J Korean Med Assoc.  2013 Jun;56(6):533-540.

Clinical chemistry values in elderly Korean people: single institutional study

• Seo BY
• Ham JY
• Kim YK
• Song JH
• Song KE

Abstract

Laboratory values change with age and interpreting laboratory results from elderly people using the reference intervals for younger adults may not be appropriate. The authors investigated the distribution patterns of routine chemistry values from elderly people to determine whether current reference intervals are also valid for elderly people. A total of 1,215 persons older than 65 years and 1,827 healthy adults below 65 years of age were evaluated. Blood samples were collected after an overnight fast and analyzed for chemistry tests. Computing the central 95th percentile showed that the total protein, albumin, ALP, LD, creatinine, uric acid, triglyceride, HDL-cholesterol, and electrolytes of elderly people were within the standard reference intervals used in our laboratory. For AST and ALT, the upper range of the central 95th percentile in the elderly population was found to be outside the common reference interval. However, the central 90th percentile values of AST and ALT were compatible with the common reference intervals. GGT, BUN, total cholesterol, LDL-cholesterol, and glucose showed higher values than the upper limits of the reference intervals. For common clinical chemistry tests, the common reference values in general should be applicable to elderly people, even though some parameters showed wider distributions in the elderly.

Keyword

Clinical chemistry tests; Reference values; Aged

MeSH Terms

Adult
Aged
Chemistry, Clinical
Cholesterol
Clinical Chemistry Tests
Creatinine
Electrolytes
Glucose
Humans
Reference Values
Uric Acid
Cholesterol
Creatinine
Electrolytes
Glucose
Uric Acid

Figure

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  Figure 1 Central 95th percentile of clinical chemistry values in elderly people. ALP, alkaline phosphatase; RI, common reference interval; LD, lactate dehydrogenase; HDL, high-density lipoprotein. a)2.5 to 97.5 percentile in the age group I (65 years or above) of the research subjects. The upper and lower limits of the box are the 97.5 and 2.5 percentile and the horizontal bar is the median value (n=1,215).

• 

  Figure 2 Central 90th percentile, central 95th percentile of clinical chemistry values in elderly people. AST, aspartate transaminase; RI, common reference interval; GGT, gamma-glutamyl transpeptidase; BUN, blood urea nitrogen; T-Chol, total cholesterol; LDL, low-density lipoprotein; ALT, alanine transaminase. a)5.0 to 95.0 percentile in the age group I (65 years or above) of the research subjects. The upper and lower limits of the box are the 95.0 and 5.0 percentile and the horizontal bar is the median value. b)2.5 to 97.5 percentile in the age group I (65 years or above) of the research subjects. The upper and lower limits of the box are the 97.5 and 2.5 percentile and the horizontal bar is the median value (n=1,215).

Reference

1. Statistics Korea. Summary of census population [Internet]. Daejeon: Statistics Korea;cited 2013 May 21. Available from: http://kosis.kr/gen_etl/start.jsp?orgId=101&tblId=DT_1IN1003&conn_path=I2&path.

2. Statistics Korea. Population projections for Korea [Internet]. Daejeon: Statistics Korea;cited 2013 May 21. Available from: http://kosis.kr/gen_etl/start.jsp?orgId=101&tblId=DT_1B01001&conn_path=I2&path.

3. Carlsson L, Lind L, Larsson A. Reference values for 27 clinical chemistry tests in 70-year-old males and females. Gerontology. 2010; 56:259–265.

4. Melillo KD. Interpretation of laboratory values in older adults. Nurse Pract. 1993; 18:59–67.

5. Hammerman-Rozenberg R, Cohen A, Ginsberg G, Maaravi Y, Ebstein RP, Stessman J. Laboratory reference values for the 70 year olds. Isr J Med Sci. 1996; 32:611–620.

6. Boulat O, Krieg MA, Janin B, Burckhardt P, Francioli P, Bachmann C. Clinical chemistry variables in normal elderly and healthy ambulatory populations: comparison with reference values. Clin Chim Acta. 1998; 272:127–135.

7. Bourdel-Marchasson I, Laksir H, Puget E. Interpreting routine biochemistry in those aged over 65 years: a time for change. Maturitas. 2010; 66:39–45.

8. Tietz NW, Shuey DF, Wekstein DR. Laboratory values in fit aging individuals: sexagenarians through centenarians. Clin Chem. 1992; 38:1167–1185.

9. Willcox DC, Willcox BJ, Wang NC, He Q, Rosenbaum M, Suzuki M. Life at the extreme limit: phenotypic characteristics of supercentenarians in Okinawa. J Gerontol A Biol Sci Med Sci. 2008; 63:1201–1208.

10. Dietrich T. Geriatrics lacks reference values. Clin Chem News. 1983; 06. 19–20.

11. Garry PJ, Hunt WC, VanderJagt DJ, Rhyne RL. Clinical chemistry reference intervals for healthy elderly subjects. Am J Clin Nutr. 1989; 50:5 Suppl. 1219–1230.

12. Fulop T Jr, Worum I, Varga P, Foris G, Bars L, Mudri K, Leovey A. Blood laboratory parameters of carefully selected healthy elderly people. Arch Gerontol Geriatr. 1989; 8:151–163.

13. Huber KR, Mostafaie N, Stangl G, Worofka B, Kittl E, Hofmann J, Hejtman M, Michael R, Weissgram S, Leitha T, Jungwirth S, Fischer P, Tragl KH, Bauer K. Clinical chemistry reference values for 75-year-old apparently healthy persons. Clin Chem Lab Med. 2006; 44:1355–1360.

14. Landahl S, Jagenburg R, Svanborg A. Blood components in a 70-year-old population. Clin Chim Acta. 1981; 112:301–314.

15. Greenblatt DJ. Reduced serum albumin concentration in the elderly: a report from the Boston Collaborative Drug Surveillance Program. J Am Geriatr Soc. 1979; 27:20–22.

16. Zauber NP, Zauber AG. Hematologic data of healthy very old people. JAMA. 1987; 257:2181–2184.

17. Lipschitz DA, Udupa KB, Milton KY, Thompson CO. Effect of age on hematopoiesis in man. Blood. 1984; 63:502–509.

18. Fraser CG, Cummings ST, Wilkinson SP, Neville RG, Knox JD, Ho O, MacWalter RS. Biological variability of 26 clinical che-mistry analytes in elderly people. Clin Chem. 1989; 35:783–786.