1
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Washing-free chemiluminescence immunoassay for rapid detection of cardiac troponin I in whole blood samples. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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2
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Troponin I as a Biomarker for Early Detection of Acute Myocardial Infarction. Curr Probl Cardiol 2021; 48:101067. [PMID: 34826431 DOI: 10.1016/j.cpcardiol.2021.101067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/02/2023]
Abstract
Acute myocardial infarction (AMI) as the main cause of death among cardiovascular diseases is defined as a deficiency of oxygen that generates irreversible tissue necrosis in the heart muscle. For diagnostic measurements, the evaluation of cardiac markers concentration like cardiac triponin I (cTnI) in plasma or saliva thought the use of biosensors has become one of the most commonly applied strategies for prognosis of AMI. Inside this diagnostic devices, electrochemical (ECL) ones have been highly encourage to improve sensing capabilities by using different materials and configurations. In this review, the authors presents a summary of studies that involves cTnI detection using ECL biosensors modified with nanomaterials and related mechanisms.
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3
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Krintus M, Panteghini M. Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays. Clin Chem Lab Med 2021; 58:1773-1783. [PMID: 32134723 DOI: 10.1515/cclm-2020-0017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
A number of assay-related issues can affect the performance of cardiac troponin (cTn) measurement in everyday practice. In this respect, it is vital that all information on cTn assays is known and that the performance characteristics of assays are objectively assessed and adequately described. The advent of the latest generation of more sensitive cTn assays has heralded a new wave of information about low concentrations of cTn in blood. These recent generation assays have improved analytical sensitivity and corresponding performance at low cTn concentrations when compared to their predecessors, providing a convincing goal for laboratory medicine in helping clinicians in the diagnosis of acute myocardial infarction. Crucial to the clinical utility of highly sensitive cTn assays is the laboratorians' role in closely scrutinizing proposed assays and defining their value in relation to available evidence. Analytical, as well as pre-analytical and post-analytical, aspects must be documented. In this review, we describe what laboratory professionals should know about their cTn assay performance characteristics and the pre-analytical prerequisites for robustness to ensure optimal post-analytical reporting.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland, Phone: +48 52 585 44 90, Fax: +48 52 585 36 03
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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4
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Miller R, Young J, Nixon G, Pickering JW, Stokes T, Turner R, Devlin G, Watson A, Gutenstein M, Norman T, George PM, Du Toit S, Than M. Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations. J Prim Health Care 2021; 12:129-138. [PMID: 32594980 DOI: 10.1071/hc19059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Accelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand's rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise. An accelerated chest pain pathway using point-of-care troponin has been adapted for use in rural settings. A pilot study in a low-risk rural population showed no major adverse cardiac events at 30 days. A larger study is required to be confident that the pathway is safe. AIMS To assess the safety and effectiveness of an accelerated chest pain pathway adapted for rural settings and general practice using point-of-care troponin to identify low-risk patients and allow early discharge. METHODS This is a prospective observational study of an accelerated chest pain pathway using point-of-care troponin in rural hospitals and general practices in New Zealand. A total of 1000 patients, of whom we estimate 400 will be low risk, will be enrolled in the study. OUTCOME MEASURES The primary outcome is the proportion of patients identified by the pathway as low risk for a 30-day major adverse cardiac event. Secondary outcomes include the proportion of low-risk patients who were discharged directly from general practice or rural hospitals, the proportion of patients reclassified as having acute myocardial infarction by the pathway and the proportion of patients with low and intermediate risk safely managed in the rural hospital.
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Affiliation(s)
- Rory Miller
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; and Corresponding author.
| | - Joanna Young
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Garry Nixon
- Cardiology, Canterbury DHB, Christchurch Hospital, Christchurch and Department of Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - John W Pickering
- Medicine, University of Otago - Christchurch and Emergency Department, Christchurch Hospital and Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | | | - Antony Watson
- Emergency Care Foundation, St Albans, Christchurch, New Zealand
| | - Marc Gutenstein
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; and Rural Health Academic Centre Ashburton, University of Otago and Christchurch and Emergency Department, Nelson Hospital, Nelson, New Zealand
| | - Tim Norman
- Project Office, Midlands Regional Health Network Charitable Trust, Hamilton, New Zealand
| | | | - Stephen Du Toit
- Biochemistry, Waikato DHB. Biochemistry Department, Waikato Hospital, Hamilton, New Zealand
| | - Martin Than
- Emergency Department, Canterbury DHB, Christchurch Hospital, Christchurch, New Zealand
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5
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Park HD. Current Status of Clinical Application of Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:168-175. [PMID: 33053162 DOI: 10.5858/arpa.2020-0112-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. OBJECTIVE.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. DATA SOURCES.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. CONCLUSIONS.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCT so that it can be optimally used to improve patient management.
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Affiliation(s)
- Hyung-Doo Park
- From the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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6
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Hausfater P, Hajage D, Bulsei J, Canavaggio P, Lafourcade A, Paquet AL, Arock M, Durand‐Zaleski I, Riou B, Oueidat N. Impact of Point-of-care Testing on Length of Stay of Patients in the Emergency Department: A Cluster-randomized Controlled Study. Acad Emerg Med 2020; 27:974-983. [PMID: 32621374 DOI: 10.1111/acem.14072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Crowding is a frequent concern in the emergency department (ED). Laboratory point-of-care testing (POCT) has been proposed to decrease patients' length of stay (LOS). Our objective was to determine whether an extended panel of POCT solutions could reduce LOS. METHODS This was a single-center, prospective, open-label, controlled cluster-randomized study. Blood test processing was randomized into 1-week inclusion periods: interventional arm (laboratory analyses performed on POCT analyzers implemented in the ED) or control arm (central laboratory). The primary endpoint was LOS of patients in the ED. Secondary endpoints were time to result (TTR), ED crowding surrogates, and average total cost of an ED visit in each arm. RESULTS A total of 23,231 patients were included and 20,923 were analyzed for the main outcome measure. Mean ± SD age was 46 ± 20 years, and 7,905 (36%) underwent blood sampling. Mean ± SD LOSs were 203 ± 161 and 210 ± 168 minutes in the POCT and control arms, respectively. LOS reduction for the entire ED population was -9 minutes (95% confidence interval [CI] = -22 to 5, p = 0.22) compared to the control arm and -17 minutes (95% CI = -34.0 to 0.6, p = 0.06) for patients undergoing blood sampling. The mean ± SD TTRs were 28 ± 31 and 79 ± 34 minutes in the POCT and control arms, respectively (TTR reduction = -51 minutes, 95% CI = -54 to -48 minutes, p < 0.001). CONCLUSIONS The implementation of an extended panel of POCT solutions in an ED did not significantly reduce the LOS, but reduced the TTR.
