A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers
Kiyoshi Ichihara, Reo Kawano, Diler Aslan, Hulya Aybek, Zeki Ari, Fatma Taneli, Canan Coker, Pinar Akan, Ali Riza Sisman, Onur Bahceci, Nurzen Sezgin, Meltem Demir, Gultekin Yucel, Halide Akbas, Sebahat Ozdem, Gurbuz Polat, Ayse Binnur Erbagci, Mustafa Orkmez, Nuriye Mete, Osman Evliyaoglu, Aysel Kiyici, Husamettin Vatansev, Bahadir Ozturk, Dogan Yucel, D. Kayaalp, Kubra Dogan, Asli Pinar, Mehmet Gurbilek, Cigdem Damla Cetinkaya, Okhan Akin, Muhittin Serdar, Ismail Kurt, Selda Erdinc, Ozgur Kadicesme, Necip Ilhan, Dilek Sadak Atali, Ebubekir Bakan, Harun Polat, Tevfik Noyan, M Can, Abdulkerim Bedir, Ali Okuyucu, Orhan Deger, Suret Agac, Evin Ademoglu, Aysem Kaya, Turkan Nogay, Nezaket Eren, Yesim Ozarda, Melahat Dirican, GulOzlem Tuncer, Mehmet Aykus, Yeliz Gunes, Sevda Unalli Ozmen, Sehavet Tezcan, Ozlem Demirpence, Elif Degirmen
article (Uluslararası, Hakemli) | Yazar(lar): Kiyoshi Ichihara, Reo Kawano, Diler Aslan, Hulya Aybek, Zeki Ari, Fatma Taneli, Canan Coker, Pinar Akan, Ali Riza Sisman, Onur Bahceci, Nurzen Sezgin, Meltem Demir, Gultekin Yucel, Halide Akbas, Sebahat Ozdem, Gurbuz Polat, Ayse Binnur Erbagci, Mustafa Orkmez, Nuriye Mete,
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.-glutamyltransferase. Their RIs were thus derived by applying stricter criteria excluding individuals with BMI >28 kg/m(2). 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.