLU, CK, TRIG, LDL, HCY, IL-6 FOL, Vit B12, VIT D-T, PTH, and AMH. Additionally, significant differences were observed in RBC, HGB, HCT, MPV, Alb, BUN, Cre, GLU, CHOL, TRIG, HDL, LDL, HCY, and VIT D-T between the two sexes. An age-sex interaction exerted a significant effect on WBC, NEUT#, MCV, MCHC, PDW, GLB, ALP, Cre, CHOL, TRIG, HDL, LDL, HCY, IL-6, Vit B12, VIT D-T. However, neither age, sex, and age-sex interactions exerted significant effects on MO%, MOMO#, MCH, RDW-SD, CRP, and CT.

CONCLUSION

Our study investigated the blood parameters of rhesus monkeys to provide a reference basis for rhesus monkey-related scientific experimental research.

Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?

BACKGROUND

In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access.

METHODS

A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results.

RESULTS

We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (- 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87-25.05). Using our model, the actual probability was 4.14% (0.01-0.074) and the counterfactual probability was 2.79% (- 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis.

CONCLUSIONS

So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.

Serum N-terminal-pro-B-type natriuretic peptide is dependent on age and sex: a cross-sectional analysis in healthy adults from Northeast China

Background:

Previous studies suggested higher serum N-terminal-pro-B-type natriuretic peptide (NT-proBNP) level with older age and in women, but the reference intervals (RIs) recommended by assay manufacturers do not fully recognize such pattern.

Aims:

In this study, we aimed to establish a set of age- and sex-specific RIs for serum NT-proBNP in healthy adults from Northeast China.

Methods:

Healthy adult subjects (20 to ≤95 years old) were recruited from the physical examination center at a teaching hospital during a period from March 2020 to July 2020. Serum NT-proBNP concentration was measured using the VITROS 5600 Integrated System with a chemiluminescence method. RIs were calculated based on the EP28-A3c guidelines by the Clinical and Laboratory Standards Institute. A generalized linear model was performed to factors that were associated with NT-proBNP level.

Results:

The final analysis included 2,183 subjects (1,074 men and 1,109 women, mean age 54.2 ± 19.5 years). Serum NT-proBNP level increased with advancing age (20 to <50, 50 to <60, 60 to <75 and ≥75 years), and was significantly higher in women than in men with the exception of the ≥75 age group. Higher NT-proBNP level was associated with the female sex, older age, lower body mass index, higher urea nitrogen, higher creatinine, lower uric acid, and lower triglyceride (P < 0.05 for all). The strongest association was with the female sex, followed by age.

Conclusions:

Serum NT-proBNP level must be interpreted with consideration of sex and age. Higher NT-proBNP is associated with the female sex and older age.

Determination of 11 minerals in children using inductively coupled plasma mass spectrometry

BACKGROUND

Minerals play an important role in children's growth and cognition. In this study, our aim was to establish reference intervals of mineral level in Children of Liaoning province (China) and provide a reliable basis for future preventive healthcare guidelines.

METHODS

Random samples of 2217 healthy children aged 0-15 years who were referred for routine hospital laboratory examinations in the cities of Shenyang, Fushun, Fuxin, Benxi, Chaoyang and Lingyuan were invited to participate in the study. Serum levels of Calcium (Ca), Iron (Fe), Zinc (Zn), Magnesium (Mg), Copper (Cu), Manganese (Mn), Selenium (Se), Mercury (Hg), Nickel (Ni), Cobalt (Co), and Lithium (Li) were determined by inductively coupled plasma mass spectrometer(ICP-MS).

RESULTS

Sex-related significant differences in the serum concentrations of the Mg and Cu (P < 0.05). Age-related significant differences were found in serum levels of Ca, Fe, Zn, Mg, Cu and Mn (P < 0.05) and the concentrations of 9 minerals (Ca, Mg, Cu, Mn,Se,Hg,Ni,Co and Li in serum varied from season to season (P < 0.05). The Spearman correlation matrix of 11 minerals was shown as a heat map, the correlations between Ca-Zn, Ca-Mg, Fe-Zn, Fe-Se, Mn-Ni, Se-Hg, Se-Ni, Hg-Ni, and Ni-Co, Ni-Li were the strongest compared with others.