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Affiliation(s)
- Pierre Hausfater
- From the Emergency DepartmentHôpital Pitié‐SalpêtrièreAPHP ParisFrance
- the UMR INSERM 1166 IHU ICAN Sorbonne Université, GRC‐14 BIOSFAST ParisFrance
| | - David Hajage
- the Département Biostatistique Santé Publique et Information Médicale Centre de Pharmacoépidémiologie (Cephepi) Sorbonne UniversitéAPHP ParisFrance
| | - Julie Bulsei
- the AP‐HP URC Eco Ile de France Hôpital de l'Hôtel Dieu ParisFrance
- the CRESS INSERM INRA Université de Paris ParisFrance
| | | | | | - Anne Laure Paquet
- From the Emergency DepartmentHôpital Pitié‐SalpêtrièreAPHP ParisFrance
| | - Michel Arock
- the Sorbonne Université ParisFrance
- and the Biochemisty and Emergency Biology Department Hôpital Pitié‐SalpêtrièreAPHP Paris France
| | - Isabelle Durand‐Zaleski
- the AP‐HP URC Eco Ile de France Hôpital de l'Hôtel Dieu ParisFrance
- the CRESS INSERM INRA Université de Paris ParisFrance
| | - Bruno Riou
- From the Emergency DepartmentHôpital Pitié‐SalpêtrièreAPHP ParisFrance
- the UMR INSERM 1166 IHU ICAN Sorbonne Université, GRC‐14 BIOSFAST ParisFrance
| | - Nathalie Oueidat
- and the Biochemisty and Emergency Biology Department Hôpital Pitié‐SalpêtrièreAPHP Paris France
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Austin EE, Blakely B, Tufanaru C, Selwood A, Braithwaite J, Clay-Williams R. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med 2020; 28:55. [PMID: 32539739 PMCID: PMC7296671 DOI: 10.1186/s13049-020-00749-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. Methods and findings We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. Conclusions ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Brette Blakely
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Catalin Tufanaru
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Lin YH, Zhang Y, Liu YT, Cui K, Kang JS, Zhou Z. How to choose a point-of-care testing for troponin. J Clin Lab Anal 2020; 34:e23263. [PMID: 32222055 PMCID: PMC7370753 DOI: 10.1002/jcla.23263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Point-of-care (POC) cTn assays are needed when the central laboratory is unable to provide timely results to the emergency department. Many POC devices are available. The prospect of choosing them is daunting. In order to provide a quick decision-making reference for POC cTn device selection comparing them to the central laboratory, seven POC devices commonly employed by emergency department were evaluated. METHODS Firstly, we reviewed all devices package inserts. Secondly, we evaluated several POC cTn assays for imprecision, linearity, and correlation with central laboratory assays according to CLSI EP protocols. The linear regression analyses were performed only for the detectable concentrations. Five cTnI devices (Alere Triage, BioMerieux Vidas, Mitsubishi Pathfast, ReLIA TZ-301, and Radiometer AQT90) were evaluated against a contemporary cTnI assay (Beckman Access II Accu TnI). Two cTnT assays (Radiometer AQT90 and Roche Cobas h232) were compared to a high-sensitivity (hs) cTnT method (Roche Cobas e601). RESULTS For cTn levels around the 99th percentile upper reference limits (URLs) of the comparator assays, imprecision could not be assessed for the Alere, BioMerieux, and Cobas h232 as they gave undetectable readings due to a lack of assay sensitivity. Imprecision (CV) was unacceptably high for the ReLIA (33.3%). On account of this precision metric, these four assays were deemed unsuitable. Regression analyses showed acceptable linearity for all the POC devices. The correlation coefficients for ReLIA, BioMerieux, Cobas h232, and Radiometer cTnT were >0.95. Unlike the cTnT devices, the cTnI assays employ different capture and detection antibodies leading to non-commutable results. The POC cTn results were concordant with their comparator-Radiometer cTnT 90%, Pathfast cTnI 85%, and Radiometer cTnI 75%. CONCLUSION Our study provides the procedure and essential data to guide selection of a POC cTn device. Of the point-of-care devices, methods evaluated Radiometer AQT90 (cTnI and cTnT) and Pathfast might be considered.
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Affiliation(s)
- Ya-Hui Lin
- Center of Laboratory Medicine, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Zhang
- Center of Laboratory Medicine, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu-Tao Liu
- Center of Laboratory Medicine, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kai Cui
- Center of Laboratory Medicine, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jin-Suo Kang
- Center of Laboratory Medicine, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhou Zhou
- Center of Laboratory Medicine, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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9
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Alghamdi A, Reynard C, Morris N, Moss P, Jarman H, Hardy E, Harris T, Horner D, Parris R, Body R. Diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a point-of-care cardiac troponin assay. Emerg Med J 2020; 37:223-228. [PMID: 32047076 DOI: 10.1136/emermed-2019-208882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Point-of-care (POC) cardiac troponin (cTn) assays have a rapid turnaround time but are generally less sensitive than laboratory-based assays. Previous research found that the Abbott i-Stat cardiac troponin I (cTnI) assay has good diagnostic accuracy when used with the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid and serial sampling over 3 hours. Accuracy of other assays may differ. We therefore evaluated the diagnostic accuracy of a different POC cTnI assay with serial sampling over 3 hours, both with T-MACS and when used alone. METHODS In a prospective diagnostic accuracy study at eight EDs in England (July 2015-October 2017), we collected clinical data from consenting adults with suspected ACS at the time of assessment in the ED. Blood samples were drawn on arrival and 3 hours later for POC cTnI (Cardio 3 Triage, Alere). The target condition was an adjudicated diagnosis of acute myocardial infarction (AMI), based on reference standard serial laboratory-based cTn testing. We calculated test characteristics for POC cTnI using the limit of detection (LoD, 0.01 µg/L) and the T-MACS decision aid. RESULTS Of 347 participants, 59 (14.9%) had AMI. With serial POC cTnI testing over 3 hours, POC cTnI at the LoD cut-off ruled out AMI in 193 (55.6%) patients with 98.1% sensitivity (95% CI 89.9% to 100.0%) and 99.5% negative predictive value (NPV, 95% CI 96.5% to 99.9%). T-MACS ruled out AMI in 117 (33.7%) patients with 98.1% sensitivity (95% CI 89.9% to 100%) and 99.2% NPV (95% CI 94.3% to 99.9%). T-MACS ruled in AMI with 97.9% specificity (95% CI 95.8% to 99.5%) and 83.7% positive predictive value (95% CI 70.6% to 91.7%). CONCLUSIONS With serial sampling over 3 hours, the Alere Cardio 3 Triage cTnI assay has relatively high NPV for AMI using either the LoD cut-off alone or the T-MACS decision aid. However, wide CIs around the measures of diagnostic accuracy mean that further prospective testing of this strategy is required before clinical implementation. TRIAL REGISTRATION NUMBER UKCRN 18000.
