Ann Lab Med.  2016 Sep;36(5):427-433. 10.3343/alm.2016.36.5.427.

Evaluation of Serum Cotinine Cut-Off to Distinguish Smokers From Nonsmokers in the Korean Population

Affiliations
  • 1Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. mjkkmd@gmail.com, drwhy@hanmail.net
  • 2Institute of Metabolism, Green Cross Laboratories, Yongin, Korea.

Abstract

BACKGROUND
Cotinine has been widely used as an objective marker to identify current smokers. We conducted this study to address the absence of Korean studies investigating the efficacy of immunoassays and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the detection of serum cotinine and to determine the optimal serum cotinine cut-off level for differentiating current smokers from nonsmokers.
METHODS
Serum specimens were obtained from 120 subjects. They were randomly chosen to represent a broad distribution of urine cotinine levels based on a retrospective review of questionnaires and results of urine cotinine levels. We determined serum cotinine levels using the IMMULITE 2000 XPi Immunoassay System (Siemens Healthcare Diagnostics Inc., USA) and LC-MS/MS (API-4000, Applied Biosystems, USA). Correlation was analyzed between IMMULITE serum cotinine, urine cotinine, and LC-MS/MS serum cotinine levels. ROC curve was analyzed to identify the optimal IMMULITE serum cotinine cut-off level for differentiating current smokers from nonsmokers.
RESULTS
IMMULITE serum cotinine levels correlated with both urine cotinine and LC-MS/MS serum cotinine levels, with correlation coefficients of 0.958 and 0.986, respectively. The optimal serum cotinine cut-off level for distinguishing current smokers from nonsmokers was 13.2 ng/mL (95.7% sensitivity, 94.1% specificity) using IMMULITE.
CONCLUSIONS
This is the first study to investigate the use of LC-MS/MS for the measurement of serum cotinine and to determine the optimal serum cotinine cut-off level for the IMMULITE immunoassay. Our results could provide guidelines for differentiating current smokers from nonsmokers in the Korean population.

Keyword

Cotinine; Cut-off; Korean; LC-MS/MS; Serum

MeSH Terms

Adult
Area Under Curve
Asian Continental Ancestry Group
*Chromatography, High Pressure Liquid
Cotinine/*blood/urine
Female
Humans
Immunoassay
Male
Middle Aged
ROC Curve
Republic of Korea
Retrospective Studies
*Smoking
Surveys and Questionnaires
*Tandem Mass Spectrometry
Cotinine

Figure

  • Fig. 1 Selectivity of serum cotinine using LC-MS/MS (A) Noise peaks (B) Front ghost peak (C) Cotinine (D) Internal standard (IS). No noticeable differences are observed in the chromatograms. Cotinine and the IS are separated from the noise peaks, and IS is sufficiently separated from the front ghost peak.Abbreviation: cps, counts per second; LC-MS/MS, liquid chromatography-tandem mass spectrometry.

  • Fig. 2 Correlation between (A) IMMULITE serum cotinine and urine cotinine levels and between (B) IMMULITE serum cotinine and LC-MS/MS serum cotinine levels.Abbreviations: CI, confidence interval; LC-MS/MS, liquid chromatography-tandem mass spectrometry.

  • Fig. 3 ROC curve analysis of IMMULITE serum cotinine levels for differentiating current smokers from nonsmokers.Abbreviations: AUC, area under the curve; CI, confidence interval.


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