Determination of Upper Reference Limit for High-Sensitivity Troponin T in the Healthy Population of Balochistan

Abstract

Objective: To determine the 99th percentile upper reference limit of high-sensitivity cardiac troponin T in the healthy population of North and South Balochistan, Pakistan, with age-and gender- stratification.
Study Design: Cross-sectional, Observational.
Place and Duration of the Study: Combined Military Hospital, Quetta, between July 1, 2024, to June 30, 2025.
Materials and Methods: Following the acquisition of informed consent, 217 healthy participants (110 men and 107 women) underwent cardiovascular evaluation included vital signs, chest auscultation, ECG, eGFR, and NT-proBNP to exclude subclinical disease. High-sensitivity cardiac troponin T (hs-cTnT) was measured using the Roche Diagnostics Cobas e-411 platform, with electrochemiluminescence technology. The 99th percentile upper reference limit (URL) for hs-cTnT was determined using non-parametric statistical methods, with age and gender-stratified comparisons.
Results: This study included 110 male (50.7%) and 107 female (49.3 %) participants. The median age, accompanied by “interquartile ranges was 41.50 (32.00 – 53.00) years for males and 43.00 (32.00 – 57.00) years for females. The 99th percentile URL of hs-cTnT was 20.94 ng/L overall, with gender-specific values of 34.00 ng/L in men and 16.00 ng/L in women (p < 0.001). Median hs-cTnT concentrations were significantly higher in males [12.00 (8.00 - 29.25) ng/L] compared to females [4.00 (3.00 - 10.00) ng/L].
Conclusion: This study established the 99th percentile upper reference limit of hs-cTnT in a healthy population from Balochistan at 20.94 ng/L. Significant differences were observed by gender and age, with men and older individuals showing higher values, underscoring the need for gender- and age-specific diagnostic thresholds. No statistically significant differences were observed between Pathan and Baloch participants in this sample.