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Affiliation(s)
- Abdulrhman Alghamdi
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK .,College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Charles Reynard
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Medicine and Intensive Care Research Group, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Niall Morris
- Emergency Medicine and Intensive Care Research Group, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Phil Moss
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elaine Hardy
- Emergency Department, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Tim Harris
- Emergency Department, Queen Mary's Hospital, London, UK
| | - Daniel Horner
- Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Richard Parris
- Emergency Department, Bolton NHS Foundation Trust, Bolton, UK
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester Royal Infirmary, Manchester, UK
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Han GR, Ki H, Kim MG. Automated, Universal, and Mass-Producible Paper-Based Lateral Flow Biosensing Platform for High-Performance Point-of-Care Testing. ACS APPLIED MATERIALS & INTERFACES 2020; 12:1885-1894. [PMID: 31813220 DOI: 10.1021/acsami.9b17888] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Paper-based lateral flow assays (LFAs) are among the most widely used biosensing platforms for point-of-care testing (POCT). However, the conventional colloidal gold label of LFAs show low sensitivity and limited quantitative capacity. Alternatively, the use of enzyme/chemical reaction-based signal amplification with structural modifications has enhanced analytical capacity but requires multiple user interventions as a trade-off, increasing complexity, test imprecision, and time. These platforms are also difficult to manufacture, limiting their practical applications. In this study, within the current LFA production framework, we developed a highly sensitive, automated, universal, and manufacturable LFA biosensing platform by (i) incorporating gold nanoparticles into a polymer-networked peroxidase with an antibody as a new scheme for enhanced enzyme conjugation and (ii) integrating a mass-producible and time-programmable amplification part based on a water-swellable polymer for automating the sequential reactions in the immunoassay and signal amplification, without compromising performance, simplicity, and production feasibility. We applied this platform to evaluate cardiac troponin I (cTnI), a gold-standard biomarker for myocardial infarction diagnosis. Quantitative analysis of cTnI in clinical setting remains limited to the laboratory-based high-end and costly standard equipment. Coupled with an enzyme-catalyzed chemiluminescence method, this platform enables automated, cost-effective (0.66 USD per test), and high-performance testing of human cTnI in serum samples within 20 min with a detection range of 6 orders of magnitude, detection limit of 0.84 pg mL-1 (595-fold higher than conventional cTnI-LFA), and a coefficient of variation of 2.9-8.5%, which are comparable to the standard equipment and acceptable for clinical use. Moreover, cTnI analysis results using clinical serum/plasma samples revealed a strong correlation (R2 = 0.991) with contemporary standard equipment, demonstrating the practical application of this platform for high-performance POCT.
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Affiliation(s)
- Gyeo-Re Han
- Department of Chemistry, School of Physics and Chemistry , Gwangju Institute of Science and Technology (GIST) , 123 Cheomdangwagi-ro , Buk-gu, Gwangju 61005 , Republic of Korea
| | - Hangil Ki
- Department of Chemistry, School of Physics and Chemistry , Gwangju Institute of Science and Technology (GIST) , 123 Cheomdangwagi-ro , Buk-gu, Gwangju 61005 , Republic of Korea
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry , Gwangju Institute of Science and Technology (GIST) , 123 Cheomdangwagi-ro , Buk-gu, Gwangju 61005 , Republic of Korea
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11
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Braga F, Aloisio E, Panzeri A, Nakagawa T, Panteghini M. Analytical validation of a highly sensitive point-of-care system for cardiac troponin I determination. ACTA ACUST UNITED AC 2019; 58:138-145. [DOI: 10.1515/cclm-2019-0801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/22/2019] [Indexed: 12/28/2022]
Abstract
Abstract
Background
Highly sensitive cardiac troponin assays (hs-cTn) are not available as point-of-care (POC) measurements. As rapid testing cannot be achieved at the expense of clinical performance, there is an urgent need to develop and rigorously validate POC hs-cTn. Konica Minolta (KM) has recently developed a surface plasmon-field enhanced fluorescence spectroscopy-based POC hs-cTn I system.
Methods
We validated the analytical characteristics of the KM POC system according to the international guidelines.
Results
Limit of blank (LoB) and limit of detection (LoD) were 0.35 and 0.62 ng/L, respectively, hs-cTn I concentrations corresponding to a total CV of 20%, 10% and 5% were 1.5, 3.9 and 11.0 ng/L, respectively. Method comparison studies showed that KM calibration was successfully traced to higher-order references. Limit of quantitation (LoQ), i.e. the hs-cTn I concentration having a total error of measurement of ≤34%, was 10.0 ng/L. The upper reference limit (URL) for 600 healthy blood donors was calculated at 12.2 ng/L (90% confidence interval [CI]: 9.2–39.2), while sex-partitioned URLs were 20.6 (males) and 10.7 ng/L (females), respectively (p < 0.0001). KM assay measured hs-cTn I concentrations >LoD in 65.7% of all reference individuals, in 76.7% of males and in 54.7% of females, respectively.
Conclusions
The KM system joins the characteristics of POC systems to the analytical performance of hs-cTn.
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Affiliation(s)
- Federica Braga
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Via GB Grassi 74 , 20157 Milano , Italy , Phone: +390239042743, Fax: +390250319835
| | - Elena Aloisio
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italy
| | - Andrea Panzeri
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italy
| | - Takahito Nakagawa
- Konica Minolta, Inc., Project Promotion Department , Product Planning Division, Precision Medicine Business Unit , Tokyo , Japan
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’ , Università di Milano , Milan , Italy
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italy
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12
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Damhorst GL, Tyburski EA, Brand O, Martin GS, Lam WA. Diagnosis of acute serious illness: the role of point-of-care technologies. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019; 11:22-34. [PMID: 34079919 PMCID: PMC8168915 DOI: 10.1016/j.cobme.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Access to rapid diagnostic information is a core value of point-of-care (POC) technology. This is particularly relevant in acute, emergency, and critical care settings where diagnostic speed and precision directly guide the management of patients with potentially life-threatening conditions. Many POC diagnostics described in the literature, however, remain largely unproven and have yet to enter the market entirely. Only a few have traversed the translation and commercialization pathways to reach widespread clinical adoption. Moreover, even technologies that have successfully translated to the patient bedside still frequently lack an evidence base showing improvement of clinical outcomes. In this review, we present aspects of diagnosis of acute life-threatening diseases and describe the potential role of POC technologies, emphasizing the available evidence of clinical outcomes. Finally, we discuss what is needed to identify clinically meaningful new technologies and translate them toward the long-promised goal of better health through rapid POC diagnosis.
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Affiliation(s)
| | - Erika A Tyburski
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Sanguina, LLC, Peachtree Corners, GA, USA
| | - Oliver Brand
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Greg S Martin
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
- Georgia Clinical and Translational Science Alliance, Atlanta, GA, USA
| | - Wilbur A Lam
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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Regan B, Boyle F, O'Kennedy R, Collins D. Evaluation of Molecularly Imprinted Polymers for Point-of-Care Testing for Cardiovascular Disease. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3485. [PMID: 31395843 PMCID: PMC6720456 DOI: 10.3390/s19163485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
Molecular imprinting is a rapidly growing area of interest involving the synthesis of artificial recognition elements that enable the separation of analyte from a sample matrix and its determination. Traditionally, this approach can be successfully applied to small analyte (<1.5 kDa) separation/ extraction, but, more recently it is finding utility in biomimetic sensors. These sensors consist of a recognition element and a transducer similar to their biosensor counterparts, however, the fundamental distinction is that biomimetic sensors employ an artificial recognition element. Molecularly imprinted polymers (MIPs) employed as the recognition elements in biomimetic sensors contain binding sites complementary in shape and functionality to their target analyte. Despite the growing interest in molecularly imprinting techniques, the commercial adoption of this technology is yet to be widely realised for blood sample analysis. This review aims to assess the applicability of this technology for the point-of-care testing (POCT) of cardiovascular disease-related biomarkers. More specifically, molecular imprinting is critically evaluated with respect to the detection of cardiac biomarkers indicative of acute coronary syndrome (ACS), such as the cardiac troponins (cTns). The challenges associated with the synthesis of MIPs for protein detection are outlined, in addition to enhancement techniques that ultimately improve the analytical performance of biomimetic sensors. The mechanism of detection employed to convert the analyte concentration into a measurable signal in biomimetic sensors will be discussed. Furthermore, the analytical performance of these sensors will be compared with biosensors and their potential implementation within clinical settings will be considered. In addition, the most suitable application of these sensors for cardiovascular assessment will be presented.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin 9, Ireland.
