Key result
Age + Sex + Creatinine modeling did not improve hs-cTnI >19.8 ng/L discrimination over Age + Sex alone, and male-sex associations varied by cutoff.
Why the study?
High-sensitivity cardiac troponin I (hs-cTnI) interpretation depends on assay-specific reference limits, motivating an evaluation of correlates above a study-specific cutoff, parsimonious logistic models, temporal transportability, and threshold sensitivity.
Does adding serum creatinine to an Age + Sex logistic model improve discrimination and temporal transportability for predicting elevated hs-cTnI (>19.8 ng/L), and how do clinical correlates vary across assay threshold definitions in health-examination cohorts?
Cross-Sectional (n=3,939)
No
Does adding serum creatinine to an Age + Sex logistic model improve discrimination and temporal transportability for predicting elevated hs-cTnI (>19.8 ng/L), and how do clinical correlates vary across assay threshold definitions in health-examination cohorts?
In health-examination cohorts, age is the most consistent correlate of hs-cTnI while male-sex associations depend heavily on threshold definitions, and adding creatinine to age and sex does not improve model discrimination.
Answers are grounded in this paper and cite their sources.
Adding creatinine yields no hs-cTnI discrimination gain; leaves open standardized sex-specific thresholds and external validation.
Background High-sensitivity cardiac troponin I (hs-cTnI) interpretation depends on assay-specific reference limits. We examined correlates of hs-cTnI above a study-specific cutoff, compared two parsimonious logistic models, and assessed temporal transportability and threshold sensitivity. Methods The 2025 development cohort comprised 1,758 adults undergoing a standardized health-examination package; 86 (4.9%) had hs-cTnI >19.8 ng/L. Unweighted Age + Sex and Age + Sex + Creatinine models were fitted using all participants, with 1,000-bootstrap internal validation. Fixed equations were evaluated in a same-center cohort examined during January–June 2026: 2,181 participants for Age + Sex and 2,179 for Age + Sex + Creatinine because two participants lacked creatinine. Threshold sensitivity analyses were feasible only in 2026, using report-based sex-specific limits (15.6 ng/L for women; 34.2 ng/L for men), FDA-reported sex-specific limits (17/35 ng/L), and an overall 28 ng/L cutoff. A left-censored analysis evaluated continuous hs-cTnI. Results Development Age + Sex ROC-AUC was 0.838, with an optimism-corrected AUC of 0.836. Adding creatinine changed AUC by +0.002 (95% CI −0.003 to +0.006). Temporal ROC-AUC was 0.716 (95% CI 0.649–0.774) for Age + Sex and 0.705 (0.640–0.762) for Age + Sex + Creatinine; both models overpredicted the probability of hs-cTnI >19.8 ng/L. In 2026, the age-adjusted male-sex OR was 2.39 under the common cutoff, 0.64 (95% CI 0.33–1.24) with report-based sex-specific limits, and 0.72 (0.36–1.43) with FDA-reported sex-specific limits. Both sex-specific intervals included 1; these threshold-dependent estimates do not establish an inverse male-sex association. Age remained positively associated across threshold definitions. Conclusions Age was the most consistent correlate among available variables. Male-sex estimates varied by cutoff definition in the 2026 cohort. Adding creatinine provided no evidence of improved discrimination beyond Age + Sex. Calibration deteriorated in the temporal cohort, but its cause remains uncertain. These descriptive findings do not support clinical risk categories, electronic alerts, or replacement of direct hs-cTnI measurement.
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Liang et al. (2026) conducted a cross-sectional in Health-examination cohort undergoing high-sensitivity cardiac troponin I (hs-cTnI) testing (n=3,939). Age + Sex + Creatinine logistic regression model vs. Age + Sex logistic regression model was evaluated on Discrimination (ROC-AUC) for hs-cTnI >19.8 ng/L in temporal validation. Age + Sex + Creatinine modeling did not improve hs-cTnI >19.8 ng/L discrimination over Age + Sex alone, and male-sex associations varied by cutoff.
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