Abstract
Objectives: To introduce a creatinine biosensor and a total carbon dioxide content (TCO2) method for whole-blood measurements, to evaluate the clinical performance of a new transportable analyzer that simultaneously performs these two and six other tests (Na+, K+, Cl-, glucose, urea nitrogen, and hematocrit), and to assess the potential of the new analyzer for point-of-care testing in critical care by comparing results obtained by nonlaboratory personnel and by medical technologists. Design: Multicenter sites compared whole-blood measurements with the transportable analyzer to plasma measurements from the same specimens with local reference instruments. One site compared whole-blood results produced by nonlaboratory personnel vs. medical technologists and evaluated day-to-day and within-day precision at the point of care. Settings and Patients: Four medical centers in the United States. Venous and arterial specimens from 710 critically ill patients with a variety of diagnoses. Point-of-care testing in the emergency room and operating room. Results: The linear regression analyses at the four medical centers showed the following: creatinine (a) slope, 0.91 to 1.22, (b) y intercept, -0.07 to 0.15 mg/dL, and (c) r2, 0.77 to 1.00; and TCO2: (a) slope, 0.64 to 1.00, (b) y intercept, 1.36 to 9.6 mmol/L, and (c) r2, 0.52 to 0.72 (y(i), whole-blood analyses; x(i), plasma reference measurements). Bland-Altman plots also were used to assess multicenter creatinine and TCO2 results. Of the other analytes, K+, glucose, and urea nitrogen had the highest r2)-values. For the eight chemistry profile tests performed at the point of care (y(i), nonlaboratory personnel results; x(i), medical technologist results), the average value of r2 was 0.96 (SD 0.08) in the operating room and 0.96 (SD 0.06) in the emergency room, and mean paired differences (y(i) - x(l)) were not statistically or clinically significant. Precision was acceptable. Conclusions: The performance of the creatinine biosensor and the TCO2 method was acceptable for whole-blood samples. Comparisons of whole-blood results from the transportable analyzer and plasma results from the local reference instruments revealed analyte biases that may be attributed to differences between direct whole-blood analyses and indirect-diluted plasma measurements and other factors. Performance of nonlaboratory personnel and medical technologists was equivalent for point- of-care testing in critical care settings. The whole-blood analyzer should be useful when patient care demands immediate results.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2379-2389 |
| Number of pages | 11 |
| Journal | Critical Care Medicine |
| Volume | 28 |
| Issue number | 7 |
| State | Published - 2000 |
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Keywords
- And whole-blood analyzer
- Biosensor
- Carbon dioxide
- Chloride
- Emergency room
- Glucose
- Hematocrit
- Operating room
- Potassium
- Precision sodium
- Substrate- specific electrode
- Urea nitrogen
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Multicenter study of whole-blood creatinine, total carbon dioxide content, and chemistry profiling for laboratory and point-of-care testing in critical care in the United States. / Kost, Gerald J; Vu, Huynh Truong; Inn, Michael; DuPlantier, Richard; Fleisher, Martin; Kroll, Martin H.; Spinosa, John C.
In: Critical Care Medicine, Vol. 28, No. 7, 2000, p. 2379-2389.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Multicenter study of whole-blood creatinine, total carbon dioxide content, and chemistry profiling for laboratory and point-of-care testing in critical care in the United States
AU - Kost, Gerald J
AU - Vu, Huynh Truong
AU - Inn, Michael
AU - DuPlantier, Richard
AU - Fleisher, Martin
AU - Kroll, Martin H.
AU - Spinosa, John C.