| | - Fiona Boyle
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
- Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin 9, Ireland
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Diagnostic Roles of Postmortem cTn I and cTn T in Cardiac Death with Special Regard to Myocardial Infarction: A Systematic Literature Review and Meta-Analysis. Int J Mol Sci 2019; 20:ijms20133351. [PMID: 31288395 PMCID: PMC6651768 DOI: 10.3390/ijms20133351] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/29/2019] [Accepted: 07/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Cardiac troponin I (cTn I) and cardiac troponin T (cTn T) are currently widely used as diagnostic biomarkers for myocardial injury caused by ischemic heart diseases in clinical and forensic medicine. However, no previous meta-analysis has summarized the diagnostic roles of postmortem cTn I and cTn T. The aim of the present study was to meta-analyze the diagnostic roles of postmortem cTn I and cTn T for cardiac death in forensic medicine, present a systematic review of the previous literature, and determine the postmortem cut-off values of cTn I and cTn T. Methods: We searched multiple databases for the related literature, performed a meta-analysis to investigate the diagnostic roles of postmortem cardiac troponins, and analyzed the receiver operating characteristic (ROC) curve to determine their postmortem cut-off values. Results and Conclusions: The present meta-analysis demonstrated that postmortem cTn I and cTn T levels were increased in pericardial fluid and serum in cardiac death, especially in patients with acute myocardial infarction (AMI). We determined the postmortem cut-off value of cTn I in the pericardial fluid at 86.2 ng/mL, cTn I in serum at 9.5 ng/mL, and cTn T in serum at 8.025 ng/mL.
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Christ M, Geier F, Blaschke S, Giannitsis E, Khellaf M, Mair J, Pariente D, Scharnhorst V, Semjonow V, Hausfater P. Clinical performance of a new point-of-care cardiac troponin I test. Clin Chem Lab Med 2019; 56:1336-1344. [PMID: 29630502 DOI: 10.1515/cclm-2017-0693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 02/06/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND We evaluated the clinical performance of the Minicare cardiac troponin-I (cTnI), a new point-of-care (POC) cTnI test for the diagnosis of acute myocardial infarction (AMI) in a prospective, multicentre study (ISRCTN77371338). METHODS Of 474 patients (≥18 years) admitted to an emergency department (ED) or chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS; ≤12 h from symptom onset), 465 were eligible. Minicare cTnI was tested immediately, 3 h and 6 h after presentation. AMI diagnoses were adjudicated independently based on current guidelines. RESULTS The diagnostic performance of the Minicare cTnI test at 3 h was similar for whole blood and in plasma: sensitivity 0.92 vs. 0.90; specificity 0.91 vs. 0.90; positive predictive value (PPV) 0.68 vs. 0.66; negative predictive value (NPV) 0.98 vs. 0.98; positive likelihood ratio (LR+) 10.18 vs. 9.41; negative likelihood ratio (LR-) 0.09 vs. 0.11. The optimal diagnostic performance was obtained at 3 h using cut-offs cTnI >43 ng/L plus cTnI change from admission ≥18.5 ng/L: sensitivity 0.90, specificity 0.96, PPV 0.81, NPV 0.98, and LR+ 21.54. The area under the receiver operating characteristics (ROC) curve for cTnI whole blood baseline value and absolute change after 3 h curve was 0.93. CONCLUSIONS These data support the clinical usefulness of Minicare cTnI within a 0 h/3 h-blood sampling protocol supported by current guidelines for the evaluation of suspected ACS.
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Affiliation(s)
- Michael Christ
- Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuernberg, Germany.,Department of Emergency, Luzerner Kantonsspital, Luzern, Switzerland
| | - Felicitas Geier
- Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuernberg, Germany
| | - Sabine Blaschke
- Interdisciplinary Emergency Care Unit, University Medical Center Göttingen, Göttingen, Germany
| | | | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, Créteil, France
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - David Pariente
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Volkher Scharnhorst
- Clinical Laboratory, Catharina Ziekenhuis Eindhoven and Technical University Eindhoven, Eindhoven, TheNetherlands
| | | | - Pierre Hausfater
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.,Sorbonne Universités UPMC Univ-Paris 06, GRC-UPMC BIOSFAST, Paris, France
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Halushka PV, Goodwin AJ, Halushka MK. Opportunities for microRNAs in the Crowded Field of Cardiovascular Biomarkers. ANNUAL REVIEW OF PATHOLOGY 2019; 14:211-238. [PMID: 30332561 PMCID: PMC6442682 DOI: 10.1146/annurev-pathmechdis-012418-012827] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiovascular diseases exist across all developed countries. Biomarkers that can predict or diagnose diseases early in their pathogeneses can reduce their morbidity and mortality in afflicted individuals. microRNAs are small regulatory RNAs that modulate translation and have been identified as potential fluid-based biomarkers across numerous maladies. We describe the current state of cardiovascular disease biomarkers across a range of diseases, including myocardial infarction, acute coronary syndrome, myocarditis, hypertension, heart failure, heart transplantation, aortic stenosis, diabetic cardiomyopathy, atrial fibrillation, and sepsis. We present the current understanding of microRNAs as possible biomarkers in these categories and where their best opportunities exist to enter clinical practice.
