A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers
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Date
2014
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Abstract
Background: A nationwide multicenter study was organized to establish reference intervals (RIs) in the Turkish population for 25 commonly tested biochemical analytes and to explore sources of variation in reference values, including regionality. Methods: Blood samples were collected nationwide in 28 laboratories from the seven regions (≥400 samples/region, 3066 in all). The sera were collectively analyzed in Uludag University in Bursa using Abbott reagents and analyzer. Reference materials were used for standardization of test results. After secondary exclusion using the latent abnormal values exclusion method, RIs were derived by a parametric method employing the modified Box-Cox formula and compared with the RIs by the non-parametric method. Three-level nested ANOVA was used to evaluate variations among sexes, ages and regions. Associations between test results and age, body mass index (BMI) and region were determined by multiple regression analysis (MRA). Results: By ANOVA, differences of reference values among seven regions were significant in none of the 25 analytes. Significant sex-related and age-related differences were observed for 10 and seven analytes, respectively. MRA revealed BMI-related changes in results for uric acid, glucose, triglycerides, high-density lipoprotein (HDL)-cholesterol, alanine aminotransferase, and γ-glutamyltransferase. Their RIs were thus derived by applying stricter criteria excluding individuals with BMI >28 kg/m2. Ranges of RIs by non-parametric method were wider than those by parametric method especially for those analytes affected by BMI. Conclusions: With the lack of regional differences and the well-standardized status of test results, the RIs derived from this nationwide study can be used for the entire Turkish population. © by De Gruyter 2014.
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Adult , Age Factors , Aged , Analysis of Variance , Blood Proteins , Body Mass Index , Clinical Chemistry Tests , Female , Humans , Inorganic Chemicals , Lipids , Male , Middle Aged , Multivariate Analysis , Organic Chemicals , Reference Values , Turkey , alanine aminotransferase , albumin , alkaline phosphatase , amylase , aspartate aminotransferase , bilirubin , bilirubin glucuronide , calcium , chloride , creatine kinase , creatinine , gamma glutamyltransferase , glucose , high density lipoprotein , lactate dehydrogenase , low density lipoprotein , magnesium , nitrogen , phosphate , potassium , protein , sodium , triacylglycerol , uric acid , inorganic compound , lipid , organic compound , plasma protein , adult , age , aged , alanine aminotransferase blood level , albumin blood level , alkaline phosphatase blood level , amylase blood level , analysis of variance , Article , aspartate aminotransferase blood level , bilirubin blood level , blood analysis , blood sampling , body mass , calcium blood level , chemical analyzer , chloride blood level , cholesterol blood level , controlled study , correlation analysis , creatine kinase blood level , creatinine blood level , female , gamma glutamyl transferase blood level , glucose blood level , human , lactate dehydrogenase blood level , lipoprotein blood level , magnesium blood level , male , multiple regression , nonparametric test , normal human , parametric test , phosphate blood level , potassium blood level , protein blood level , reference value , sex difference , sodium blood level , standardization , triacylglycerol blood level , Turk (people) , urea nitrogen blood level , uric acid blood level , blood , clinical chemistry , clinical trial , middle aged , multicenter study , multivariate analysis , reference value , standards , Turkey