A-027 Distribution characteristics and upper reference limits of high-sensitivity cardiac troponin I in high cardiovascular risk population

Abstract Background Although high-sensitivity cardiac troponin I (hs-cTnI) is a well-established biomarker for myocardial injury, its utility in risk management and prognostic assessment of high cardiovascular risk populations (hypertension, diabetes, dyslipidemia, and chronic kidney disease [CKD]) remains inconclusive. The objective of this study is to analyze the characteristics of the hs-cTnI distribution in different cardiovascular risk groups and explore the relationship with current cardiovascular risk stratification. Additionally, the study aims to establish risk degree-specific upper reference limits (URLs) for hs-cTnI, to improve the clinical management of individuals with high cardiovascular risk. Methods A total of 1,450 general subjects with one or more cardiovascular risk factors, including hypertension, diabetes, dyslipidemia, and CKD, were enrolled. The cardiovascular risk degree of all subjects was defined according to the most recent guidelines for the management of each disease. Hs-cTnI levels were measured using the Mindray CL-8000i automated chemiluminescence immunoassay analyzer. The risk degree-specific URLs were established using the recommended nonparametric method. Independent correlations between variables and elevated hs-cTnI were analyzed using stepwise multivariate logistic regression. Results The results showed that the 95th percentile URLs in hypertension were 6.7ng/L (low-risk, 95CI: 3.6-8.9ng/L), 8.2ng/L (moderate-risk, 95CI: 6.5-17.9ng/L) and 14.8ng/L (high-risk, 95CI: 9.1-19.5ng/L), respectively. The 95th percentile URLs in diabetes were 3.7ng/L (moderate-risk, 95CI: 2.5-6.6ng/L), 6.3ng/L (high-risk, 95CI: 5.0-9.1ng/L) and 16.2ng/L (very high-risk, 95CI: 9.9-26.8ng/L), respectively. The 95th percentile URLs in CKD were 21.2ng/L (stage III, 95CI: 14.1-31.0ng/L), 61.6ng/L (stage IV, 95CI: 23.1-69.7ng/L) and 61.6ng/L (stage V, 95CI: 37.6-91.6ng/L), respectively. In the high-risk hypertension population, hs-cTnI levels were significantly lower in well-managed group than under-managed group (P<0.0001), and similar results were discovered in blood lipid control of dyslipidemia. Multivariate regression showed that women were 2.5 (95CI: 1.4-5.0) times more likely to have elevated hs-cTnI than men, and that patients with a history of smoking were 3.6 (95CI: 1.3-9.8) times more likely to have elevated hs-cTnI than non-smokers. Patients with CKD stage II, CKD stage III, CKD stage IV and CKD stage V were 7.8 (95CI: 2.2-27.2), 20.3 (95CI: 5.8-71.5), 92.6 (95CI: 23.9-358.8) and 88.9 (95CI: 26.7-295.6) times more likely to have elevated hs-cTnI than patients with CKD I, respectively. Conclusion Hs-cTnI levels strongly correlate with cardiovascular risk severity. Establishing disease-specific URLs may refine personalized risk assessment and guide targeted interventions in high-risk populations. These findings underscore the potential of hs-cTnI as a dynamic tool for optimizing clinical management in cardiovascular care.