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Affiliation(s)
- Perry V Halushka
- Department of Pharmacology, South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, South Carolina 29425, USA;
- Department of Medicine, South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, South Carolina 29425, USA
| | - Andrew J Goodwin
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA;
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA;
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Goldsmith BR, Locascio L, Gao Y, Lerner M, Walker A, Lerner J, Kyaw J, Shue A, Afsahi S, Pan D, Nokes J, Barron F. Digital Biosensing by Foundry-Fabricated Graphene Sensors. Sci Rep 2019; 9:434. [PMID: 30670783 PMCID: PMC6342992 DOI: 10.1038/s41598-019-38700-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/31/2018] [Indexed: 01/17/2023] Open
Abstract
The prevailing philosophy in biological testing has been to focus on simple tests with easy to interpret information such as ELISA or lateral flow assays. At the same time, there has been a decades long understanding in device physics and nanotechnology that electrical approaches have the potential to drastically improve the quality, speed, and cost of biological testing provided that computational resources are available to analyze the resulting complex data. This concept can be conceived of as "the internet of biology" in the same way miniaturized electronic sensors have enabled "the internet of things." It is well established in the nanotechnology literature that techniques such as field effect biosensing are capable of rapid and flexible biological testing. Until now, access to this new technology has been limited to academic researchers focused on bioelectronic devices and their collaborators. Here we show that this capability is retained in an industrially manufactured device, opening access to this technology generally. Access to this type of production opens the door for rapid deployment of nanoelectronic sensors outside the research space. The low power and resource usage of these biosensors enables biotech engineers to gain immediate control over precise biological and environmental data.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Deng Pan
- Cardea Bio Inc., San Diego, CA, USA
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18
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Greiser A, Winter T, Mahfoud H, Kallner A, Ittermann T, Masuch A, Lubenow N, Kohlmann T, Greinacher A, Nauck M, Petersmann A. The 99th percentile and imprecision of point-of-care cardiac troponin I in comparison to central laboratory tests in a large reference population. Clin Biochem 2017; 50:1198-1202. [DOI: 10.1016/j.clinbiochem.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/19/2017] [Accepted: 08/10/2017] [Indexed: 01/28/2023]
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Pecoraro V, Banfi G, Germagnoli L, Trenti T. A systematic evaluation of immunoassay point-of-care testing to define impact on patients' outcomes. Ann Clin Biochem 2017; 54:420-431. [PMID: 28135840 DOI: 10.1177/0004563217694377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Point-of-care testing has been developed to provide rapid test results. Most published studies focus on analytical performance, neglecting its impact on patient outcomes. Objective To review the analytical performance and accuracy of point-of-care testing specifically planned for immunoassay and to evaluate the impact of faster results on patient management. Methods A search of electronic databases for studies reporting immunoassay results obtained in both point-of-care testing and central laboratory scenarios was performed. Data were extracted concerning the study details, and the methodological quality was assessed. The analytical characteristics and diagnostic accuracy of six points-of-care testing: troponin, procalcitonin, parathyroid hormone, brain natriuretic peptide, C-reactive protein and neutrophil gelatinase-associated lipocalin were evaluated. Results A total of 116 scientific papers were analysed. Studies measuring procalcitonin, parathyroid hormone and neutrophil gelatinase-associated lipocalin reported a limited impact on diagnostic decisions. Seven studies measuring C-reactive protein claimed a significant reduction of antibiotic prescription. Several authors evaluated brain natriuretic peptide or troponin reporting faster decision-making without any improvement in clinical outcome. Forty-four per cent of studies reported analytical data, showing satisfactory correlations between results obtained through point-of-care testing and central laboratory setting. Half of studies defined the diagnostic accuracy of point-of-care testing as acceptable for troponin (median sensitivity and specificity: 74% and 94%, respectively), brain natriuretic peptide (median sensitivity and specificity: 82% and 88%, respectively) and C-reactive protein (median sensitivity and specificity 85%). Conclusions Point-of-care testing immunoassay results seem to be reliable and accurate for troponin, brain natriuretic peptide and C-reactive protein. The satisfactory analytical performance, together with an excellent practicability, suggests that it could be a consistent tool in clinical practice, but data are lacking regarding the patient outcomes.
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Affiliation(s)
- Valentina Pecoraro
- 1 Department of Laboratory Medicine, Clinical Pathology-Toxicology, Ospedale Civile Sant'Agostino Estense, Modena, Italy.,2 Laboratory of Regulatory Policies, IRCCS - "Mario Negri", Institute of Pharmacological Research, Milan, Italy
| | - Giuseppe Banfi
- 3 Vita-Salute San Raffaele University, Milan, Italy.,4 I.R.C.C.S. Orthopedic Institute Galeazzi, Milan, Italy
| | | | - Tommaso Trenti
- 1 Department of Laboratory Medicine, Clinical Pathology-Toxicology, Ospedale Civile Sant'Agostino Estense, Modena, Italy
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Improving early exclusion of acute coronary syndrome in primary care: the added value of point-of-care troponin as stated by general practitioners. Prim Health Care Res Dev 2017; 18:386-397. [PMID: 28462739 DOI: 10.1017/s1463423617000135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim To investigate general practitioners' (GPs') desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements. BACKGROUND Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8-15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test's potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory. METHODS An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015. Findings A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.
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Venge P, van Lippen L, Blaschke S, Christ M, Geier F, Giannitsis E, Hagström E, Hausfater P, Khellaf M, Mair J, Pariente D, Scharnhorst V, Semjonow V. Equal clinical performance of a novel point-of-care cardiac troponin I (cTnI) assay with a commonly used high-sensitivity cTnI assay. Clin Chim Acta 2017; 469:119-125. [PMID: 28347675 DOI: 10.1016/j.cca.2017.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. METHODS The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. RESULTS Minicare cTnI correlated with Architect hs-cTnI (r2=0.85, p<0.0001) and I-Stat cTnI (r2=0.93, p<0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p=ns) and 0.96-0.97 3h after admission (p=ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4h, and similar to Architect hs-cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p<0.01). Negative likelihood ratios (LR-) after 2-4h were 0.06 (0.02-0.17, 95% CI) for Minicare cTnI, 0.11 (0.05-0.24) for Architect hs-cTnI (p=0.02) and 0.28 (0.18-0.43) for I-Stat cTnI (p<0.0001). The clinical concordances between Minicare cTnI and Architect hs-cTnI were 92% (admission) and 95% (2-4h), with lower concordances between Minicare cTnI and I-Stat cTnI (83% and 78%, respectively; p=0.007). CONCLUSIONS The Minicare cTnI POC assay may become useful for prompt and safe ruling-out of AMI in ED patients with suspected AMI using a guideline supported 0/3h sampling protocol.
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Affiliation(s)
- Per Venge
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden.
| | | | - Sabine Blaschke
- Interdisciplinary Emergency Care Unit, University Medical Center Göttingen, Germany
| | - Michael Christ
- Emergency Department, Luzerner Kantonsspital, Luzern, Switzerland; Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuernberg, Germany
| | - Felicitas Geier
- Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuernberg, Germany
| | | | | | - Pierre Hausfater
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP and Sorbonne Universités UPMC Univ-Paris 06, GRC-14 BIOSFAST, Paris, France
| | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, Créteil, France
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - David Pariente
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Volkher Scharnhorst
- Clinical Laboratory, Catharina Ziekenhuis Eindhoven and Technical University Eindhoven, Eindhoven, The Netherlands
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Lopez-Calle E, Espindola P, Spinke J, Lutz S, Nichtl A, Tgetgel A, Herbert N, Marcinowski M, Klepp J, Fischer T, Brueckner T, Boehm C, Keller T. A new immunochemistry platform for a guideline-compliant cardiac troponin T assay at the point of care: proof of principle. ACTA ACUST UNITED AC 2017; 55:1798-1804. [DOI: 10.1515/cclm-2016-1078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/24/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:A multitude of troponin assays for the point-of-care (POC) have been developed showing a lack of analytical sensitivity and precision. We present a new platform solution for the high-sensitivity detection of cardiac troponin T (cTnT) in a 30 μL whole blood sample with a turnaround time of 11 min.Methods:The immunoassay was completely run in a ready-to-use plastic disposable, a centrifugal microfluidic disc with fully integrated reagents. After the sample application, the assay was automatically processed by separating the cellular blood components via centrifugation, followed by incubation of a defined volume from the generated plasma with the immunoreagents. The fluorescence in the signal zone of a membrane was measured after its washing for the cTnT quantitation.Results:A calibration curve, measured in whole blood samples spiked with native human cTnT, was generated covering a range up to a concentration of approximately 8300 ng/L. The lower detection limit was determined to be 3.0 ng/L. At a concentration of 14 ng/L, the 99th percentile value from the high-sensitivity cardiac troponin T (hs-cTnT) assay in the ElecsysConclusions:The described technology shows that an analytical performance for a highly sensitive determination of cTnT can be achieved in a POC setting.
