Key result
Continuous hsTnT reference intervals and zlog transformation remove age dependency in children aged 0-10.
Why the study?
Age-dependent physiology makes interpreting hsTnT challenging in early childhood, and values below the analytical limit create left-censored data that complicate reference interval estimation.
Observational (n=1,635)
Yes
The establishment of continuous, age-dependent reference intervals and a zlog transformation for hsTnT in children aged 0-10 years enables age-independent interpretation and longitudinal monitoring in pediatric cardiology.
Answers are grounded in this paper and cite their sources.
zlog hsTnT RIs may aid interpretation in young children; leaves open prospective outcome validation before routine use.
Objectives Age-dependent physiology makes interpreting high-sensitivity cardiac troponin T (hsTnT) challenging in early childhood. Values below the analytical limit create left-censored data, complicating reference interval (RI) estimation. Methods We combined two paediatric cohorts (CALIPER, n=277; LIFE Child, n=1,358; ages 0–10 years) to derive continuous, age-dependent hsTnT RIs. Empirical quantiles were estimated using a sliding-window approach and fitted with four-parameter logistic functions. To address the high proportion of values below the analytical limit of detection (LOD; 3 ng/L), the 2.5th percentile was inferred from the 65th and 97.5th percentiles assuming lognormal distribution. A closed-form zlog transformation was established to standardise hsTnT values. Pointwise 95 % bootstrap confidence bands (100,000 stratified resamples) were computed for both reference limits. Results HsTnT concentrations declined steeply during infancy and stabilised at low levels thereafter, with 46 % of samples below the analytical limit. The closed-form approach modelled reference limits according to the following logistic equation <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" overflow="scroll"> <m:mrow> <m:mi>f</m:mi> <m:mrow> <m:mfenced close=")" open="(" separators="|"> <m:mrow> <m:mi>x</m:mi> </m:mrow> </m:mfenced> </m:mrow> <m:mo>=</m:mo> <m:mrow> <m:mfenced close=")" open="(" separators="|"> <m:mrow> <m:mfrac> <m:mn>1</m:mn> <m:mrow> <m:mn>1</m:mn> <m:mo>+</m:mo> <m:msup> <m:mi>e</m:mi> <m:mrow> <m:mo>−</m:mo> <m:mrow> <m:mfenced close=")" open="(" separators="|"> <m:mrow> <m:mi>a</m:mi> <m:mo>+</m:mo> <m:mi>b</m:mi> <m:mo>·</m:mo> <m:mi>x</m:mi> </m:mrow> </m:mfenced> </m:mrow> </m:mrow> </m:msup> </m:mrow> </m:mfrac> </m:mrow> </m:mfenced> </m:mrow> <m:mo>·</m:mo> <m:mrow> <m:mfenced close=")" open="(" separators="|"> <m:mrow> <m:mtext>maxv</m:mtext> <m:mo>−</m:mo> <m:mtext>minv</m:mtext> </m:mrow> </m:mfenced> </m:mrow> <m:mo>+</m:mo> <m:mtext>minv</m:mtext> </m:mrow> </m:math> f(x)=(11+e-(a+b· x))· (maxv-minv)+minv with parameters: a=−1.15 and 0.47, b=−4.13 and −6.64, minv=1.13 and 7.50 and maxv=124.13 and 210.3 for lower and upper limits, respectively. Bootstrap confidence bands were widest in the first six months of life and narrowed substantially thereafter. The zlog transformation effectively removed age dependency, with >95 % of values within the theoretical RI (−1.96 to +1.96). Conclusions We present the first continuously modelled, closed-form RIs and corresponding zlog-transformation for paediatric hsTnT (ages 0–10 years). This framework enables direct LIS/EHR deployment without specialized software and facilitates age-independent interpretation and longitudinal monitoring in paediatric cardiology.
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Trulson et al. (2026) reported an observational. High-sensitivity cardiac troponin T (hsTnT) measurement was evaluated on Continuous, age-dependent hsTnT reference intervals. A closed-form zlog transformation and continuous reference intervals for high-sensitivity cardiac troponin T were established for children aged 0-10 years, effectively removing age dependency.
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