What is the clinical evidence from this study?

Study design: Observational. Population: Healthy children (for reference intervals) (n=93196). Intervention: Myocardial enzyme levels. Primary outcome: Establishment of age- and sex-specific reference intervals for AST, LDH, HBDH, CK, and CK-MB.

What does this research mean for the field?

Pediatric serum levels of myocardial enzymes (AST, LDH, HBDH, CK, and CK-MB) exhibit significant age dependency and post-pubertal sexual dimorphism, and their reference intervals in Chinese children show strong consistency with international standards. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

September 5, 2026BMC PediatricsOpen Access

Establishment of pediatric reference intervals for myocardial enzymes in Beijing using an indirect method

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Key result

Pediatric reference intervals for five myocardial enzymes show significant age dependency and post-pubertal sexual dimorphism.

n=93,196

Why the study?

Pediatric myocardial enzyme reference intervals are critical for diagnosing myocardial injury, but China lacks pediatric-specific reference intervals for most cardiac biomarkers and instead relies on adult standards.

Population

93,196 test records from children aged 28 days to 18 years in Beijing

Comparison

Established reference intervals compared with Chinese national standards and CALIPER data

Design

Retrospective cross-sectional study

Authors

MGMenglei GeChildren's Hospital of Capital Institute of Pediatrics JLJing LiCapital Institute of Pediatrics QSQinwei SongPeking University

Discussion

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Implication

May refine myocardial injury diagnosis in Beijing children; extends national and CALIPER standards but leaves generalizability open.

Key Points

To establish age- and sex-specific pediatric serum reference intervals for five myocardial enzymes (AST, LDH, HBDH, CK, and CK-MB) using an indirect Hoffmann method.
Retrospective analysis of 93,196 test records from children aged 28 days to 18 years evaluated at the Capital Institute of Pediatrics in Beijing between January 2021 and November 2024.
Excluded patients with cardiac, hepatic, respiratory, muscular, or metabolic disorders, as well as Tukey outliers, yielding valid datasets of 76,730 to 87,265 cases across analytes.
Applied the indirect Hoffmann method to calculate the central 95% reference intervals (2.5th–97.5th percentiles) for AST, LDH, HBDH, and CK, and the 95th percentile upper limit for CK-MB, with partitions validated by Harris-Boyd testing.
AST, LDH, and HBDH levels peaked in infancy, steadily declined through childhood, and exhibited lower values in females than males after age 12 years (AST 12–18 years: males 13–35 U/L vs. females 11–29 U/L).
CK declined in early childhood (28 days–1 year: 38–346 U/L), plateaued from ages 2 to 12 years (48–192 U/L), and rose substantially in males after age 12 years (47–250 U/L vs. females 28–184 U/L).
CK-MB upper reference limits dropped from 10.69 U/L in infants (28 days–2 years) to 3.64 U/L in children aged 6–12 years, showing divergence after age 12 years (males 3.96 U/L vs. females 2.96 U/L).

Study Design

Type

Observational (n=93,196)

Multicenter

Structured PICO

Population

93,196 test records from children aged 28 days to 18 years without diseases affecting cardiac, hepatic, respiratory, skeletal muscle, or metabolic functions, used to establish pediatric reference intervals for myocardial enzymes.

Outcome

Age- and sex-specific pediatric serum reference intervals for five myocardial enzymes (AST, LDH, HBDH, CK, and CK-MB)surrogate

This study establishes pediatric-specific reference intervals for five myocardial enzymes in Beijing children, filling a critical clinical gap for the accurate diagnosis of pediatric myocardial injury.

Limitations

Retrospective design cannot match the methodological rigor of the direct method
Some data from patients with underlying diseases were inevitably included
Uneven age distribution of the study population
All laboratory tests were performed on a single Siemens platform, lacking cross-platform comparisons
Single-center study
Excludes neonates (younger than 28 days)
Requires validation across multiple analytical platforms

Cite This Study

Ge et al. (2026) conducted an observational in Healthy children (for reference intervals) (n=93,196). Myocardial enzyme levels was evaluated on Establishment of age- and sex-specific reference intervals for AST, LDH, HBDH, CK, and CK-MB. Age- and sex-specific pediatric reference intervals for five myocardial enzymes (AST, LDH, HBDH, CK, and CK-MB) were established for children aged 28 days to 18 years in Beijing, demonstrating significant age dependency and post-pubertal sexual dimorphism.

synapsesocial.com/papers/6a9bd3726b95aff0620eabcc https://doi.org/10.1186/s12887-026-07615-7

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Establishment of pediatric reference intervals for myocardial enzymes in Beijing using an indirect method

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Establishment of pediatric reference intervals for myocardial enzymes in Beijing using an indirect method

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

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