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Abstract
Acute coronary syndrome (ACS) encompasses a pathophysiological spectrum of cardiovascular diseases, all of which have significant morbidity and mortality. ACS was once considered an acute condition; however, new treatment strategies and improvements in biomarker assays have led to ACS being an acute and chronic disease. Cardiac troponin is the preferred biomarker for the diagnosis of myocardial infarction, and there is considerable interest and efforts toward development and implementation of high-sensitivity cardiac troponin (hs-cTn) assays worldwide. Analytical and clinical performance characteristics of hs-cTn assays as well as testing limitations are important for laboratorians and clinicians to understand in order to utilize testing appropriately. Furthermore, expanding the clinical utility of hs-cTn into other cohorts such as asymptomatic community dwelling populations, heart failure, and chronic kidney disease populations supports novel opportunities for improved short- and long-term prognosis.
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Quelle place pour la biologie délocalisée aux urgences ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kemper DW, Semjonow V, de Theije F, Keizer D, van Lippen L, Mair J, Wille B, Christ M, Geier F, Hausfater P, Pariente D, Scharnhorst V, Curvers J, Nieuwenhuis J. Analytical evaluation of a new point of care system for measuring cardiac Troponin I. Clin Biochem 2016; 50:174-180. [PMID: 27847339 DOI: 10.1016/j.clinbiochem.2016.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS Li-heparin whole blood and plasma were used to perform analytical studies. The sample type comparison study was performed at 4 different hospitals. The 99th percentile upper reference limit (URL) study was performed using Li-heparin plasma, Li-heparin whole blood and capillary blood samples from 750 healthy adults, aging from 18 to 86years. RESULTS Limit of the blank, limit of detection and limit of quantitation at 20% coefficient of variation (CV) were determined to be 8.5ng/L, 18ng/L and 38ng/L respectively without significant differences between whole blood and plasma for LoQ. Cross-reactivity and interferences were minimal and no high-dose hook was observed. Total CV was found to be from 7.3% to 12% for cTnI concentrations between 109.6 and 6135.4ng/L. CV at the 99th percentile URL was 18.6%. The sample type comparison study between capillary blood, Li-heparin whole blood and Li-heparin plasma samples demonstrated correlation coefficients between 0.99 and 1.00 with slopes between 1.03 and 1.08. The method comparison between Minicare cTnI and Beckman Coulter Access, AccuTnI+3 demonstrated a correlation coefficient of 0.973 with a slope of 1.09. The 99th percentile URL of a healthy population was calculated to be 43ng/L with no significant difference between genders or sample types. CONCLUSIONS The Minicare cTnI assay is a sensitive and precise, clinical usable test for determination of cTnI concentration that can be used in a near-patient setting as an aid in the diagnosis of acute myocardial infarction.
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Affiliation(s)
| | | | | | | | | | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernadette Wille
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Christ
- Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuernberg, Germany
| | - Felicitas Geier
- Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuernberg, Germany
| | - Pierre Hausfater
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP et Sorbonne Universités UPMC Univ-Paris 06, France
| | - David Pariente
- Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP et Sorbonne Universités UPMC Univ-Paris 06, France
| | - Volkher Scharnhorst
- Clinical laboratory, Catharina Ziekenhuis Eindhoven and Technical University Eindhoven, Eindhoven, The Netherlands
| | - Joyce Curvers
- Clinical laboratory, Catharina Ziekenhuis Eindhoven and Technical University Eindhoven, Eindhoven, The Netherlands
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Cummins BM, Ligler FS, Walker GM. Point-of-care diagnostics for niche applications. Biotechnol Adv 2016; 34:161-76. [PMID: 26837054 PMCID: PMC4833668 DOI: 10.1016/j.biotechadv.2016.01.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 01/26/2023]
Abstract
Point-of-care or point-of-use diagnostics are analytical devices that provide clinically relevant information without the need for a core clinical laboratory. In this review we define point-of-care diagnostics as portable versions of assays performed in a traditional clinical chemistry laboratory. This review discusses five areas relevant to human and animal health where increased attention could produce significant impact: veterinary medicine, space travel, sports medicine, emergency medicine, and operating room efficiency. For each of these areas, clinical need, available commercial products, and ongoing research into new devices are highlighted.
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Affiliation(s)
- Brian M Cummins
- Joint Department of Biomedical Engineering, University of North Carolina - Chapel Hill and North Carolina State University, Raleigh, NC, 27695, USA
| | - Frances S Ligler
- Joint Department of Biomedical Engineering, University of North Carolina - Chapel Hill and North Carolina State University, Raleigh, NC, 27695, USA
| | - Glenn M Walker
- Joint Department of Biomedical Engineering, University of North Carolina - Chapel Hill and North Carolina State University, Raleigh, NC, 27695, USA.
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Laboratory medicine in the new healthcare environment. ACTA ACUST UNITED AC 2016; 54:523-33. [DOI: 10.1515/cclm-2015-0803] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
AbstractThe 21st century challenge is to redesign healthcare systems to be safe, efficient, effective, timely, equitable and patient-centred. Although laboratory medicine is integral to many of these objectives involving prevention, diagnosis, treatment, and managing disease of patients, it suffers from poor visibility as a medical discipline and as a profession and fewer rewards for educational efforts when compared to other medical disciplines. Laboratory scientists are often perceived as managing machinery and equipment, but conversely they need to take a position of shared clinical leadership, showing the role of laboratory tests to guarantee optimal care for patients. This is however challenging because of some reluctance by laboratory professionals to involve themselves in test structuring and requesting and in the inspection of work as it arrives because it is assumed that all requests are clinically necessary; there is a poor communication and integration between clinical wards and laboratory; and, importantly, there is the need for an excellent cultural and scientific background of laboratory professionals for implementing outcome research and to act as knowledge managers and skilled clinical consultants. By combining the unique talent of performing quality laboratory assays with knowledge of the pathophysiologic rationale behind the tests, laboratory professionals have the expertise to advise their clinical colleagues in regard to the appropriate test selection and interpretation of laboratory results, thereby creating opportunities to define the added value and the pivotal role of laboratory medicine on healthcare delivery.
