Establishing continuous reference intervals for liver function analytes using fractional polynomial regression

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dc.authorid0000-0002-7498-604X
dc.authorid0000-0001-7709-6133
dc.authorid0000-0002-4405-521X
dc.contributor.authorYildirim, Didem Derici
dc.contributor.authorFidanci, Senay Balci
dc.contributor.authorSengul, Merve Turkegun
dc.contributor.authorCimen, M. Burak Y.
dc.contributor.authorTamer, Lulufer
dc.date.accessioned2026-01-24T12:29:14Z
dc.date.available2026-01-24T12:29:14Z
dc.date.issued2025
dc.departmentAlanya Alaaddin Keykubat Üniversitesi
dc.description.abstractObjectives Reference intervals (RIs) play a crucial role in contemporary healthcare by providing critical support for clinical decision-making. RI calculation methods have certain limitations. They cannot capture age-related variations in laboratory values and non-linear relations between variables. Therefore, alternative methods that preserve the continuous type of age and consider non-linear relations must be explored. This study aimed to suggest an alternative method, namely, fractional polynomial (FP) regression models, to overcome these limitations and estimate the reference limits based on this method for ALT and AST markers.Methods This retrospective study is conducted on a large hospital database to establish continuous age and sex-specific RIs for ALT and AST in a Turkish population. The study included 4,386 and 2,834 individuals for ALT and AST, respectively, aged 18-92 years. FP models and a non-parametric approach are used to calculate RIs.Results For AST in females, a linear model indicated the relationship between age and AST in females (p=0.673). However, more complex models (m0=4) were explored for female ALT values. After several comparisons, the FP3 model was chosen as the best fit (p=0.098). For male ALT and AST, FP analysis showed no significant age-related effects (p=0.679 and p=0.507, respectively). Therefore, traditional non-parametric methods were used to calculate RIs.Conclusions Compared with discrete RIs, continuous RIs are more accurate. Laboratories should determine RIs that reflect their population. Future research could explore the application of FP models in the pediatric population.
dc.identifier.doi10.1515/tjb-2024-0086
dc.identifier.endpage563
dc.identifier.issn0250-4685
dc.identifier.issn1303-829X
dc.identifier.issue4
dc.identifier.scopus2-s2.0-85218736310
dc.identifier.scopusqualityQ3
dc.identifier.startpage556
dc.identifier.urihttps://doi.org/10.1515/tjb-2024-0086
dc.identifier.urihttps://hdl.handle.net/20.500.12868/5218
dc.identifier.volume50
dc.identifier.wosWOS:001425134700001
dc.identifier.wosqualityQ4
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.language.isoen
dc.publisherWalter De Gruyter Gmbh
dc.relation.ispartofTurkish Journal of Biochemistry-Turk Biyokimya Dergisi
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WoS_20260121
dc.subjectcontinuous reference intervals
dc.subjectfractional polynomial regression
dc.subjectALT
dc.subjectAST
dc.subjectadults
dc.titleEstablishing continuous reference intervals for liver function analytes using fractional polynomial regression
dc.typeArticle

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