CONCLUSIONS

The reference intervals of serum 11 minerals for children should considering the sex, age and season, which may be useful for decisive diagnoses of abnormality of the 11minerals and the related diseases.

Establishment of reference intervals of ten commonly used clinical chemistry analytes: a real-world study in China

Aim: This real-world study was aimed at establishing reference intervals (RIs) of ten commonly used clinical chemistry analytes (total cholesterol, triglycerides, Apo A1, Apo B, creatine kinase (CK), CK isoenzyme MB, glucose, alkaline phosphatase, γ-glutamyltransferase and blood urea nitrogen) in an apparently healthy population in China. Materials & methods: A total of 17,356 healthy participants aged 18-79 years who underwent check-up at MJ Health Check-up Center were included. The establishment of RIs was performed according to the Clinical and Laboratory Standards Institute EP28-A3c guideline. Roche Cobas c701 automatic analyzer (Roche Diagnostics, Mannheim, Germany) was employed to measure the concentrations of analytes. Results: Total cholesterol, triglycerides, Apo B, CK, alkaline phosphatase, glucose, γ-glutamyltransferase and blood urea nitrogen required gender and age-specific partitioning. Conclusion: The RIs established in this study were parallel to current national standards and previous RIs established in Chinese population. Real-world studies may play an important and practical role in the determination of RIs in the future.

Reference intervals for 26 common biochemical analytes in term neonates in Jilin Province, China

BACKGROUND

Biochemical analytes provide information for neonatal disease management and therapy, and population-based reference intervals (RIs) are essential to accurately interpret laboratory test results. This study aimed to establish local RIs for biochemical assays in term neonates.

METHODS

A total of 195 healthy term neonates from birth to 3rd day were recruited as reference individuals prospectively. Analytes of 26 common biochemistries were measured using the VITROS 5600 Integrated System. The 3-level nested ANOVA was performed to assess the need for partitioning RIs of each analyte, and RIs were derived by a nonparametric method or robust method. Multiple regression analysis was used to evaluate specific correlations between the analytes and individual characteristics including age, gender, gestational age, birthweight and delivery mode.

RESULTS

There were no between-sex differences in all analytes, whereas there were significant between-day-age differences in 6 analytes. Small between-delivery-mode differences were observed in the results for potassium, phosphorus, and urea. The major related factor of most analytes was postnatal age. During the first 3 days, values of iron, lipids and lipoproteins increased; creatinine, urea, uric acid, creatine kinase and lactate dehydrogenase decreased; other analytes showed slight changes or relatively stable trends. Reference limits of some analytes, particularly lactate dehydrogenase and alkaline phosphatase, were significantly different from adult and pediatric groups.

CONCLUSIONS

RIs of 26 common biochemical analytes are established for term neonates aged 0 to 3 days in northeast China. Additionally, it is suggested that age-related changes should be valued in the clinical decision-making process for newborns.

Age- and Sex-Specific Pediatric Reference Intervals of Serum Electrolytes in Jilin Province of China Using the A Priori Approach

OBJECTIVES

The purpose of this study was to establish age- and sex-specific pediatric reference intervals of serum potassium (K), sodium (Na), chlorine (Cl), calcium (Ca), magnesium (Mg), and phosphorus (P) using a direct sampling technique.

METHODS

In accordance with the a priori approach, healthy individuals (n = 6,466, aged 1 month to <18 years) were enrolled from five regions in Jilin Province, China, and all analytes were performed in the center laboratory. Reference intervals were divided according to the regression tree and Harris and Boyd's method, and then they were calculated by the nonparametric rank method. The dynamic changes of reference intervals were evaluated by the lambda-mu-sigma (LMS) method.

RESULTS

Reference intervals of serum Na and Ca were divided into three age-specific partitions. The concentrations of K, Cl, and Mg remained stable with age. However, only dramatic sex-specific changes of P were shown in those 11 to less than 13 years old and 13 to less than 15 years old, with an earlier peak time in females than in males. The correlation between Na and Cl was the strongest among all serum electrolytes (r = 0.31).

CONCLUSIONS

Serum electrolyte reference intervals for children and adolescents were established by regression tree, z test, and the LMS method, which provide a more accurate interpretation for diagnosis and prognosis evaluation of clinical pediatric diseases.