BACKGROUND: Assessment of kidney function in emergency settings is essential across all medical subspecialties. Daily assessment of patient creatinine results from emergency medical services showed that some deviated from expected values, implying drug-related interference. METHODS: Real-time clinical evaluation of an enzyme method (Roche CREP2) in comparison with the Jaffé gen. 2 method (Roche CREJ2) was performed. During the period of December 2022 and January 2023, we analyzed 8,498 patient samples, where 5,524 were heavily medicated STAT patient specimens, 500 were pediatric specimens, and 2,474 were from a distant general population in a different region using the same methods. RESULTS: In 109 out of 5,524 hospital specimens (1.97%, p < 0.001), the CREP2 value was apparently (25% or more) lower than CREJ2. Suspect interfering medication was found in a sample of 43 out of 46 reviewed patients where medication data were available. This phenomenon was not observed in the general population. CONCLUSION: In a polymedicated urgent care hospital population, a creatinine enzyme method produces unreliable results, apparently due to multiple drug-related interferences.
- Publikační typ
- časopisecké články MeSH
Beta-lactam antibiotics remain one of the most preferred groups of antibiotics in critical care due to their excellent safety profiles and their activity against a wide spectrum of pathogens. The cornerstone of appropriate therapy with beta-lactams is to achieve an adequate plasmatic concentration of a given antibiotic, which is derived primarily from the minimum inhibitory concentration (MIC) of the specific pathogen. In a critically ill patient, the plasmatic levels of drugs could be affected by many significant changes in the patient's physiology, such as hypoalbuminemia, endothelial dysfunction with the leakage of intravascular fluid into interstitial space and acute kidney injury. Predicting antibiotic concentration from models based on non-critically ill populations may be misleading. Therapeutic drug monitoring (TDM) has been shown to be effective in achieving adequate concentrations of many drugs, including beta-lactam antibiotics. Reliable methods, such as high-performance liquid chromatography, provide the accurate testing of a wide range of beta-lactam antibiotics. Long turnaround times remain the main drawback limiting their widespread use, although progress has been made recently in the implementation of different novel methods of antibiotic testing. However, whether the TDM approach can effectively improve clinically relevant patient outcomes must be proved in future clinical trials.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Cíl: Popsat stav harmonizace měření HbA1c pomocí výsledků rozsáhlých mezilaboratorních studií. Materiál a metody: Použity výsledky studií NGSP-CAP s jednotkou měření v procentech HbA 1c a studií EurA1c s výsledky v jednotkách mmol/mol. Byly hodnoceny preciznost, bias, vliv různých hodnot APS na kvalitu interpretace, potenciál využití biologických variabilit. Výsledky a diskuse: Navzdory obecně dobré srovnatelnosti výsledků mezi programy externího hodnocení kvality, metodami a zeměmi, přetrvává vysoký počet laboratoří s neuspokojivou precizností a bias, což je důsledkem používání některých IVD prostředků nedostatečné kvality. Signifikantní rozdíly v preciznosti jsou důsledkem použití rozdílných jednotek měření. Kvalita analytické technologie není na potřebné úrovni personalizovaného přístupu. Proto hodnoty APS, odvozené z biologických variabilit, nelze aplikovat v kontrole kvality. Experty navržené hodnoty APS (6 % pro jednotky NGSP a 8 % pro jednotky IFCC) jsou v dané chvíli optimální a mohou být oporou harmonizace, externího hodnocení kvality a nástrojem postupů, aplikujících umělou inteligenci a strojové učení v blízké budoucnosti. Absolutní podmínkou je komutabilita referenčních materiálů (vzorky plné krve).
Materials and methods: We used the results for % HbA1c results obtained in study NGSP-CAP and for mmol/mol results obtained by study EurA1c. We are assessed precision and bias values, influence of different APS values on the postana- lytical interpretation results and possibility for derivation of APS from biological variability. Results and discussion: Comparability of results between different methods, EQA programs and countries remains sig- nificant number of laboratories with unsuitable low level of precision and bias. Very probably due to using some IVD kits lower quality. Significant differences in precision are observed due to use of using two different measurement units. Quality of analytical technology is not on the desirable level for personalized approach. An impossibility using APS values derived from biological variation is consequence of this fact. APS values suggested by experts (6% for NGSP units and 8% for IFCC units) are in this moment optimal and may serve as good basis for harmonization, external quality control and also for application of artificial intelligence and machine learning in near future. Using the commutable reference materials are absolute condition.
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- glykovaný hemoglobin * analýza MeSH
- lidé MeSH
- řízení kvality MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
This study evaluates the performance of microscopic part of a hybrid analyzer FUS-2000 (Dirui Industrial Co., Changchun, China), its analytical properties and particle recognition. The evaluation of trueness, repeatability, detection limit, carry-over, linearity range and analytical stability was performed according to Dirui protocol guidelines designed by Dirui Company to guarantee the quality of the instrument. Trueness for low, medium and high-value concentrations was calculated with bias of 15.5, 4.7 and -6.6%, respectively. Detection limit of 5 Ery/μl was confirmed. Coefficient of variation of 11.0, 5.2 and 3.8% was measured for within-run repeatability of low, medium and high concentration. Between-run repeatability for daily quality control had coefficient of variation of 3.0%. Carry-over did not exceed 0.05%. Linearity was confirmed for range of 0-16,000 particles/μl (R2 = 0.9997). The analytical stability had coefficient of variation of 4.3%. Out of 1258 analyzed urine samples, 362 positive were subjected to light microscopy urine sediment analysis and compared to the analyzer results. Cohen's kappa coefficients were calculated to express the concordance. Squared kappa coefficient was 0.927 (red blood cells), 0.888 (white blood cells), 0.908 (squamous epithelia), 0.634 (transitional epithelia), 0.628 (hyaline casts), 0.843 (granular casts) and 0.623 (bacteria). Single kappa coefficients were 0.885 (yeasts) and 0.756 (crystals), respectively. Aforementioned results show good analytical performance of the analyzer and tight agreement with light microscopy of urine sediment.
- MeSH
- analýza moči přístrojové vybavení MeSH
- lidé MeSH
- referenční hodnoty MeSH
- směrnice jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- Publikační typ
- abstrakt z konference MeSH
