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      Falsely elevated troponin I results due to outliers indicate a lack of analytical robustness.

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          Abstract

          Troponin (Tn) is the preferred biochemical marker for the diagnosis of acute coronary syndrome. Spurious false Tn results (outliers) may cause significant problems with clinical management. We investigated the occurrence of outliers and whether this phenomenon could be explained by analytical imprecision. Methods and results Troponin I (TnI) was measured in duplicate with Beckman AccuTnI reagent if the first TnI result was > or =0.04 microg/L (n = 5265). All TnI requests were performed in duplicate in a subset of samples for one calendar month (n = 881). A total of 13,178 TnI requests were received during the study period. Variables were sample type, centrifugation speed and analyser. Results were identified as outliers when the difference between two results exceeded a critical difference (CD) limit defined by CD = z x square root 2 x SD(Analytical). Outliers at the 0.0005 probability level were detected in 102 of 5265 duplicate observations (1.94 +/- 0.37%). This translated into an outlier rate of 0.55 +/- 0.13% for all TnI results and 1.37 +/- 0.31% for results above 0.04 microg/L. Outliers resulted only in falsely elevated TnI values and were not dependent on the analyser, centrifugation speed or sample type.

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          Author and article information

          Journal
          Ann. Clin. Biochem.
          Annals of clinical biochemistry
          SAGE Publications
          1758-1001
          0004-5632
          May 2010
          : 47
          : Pt 3
          Affiliations
          [1 ] Department of Chemical Pathology, Pathology Queensland, Brisbane, Australia. ungerer@mweb.co.za
          Article
          acb.2010.010012
          10.1258/acb.2010.010012
          20406778
          aa577a93-c49c-4135-8657-587f71f119ac
          History

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