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Bruno RR, Donner-Banzhoff N, Söllner W, Frieling T, Müller C, Christ M. The Interdisciplinary Management of Acute Chest Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:768-79; quiz 780. [PMID: 26585188 PMCID: PMC4660855 DOI: 10.3238/arztebl.2015.0768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute chest pain of non-traumatic origin is a common reason for presentation to physician's offices and emergency rooms. Coronary heart disease is the cause in up to 25% of cases. Because acute chest pain, depending on its etiology, may be associated with a high risk of death, rapid, goal-oriented management is mandatory. METHODS This review is based on pertinent articles and guidelines retrieved by a selective search in PubMed. RESULTS History-taking, physical examination, and a 12-lead electrocardiogram (ECG) are the first steps in the differential diagnostic process and generally allow the identification of features signifying a high risk of lifethreatening illness. If the ECG reveals ST-segment elevation, cardiac catheterization is indicated. The timedependent measurement of highly sensitive troponin values is a reliable test for the diagnosis or exclusion of acute myocardial infarction. A wide variety of other potential causes (e.g., vascular, musculoskeletal, gastroenterologic, or psychosomatic) must be identified from the history if they are to be treated appropriately. Elderly patients need special attention. CONCLUSION Acute chest pain is a major diagnostic challenge for the physician. Common errors are traceable to non-recognition of important causes and to an inadequate diagnostic work-up. Future studies should be designed to help optimize the interdisciplinary management of patients with chest pain.
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Affiliation(s)
- Raphael R Bruno
- Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg
| | | | - Wolfgang Söllner
- Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University, Nuernberg
| | - Thomas Frieling
- Department of Gastroenterology, Hepatology, Neurogastroenterology, Infectiology, Hematology and Oncology, HELIOS Hospital Krefeld
| | - Christian Müller
- Department of Cardiology, University Hospital Basel, Switzerland
| | - Michael Christ
- Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuernberg
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Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 9:59-81. [DOI: 10.1177/2048872615604119] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts’ opinions, for all emergency medical services’ health providers involved in the pre-hospital management of acute cardiovascular care.
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Human Neutrophil Lipocalin as a Superior Diagnostic Means To Distinguish between Acute Bacterial and Viral Infections. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:1025-32. [PMID: 26135974 PMCID: PMC4550662 DOI: 10.1128/cvi.00347-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 01/21/2023]
Abstract
The distinction between causes of acute infections is a major clinical challenge. Current biomarkers, however, are not sufficiently accurate. Human neutrophil lipocalin (HNL) concentrations in serum or whole blood activated by formyl-methionine-leucine-phenylalanine (fMLP) were shown to distinguish acute infections of bacterial or viral cause with high accuracy. The aim was therefore to compare the clinical performance of HNL with currently used biomarkers. Seven hundred twenty-five subjects (144 healthy controls and 581 patients with signs and symptoms of acute infections) were included in the study. C-reactive protein (CRP), the expression of CD64 on neutrophils, procalcitonin (PCT), and blood neutrophil counts were measured by established techniques, and HNL concentrations were measured in whole-blood samples after activation with fMLP. All tested biomarkers were elevated in bacterial as opposed to viral infections (P < 0.001). CRP, PCT, and CD64 expression in neutrophils was elevated in viral infections compared to healthy controls (P < 0.001). In the distinction between healthy controls and patients with bacterial infections, the areas under the receiver operating characteristic (ROC) curves were >0.85 for all biomarkers, whereas for the distinction between bacterial and viral infections, only HNL concentration in fMLP-activated whole blood showed an area under the ROC curve (AUROC) of >0.90 and superior clinical performance. The clinical performance of HNL in fMLP-activated whole blood was superior to current biomarkers and similar to previous results of HNL in serum. The procedure can be adopted for point-of-care testing with response times of <15 min.
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Abstract
People with elevated, non-diabetic, levels of blood glucose are at risk of progressing to clinical type 2 diabetes and are commonly termed 'prediabetic'. The term prediabetes usually refers to high-normal fasting plasma glucose (impaired fasting glucose) and/or plasma glucose 2 h following a 75 g oral glucose tolerance test (impaired glucose tolerance). Current US guidelines consider high-normal HbA1c to also represent a prediabetic state. Individuals with prediabetic levels of dysglycaemia are already at elevated risk of damage to the microvasculature and macrovasculature, resembling the long-term complications of diabetes. Halting or reversing the progressive decline in insulin sensitivity and β-cell function holds the key to achieving prevention of type 2 diabetes in at-risk subjects. Lifestyle interventions aimed at inducing weight loss, pharmacologic treatments (metformin, thiazolidinediones, acarbose, basal insulin and drugs for weight loss) and bariatric surgery have all been shown to reduce the risk of progression to type 2 diabetes in prediabetic subjects. However, lifestyle interventions are difficult for patients to maintain and the weight loss achieved tends to be regained over time. Metformin enhances the action of insulin in liver and skeletal muscle, and its efficacy for delaying or preventing the onset of diabetes has been proven in large, well-designed, randomised trials, such as the Diabetes Prevention Program and other studies. Decades of clinical use have demonstrated that metformin is generally well-tolerated and safe. We have reviewed in detail the evidence base supporting the therapeutic use of metformin for diabetes prevention.
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Affiliation(s)
| | - Mike Gwilt
- />GT Communications, 4 Armoury Gardens, Shrewsbury, SY2 6PH UK
| | - Steven Hildemann
- />Merck KGaA, Darmstadt, Germany
- />Universitäts-Herzzentrum Freiburg–Bad Krozingen, Bad Krozingen, Germany
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Marston NA, Shah KS, Mueller C, Neath SX, Christenson RH, McCord J, Nowak RM, Daniels LB, Hollander JE, Apple F, Nagurney J, Schreiber D, deFilippi C, Diercks D, Limkakeng A, Anand IS, Wu AHB, Jaffe AS, Peacock WF, Maisel AS. Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial. Emerg Med J 2015; 33:23-9. [DOI: 10.1136/emermed-2015-204692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/27/2015] [Indexed: 11/04/2022]
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Venge P, Håkansson LD, Garwicz D, Peterson C, Xu S, Pauksen K. Human neutrophil lipocalin in fMLP-activated whole blood as a diagnostic means to distinguish between acute bacterial and viral infections. J Immunol Methods 2015; 424:85-90. [PMID: 26002155 DOI: 10.1016/j.jim.2015.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The distinction between causes of acute infections is a major clinical challenge. Current biomarkers, however, are not sufficiently accurate. Human neutrophil lipocalin (HNL) in serum distinguishes acute infections with high accuracy, but in the emergency setting the assay time should be <15-20min, which excludes the use of serum samples. The aim was therefore to develop a novel rapid assay principle and test its clinical performance. METHODS Serum and neutrophils obtained from 84 infected and 20 healthy subjects were used in the experimental study. 725 subjects (144 healthy controls and 581 patients with signs and symptoms of acute infections) were included in the clinical study. HNL was measured in EDTA-plasma by ELISA or in heparinized whole blood after fMLP activation by a prototype point-of-care assay. RESULTS Increased release of HNL from neutrophils after activation with fMLP was seen already after 5 min incubation. The release of HNL from purified neutrophils after 15 min incubation with fMLP was significantly correlated to the HNL concentrations in serum obtained from the same patient (r = 0.74, p < 0.001). In the distinction between healthy controls and patients with bacterial infections, the areas under the ROC-curves were 0.95 (95% CI 0.91-0.97) and 0.88 (95% CI 0.84-0.91) for HNL in fMLP-activated whole blood and EDTA-plasma, respectively, (p < 0.001) and in the distinction between bacterial and viral infections 0.91 (95% CI 0.86-0.95) and 0.76 (95% CI 0.70-0.81), respectively (p < 0.001). CONCLUSION The clinical performance of HNL in fMLP-activated whole blood was superior to HNL in EDTA-plasma and similar to HNL in serum. The procedure can be adopted for point-of-care testing with response times of <15 min.
