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.
OBJECTIVE
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.


METHODS
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.


METHODS
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 (yi, whole-blood analyses; xi, 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 (yi, nonlaboratory personnel results; xi, 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 (yi - xi) 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.
Kost
G J
GJ
University of California, Davis, Health System and the Point-of-Care Testing Center for Teaching and Research, USA.
Vu
H T
HT
Inn
M
M
DuPlantier
R
R
Fleisher
M
M
Kroll
M H
MH
Spinosa
J C
JC
D015374:Biosensing Techniques / Q000295:instrumentation*; D001786:Blood Glucose; D002245:Carbon Dioxide / Q000097:blood*; D003404:Creatinine / Q000097:blood*; D003422:Critical Care; D004573:Electrolytes / Q000097:blood; D004636:Emergency Service, Hospital; D004867:Equipment Design; D006400:Hematocrit; D006801:Humans; D016014:Linear Models; D009873:Operating Rooms; D019095:Point-of-Care Systems; D011786:Quality Control; D014481:United States
D001786:Blood Glucose; D004573:Electrolytes; D002245:Carbon Dioxide; D003404:Creatinine