PY - 2000
Y1 - 2000
N2 - Objectives: To introduce a creatinine biosensor and a total carbon dioxide content (TCO2) method for whole-blood measurements, to evaluate the clinical performance of a new transportable analyzer that simultaneously performs these two and six other tests (Na+, K+, Cl-, glucose, urea nitrogen, and hematocrit), and to assess the potential of the new analyzer for point-of-care testing in critical care by comparing results obtained by nonlaboratory personnel and by medical technologists. Design: Multicenter sites compared whole-blood measurements with the transportable analyzer to plasma measurements from the same specimens with local reference instruments. One site compared whole-blood results produced by nonlaboratory personnel vs. medical technologists and evaluated day-to-day and within-day precision at the point of care. Settings and Patients: Four medical centers in the United States. Venous and arterial specimens from 710 critically ill patients with a variety of diagnoses. Point-of-care testing in the emergency room and operating room. Results: The linear regression analyses at the four medical centers showed the following: creatinine (a) slope, 0.91 to 1.22, (b) y intercept, -0.07 to 0.15 mg/dL, and (c) r2, 0.77 to 1.00; and TCO2: (a) slope, 0.64 to 1.00, (b) y intercept, 1.36 to 9.6 mmol/L, and (c) r2, 0.52 to 0.72 (y(i), whole-blood analyses; x(i), plasma reference measurements). Bland-Altman plots also were used to assess multicenter creatinine and TCO2 results. Of the other analytes, K+, glucose, and urea nitrogen had the highest r2)-values. For the eight chemistry profile tests performed at the point of care (y(i), nonlaboratory personnel results; x(i), medical technologist results), the average value of r2 was 0.96 (SD 0.08) in the operating room and 0.96 (SD 0.06) in the emergency room, and mean paired differences (y(i) - x(l)) were not statistically or clinically significant. Precision was acceptable. Conclusions: The performance of the creatinine biosensor and the TCO2 method was acceptable for whole-blood samples. Comparisons of whole-blood results from the transportable analyzer and plasma results from the local reference instruments revealed analyte biases that may be attributed to differences between direct whole-blood analyses and indirect-diluted plasma measurements and other factors. Performance of nonlaboratory personnel and medical technologists was equivalent for point- of-care testing in critical care settings. The whole-blood analyzer should be useful when patient care demands immediate results.
AB - Objectives: To introduce a creatinine biosensor and a total carbon dioxide content (TCO2) method for whole-blood measurements, to evaluate the clinical performance of a new transportable analyzer that simultaneously performs these two and six other tests (Na+, K+, Cl-, glucose, urea nitrogen, and hematocrit), and to assess the potential of the new analyzer for point-of-care testing in critical care by comparing results obtained by nonlaboratory personnel and by medical technologists. Design: Multicenter sites compared whole-blood measurements with the transportable analyzer to plasma measurements from the same specimens with local reference instruments. One site compared whole-blood results produced by nonlaboratory personnel vs. medical technologists and evaluated day-to-day and within-day precision at the point of care. Settings and Patients: Four medical centers in the United States. Venous and arterial specimens from 710 critically ill patients with a variety of diagnoses. Point-of-care testing in the emergency room and operating room. Results: The linear regression analyses at the four medical centers showed the following: creatinine (a) slope, 0.91 to 1.22, (b) y intercept, -0.07 to 0.15 mg/dL, and (c) r2, 0.77 to 1.00; and TCO2: (a) slope, 0.64 to 1.00, (b) y intercept, 1.36 to 9.6 mmol/L, and (c) r2, 0.52 to 0.72 (y(i), whole-blood analyses; x(i), plasma reference measurements). Bland-Altman plots also were used to assess multicenter creatinine and TCO2 results. Of the other analytes, K+, glucose, and urea nitrogen had the highest r2)-values. For the eight chemistry profile tests performed at the point of care (y(i), nonlaboratory personnel results; x(i), medical technologist results), the average value of r2 was 0.96 (SD 0.08) in the operating room and 0.96 (SD 0.06) in the emergency room, and mean paired differences (y(i) - x(l)) were not statistically or clinically significant. Precision was acceptable. Conclusions: The performance of the creatinine biosensor and the TCO2 method was acceptable for whole-blood samples. Comparisons of whole-blood results from the transportable analyzer and plasma results from the local reference instruments revealed analyte biases that may be attributed to differences between direct whole-blood analyses and indirect-diluted plasma measurements and other factors. Performance of nonlaboratory personnel and medical technologists was equivalent for point- of-care testing in critical care settings. The whole-blood analyzer should be useful when patient care demands immediate results.
KW - And whole-blood analyzer
KW - Biosensor
KW - Carbon dioxide
KW - Chloride
KW - Emergency room
KW - Glucose
KW - Hematocrit
KW - Operating room
KW - Potassium
KW - Precision sodium
KW - Substrate- specific electrode
KW - Urea nitrogen
UR - http://www.scopus.com/inward/record.url?scp=0033852492&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033852492&partnerID=8YFLogxK
M3 - Article
C2 - 10921568
AN - SCOPUS:0033852492
VL - 28
SP - 2379
EP - 2389
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 7
ER -