Accuracy of 23 Equations for Estimating LDL Cholesterol in a Clinical Laboratory Database of 5,051,467 Patients.
Accuracy of 23 Equations for Estimating LDL Cholesterol in a Clinical Laboratory Database of 5,051,467 Patients.
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作者：
Samuel C;Park J;Sajja A;Michos ED;Blumenthal RS;Jones SR;Martin SS
已经提出了弗里德瓦尔德低密度脂蛋白胆固醇（LDL-C）方程的替代方案。比较现有LDL-C方程与超声心动图测量的准确性。我们使用了超大型脂质数据库（VLDbL）的第二次收获，这是成人和儿童患者（N = 5，051，467）的人群代表性便利样本，在2015年10月1日至2019年6月30日期间通过垂直自动轮廓（VAP）超离心法获得了临床脂质测量结果。我们进行了系统性文献综述，以确定可用的LDL-C方程，并根据基于指南的分类比较其准确性。我们还比较了他们的中位数误差与超离心方程。我们对LDL-C方程进行了总体评估，并按年龄、性别、空腹状态和甘油三酯水平分层，以及动脉粥样硬化性心血管疾病、高血压、糖尿病、肾脏疾病、炎症和甲状腺功能障碍患者。分析5，051，467例患者中23个确定的LDL-C方程（平均值±SD年龄，56±16岁; 53.3%女性），Martin/霍普金斯方程最准确地将LDL-C分类为正确类别其次为Sampson方程（86.3%）、Chen方程（84.4%）、Puavilai方程（84.1%）、Delong方程（83.3%）和弗里德瓦尔德方程（83.2%）。其他17个方程的准确度低于弗里德瓦尔德，准确度低至35.1%。方程的中位误差范围为-10.8至18.7 mg/dL，使用Martin/霍普金斯方程（0.3，IQR-1.6至2.4 mg/dL）进行最佳优化。按年龄、性别、空腹状态、甘油三酯水平和临床亚组分层后，Martin/霍普金斯方程的准确性最高。此外，弗里德瓦尔德LDL-C <70 mg/dL的五分之一患者，以及弗里德瓦尔德LDL-C <70 mg/dL且甘油三酯水平150-399 mg/dL的几乎一半患者，通过Martin/霍普金斯方程将LDL-C正确重新分类为>70 mg/dL。大多数建议的弗里德瓦尔德方程替代方案会降低LDL-C的准确性，并且它们的使用可能会在临床护理中引入非预期的差异。Martin/霍普金斯方程显示了总体和各亚组的最高LDL-C准确度。
Alternatives to the Friedewald low-density lipoprotein cholesterol (LDL-C) equation have been proposed. To compare the accuracy of available LDL-C equations with ultracentrifugation measurement. We used the second harvest of the Very Large Database of Lipids (VLDbL), which is a population-representative convenience sample of adult and pediatric patients (N = 5,051,467) with clinical lipid measurements obtained via the vertical auto profile (VAP) ultracentrifugation method between October 1, 2015 and June 30, 2019. We performed a systematic literature review to identify available LDL-C equations and compared their accuracy according to guideline-based classification. We also compared the equations by their median error versus ultracentrifugation. We evaluated LDL-C equations overall and stratified by age, sex, fasting status, and triglyceride levels, as well as in patients with atherosclerotic cardiovascular disease, hypertension, diabetes, kidney disease, inflammation, and thyroid dysfunction. Analyzing 23 identified LDL-C equations in 5,051,467 patients (mean±SD age, 56±16 years; 53.3% women), the Martin/Hopkins equation most accurately classified LDL-C to the correct category (89.6%), followed by the Sampson (86.3%), Chen (84.4%), Puavilai (84.1%), Delong (83.3%), and Friedewald (83.2%) equations. The other 17 equations were less accurate than Friedewald, with accuracy as low as 35.1%. The median error of equations ranged from –10.8 to 18.7 mg/dL, and was best optimized using the Martin/Hopkins equation (0.3, IQR–1.6 to 2.4 mg/dL). The Martin/Hopkins equation had the highest accuracy after stratifying by age, sex, fasting status, triglyceride levels, and clinical subgroups. In addition, one in five patients who had Friedewald LDL-C <70 mg/dL, and almost half of the patients with Friedewald LDL-C <70 mg/dL and triglyceride levels 150–399 mg/dL, had LDL-C correctly reclassified to >70 mg/dL by the Martin/Hopkins equation. Most proposed alternatives to the Friedewald equation worsen LDL-C accuracy, and their use could introduce unintended disparities in clinical care. The Martin/Hopkins equation demonstrated the highest LDL-C accuracy overall and across subgroups.
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