title: Mining of hospital laboratory information systems: a model study defining age- and gender-specific reference intervals and trajectories for plasma creatinine in a pediatric population.
abstract: BACKGROUND
  The knowledge of physiological fluctuation and variation of even commonly used biochemical quantities in extreme age groups and during development is sparse. This challenges the clinical interpretation and utility of laboratory tests in these age groups. To explore the utility of hospital laboratory data as a source of information, we analyzed enzymatic plasma creatinine as a model analyte in two large pediatric hospital samples.
  
  
  METHODS
  Plasma creatinine measurements from 9700 children aged 0-18 years were obtained from hospital laboratory databases and partitioned into high-resolution gender- and age-groups. Normal probability plots were used to deduce parameters of the normal distributions from healthy creatinine values in the mixed hospital datasets. Furthermore, temporal trajectories were generated from repeated measurements to examine developmental patterns in periods of changing creatinine levels.
  
  
  RESULTS
  Creatinine shows great age dependence from birth throughout childhood. We computed and replicated 95% reference intervals in narrow gender and age bins and showed them to be comparable to those determined in healthy population studies. We identified pronounced transitions in creatinine levels at different time points after birth and around the early teens, which challenges the establishment and usefulness of reference intervals in those age groups.
  
  
  CONCLUSIONS
  The study documents that hospital laboratory data may inform on the developmental aspects of creatinine, on periods with pronounced heterogeneity and valid reference intervals. Furthermore, part of the heterogeneity in creatinine distribution is likely due to differences in biological and chronological age of children and should be considered when using age-specific reference intervals.
authors.forename: Karen
authors.initials: K
authors.lastname: Søeby
authors.forename: Peter Bjødstrup
authors.initials: PB
authors.lastname: Jensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Werge
authors.forename: Steen
authors.initials: S
authors.lastname: Sørensen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002984:Clinical Laboratory Information Systems; D003404:Creatinine / Q000097:blood*; D057225:Data Mining; D016208:Databases, Factual; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D012016:Reference Values; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine