title: Evaluation of high-resolution mass spectrometry for urine toxicology screening in a pain management setting.
abstract: To evaluate liquid chromatography-high-resolution mass spectrometry (LC-HR-MS) for urine toxicology screening, 29 analytes were quantitated in 152 urine specimens from patients with chronic pain using two unique mass spectrometry platforms. De-identified specimens were quantitated in April of 2011 by liquid chromatography-triple quadrupole mass spectrometry (LC-MS-MS) and by full-scan LC-HR-MS at Millennium Laboratories. Considering LC-MS-MS as the reference method, false positive results were identified in 19 specimens measured by LC-HR-MS. Application of relative retention times using deuterium labeled internal standards improved the rate of false positive detection to only five specimens, with four occurring for the same analyte. Ultra-high-resolution mass spectrometry (R = 100,000 at m/z 200) showed no improvement over high-resolution mass spectrometry (R = 10,000 at m/z 200) in the number of false positives detected. Quantitative results measured by LC-MS-MS and LC-HR-MS showed good agreement over four orders of dynamic range. This study demonstrates that LC-HR-MS is a suitable platform for toxicology screening for a pain management population and that quantitative accuracy and sensitivity are comparable to that achieved with LC-MS-MS. The specificity of LC-HR-MS is improved by the addition of deuterium labeled internal standards and the implementation of relative retention time matching.
authors.affiliation: Washington University School of Medicine, Saint Louis, MO 63110, USA. bcrews@path.wustl.edu
authors.forename: Bridgit O
authors.initials: BO
authors.lastname: Crews
authors.forename: Amadeo J
authors.initials: AJ
authors.lastname: Pesce
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.forename: Hugh
authors.initials: H
authors.lastname: Nguyen
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fitzgerald
mesh_terms: D000700:Analgesics / Q000032:analysis*; D002853:Chromatography, Liquid / Q000379:methods*; D059350:Chronic Pain / Q000188:drug therapy; D003903:Deuterium / Q000032:analysis; D006801:Humans; D059408:Pain Management; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D053719:Tandem Mass Spectrometry / Q000379:methods*; D016482:Urinalysis / Q000379:methods*
chemical_list: D000700:Analgesics; D003903:Deuterium