Abstract 19711: Novel Insights and Reference Intervals of Soluble ST2 in a Pediatric Population Free of Heart Failure
Introduction: Soluble ST2 is a novel prognostic biomarker in adults with chronic heart failure. The utility of ST2 in pediatric patients with heart failure and other cardiovascular co-morbidities is limited due to lack of normal interpretive values. We sought to determine the reference intervals of ST2 in a healthy pediatric population.
Methods: Sera from 240 healthy children were identified from an institutional pediatric biobank at the Mayo Clinic (Rochester, MN). 40 male and 40 female subjects within three age groups (2-6 years, 7-12 years and 13-17 years) were included in the study and those with a diagnosis of anemia, autoimmune disease, hematologic disease/bleeding, circulatory/heart failure, kidney or liver disease, malignancy, malnutrition, diabetes, or pregnancy were excluded. ST2 was measured using a novel high-sensitivity sandwich immunoassay (Presage ST2 assay; Critical Diagnostics, San Diego, CA, USA). Parametric analysis established the 95th percentile reference interval between genders and age groups.
Results: ST2 was not significantly associated with age, gender or body mass index (BMI). The median ST2 across the entire cohort was 21 ng/mL (range: 6 - 122 ng/mL). The central 95th percentile was 8 - 64 ng/mL; cut-points for the 90th and 95th percentile were 38 and 48 ng/mL, respectively. Four outliers were excluded due to an ST2 greater than 2 times the interquartile range from the next nearest value. The final central 95th percentile reference interval was 9-50 ng/mL with cut-points for the 90th and 95th percentile at 37 and 43 ng/mL, respectively (median remained 21 ng/mL). Association between ST2 and other diagnoses or medications was not statistically significant.
Conclusions: This study determined a normal reference interval for ST2 in pediatric patients without heart failure which aids in effective interpretation of ST2 in a diseased pediatric cohort. The median and upper-limit of normal in pediatric ST2 (21 and 50 ng/mL) were higher than that for adults (19 and 35 ng/mL). Further studies in pediatric cohorts, both normal and diseased, are warranted to evaluate disease-specific trends and clinical decision limits in pediatric heart failure.
Author Disclosures: J.W. Meeusen: None. J.N. Johnson: None. A.S. Jaffe: Consultant/Advisory Board; Modest; Critical Diagnostics. L.J. Donato: None. J.L. Jefferies: None. A. Dalal: None. K.O. Maher: None. A.K. Saenger: Employment; Significant; Roche Diagnostics.
- © 2014 by American Heart Association, Inc.