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Affiliation(s)
- Per Venge
- Department of Medical Sciences, Sections of Clinical Chemistry, Uppsala University, Uppsala, Sweden.
| | - Lena Douhan Håkansson
- Department of Medical Sciences, Sections of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Daniel Garwicz
- Department of Medical Sciences, Sections of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Christer Peterson
- Department of Medical Sciences, Sections of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Shengyuan Xu
- Department of Medical Sciences, Sections of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Karlis Pauksen
- Department of Infectious Diseases, Uppsala University, Uppsala, Sweden
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Hallworth MJ, Epner PL, Ebert C, Fantz CR, Faye SA, Higgins TN, Kilpatrick ES, Li W, Rana SV, Vanstapel F. Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine. Clin Chem 2015; 61:589-99. [DOI: 10.1373/clinchem.2014.232629] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.
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Affiliation(s)
- Mike J Hallworth
- Department of Clinical Biochemistry, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
| | | | | | | | | | | | | | | | - S V Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Fathil MFM, Md Arshad MK, Gopinath SCB, Hashim U, Adzhri R, Ayub RM, Ruslinda AR, Nuzaihan M N M, Azman AH, Zaki M, Tang TH. Diagnostics on acute myocardial infarction: Cardiac troponin biomarkers. Biosens Bioelectron 2015; 70:209-20. [PMID: 25841117 DOI: 10.1016/j.bios.2015.03.037] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 12/31/2022]
Abstract
Acute myocardial infarction or myocardial infarction (MI) is a major health problem, due to diminished flow of blood to the heart, leads to higher rates of mortality and morbidity. Data from World Health Organization (WHO) accounted 30% of global death annually and expected more than 23 million die annually by 2030. This fatal effects trigger the need of appropriate biomarkers for early diagnosis, thus countermeasure can be taken. At the moment, the most specific markers for cardiac injury are cardiac troponin I (cTnI) and cardiac troponin T (cTnT) which have been considered as 'gold standard'. Due to higher specificity, determination of the level of cardiac troponins became a predominant indicator for MI. Several ways of diagnostics have been formulated, which include enzyme-linked immunosorbent assay, chemiluminescent, fluoro-immunoassays, electrical detections, surface plasmon resonance, and colorimetric protein assay. This review represents and elucidates the strategies, methods and detection levels involved in these diagnostics on cardiac superior biomarkers. The advancement, sensitivity, and limitations of each method are also discussed. In addition, it concludes with a discussion on the point-of care (POC) assay for a fast, accurate and ability of handling small sample measurement of cardiac biomarker.
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Affiliation(s)
- M F M Fathil
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - M K Md Arshad
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia; School of Microelectronic Engineering (SOME), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia.
| | - Subash C B Gopinath
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - U Hashim
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia; School of Microelectronic Engineering (SOME), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - R Adzhri
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - R M Ayub
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia; School of Microelectronic Engineering (SOME), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - A R Ruslinda
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - M Nuzaihan M N
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - A H Azman
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - M Zaki
- Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis (UniMAP), Perlis, Malaysia
| | - Thean-Hock Tang
- Advance Medical & Dental Institute (AMDI), Universiti Sains Malaysia, 13200 Kepala Batas, Penang, Malaysia
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Boelstler AM, Rowland R, Theoret J, Takla RB, Szpunar S, Patel SP, Lowry AM, Pena ME. Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study. Clin Biochem 2015; 48:308-12. [DOI: 10.1016/j.clinbiochem.2014.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/19/2014] [Accepted: 10/28/2014] [Indexed: 01/07/2023]
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Sarlak H, Tanriseven M, Ardic S, Duran E. Creatine kinase-MB may lead to confusion in the ED. Am J Emerg Med 2015; 33:719. [PMID: 25682578 DOI: 10.1016/j.ajem.2015.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hakan Sarlak
- Department of Internal Medicine, Diyarbakır Military Hospital, Diyarbakır, Turkey.
| | - Mustafa Tanriseven
- Department of General Surgery, Diyarbakır Military Hospital, Diyarbakır, Turkey
| | - Sukru Ardic
- Department of Emergency, Elazıg Military Hospital, Elazıg, Turkey
| | - Eyup Duran
- Department of General Surgery, Elazıg Military Hospital, Elazıg, Turkey
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High-sensitivity cardiac troponin assays: answers to frequently asked questions. Arch Cardiovasc Dis 2015; 108:132-49. [PMID: 25669958 DOI: 10.1016/j.acvd.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 11/24/2014] [Indexed: 11/20/2022]
Abstract
Cardiac troponin (cTn) assays have quickly gained in analytical sensitivity to become what are termed 'high-sensitivity cardiac troponin' (hs-cTn) assays, bringing a flurry of dense yet incomplete literature data. The net result is that cTn assays are not yet standardized and there are still no consensus-built data on how to use and interpret cTn assay results. To address these issues, the authors take cues and clues from multiple disciplines to bring responses to frequently asked questions. In brief, the effective use of hs-cTn hinges on knowing: specific assay characteristics, particularly precision at the 99th percentile of a reference population; factors of variation at the 99th percentile value; and the high-individuality of hs-cTn assays, for which the notion of individual kinetics is more informative than straight reference to 'normal' values. The significance of patterns of change between two assay measurements has not yet been documented for every hs-cTn assay. Clinicians need to work hand-in-hand with medical biologists to better understand how to use hs-cTn assays in routine practice.
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Chest Pain Assessment and Imaging Practices for Nurse Practitioners in the Emergency Department. Adv Emerg Nurs J 2015. [DOI: 10.1097/tme.0000000000000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sonmez E, Turkdogan KA, Karabacak M, Civelek C, Yilmaz C, Ozer OF, Çavuş UY. The diagnostic role of signal peptide-C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 in non-ST-elevation acute coronary syndrome. Am J Emerg Med 2014; 33:21-4. [PMID: 25445868 DOI: 10.1016/j.ajem.2014.09.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/23/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Chest pain and/or electrocardiogram changes in non-ST elevation or suspicious chest pain and cardiac marker elevations are defined as non-ST-elevation acute coronary syndrome (NSTE-ACS). Serial electrocardiogram and marker follow-up are needed to make a diagnosis of NSTE-ACS and to eliminate noncoronary chest pain (NCCP). Signal peptide-C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 (SCUBE1) is stored within the α granules of inactive platelets and secreted at a high rate during thrombosis. We believe that SCUBE1 may be a sensitive early diagnostic indicator in distinguishing coronary-induced chest pain from noncoronary-induced chest pain. MATERIALS AND METHODS The study included 190 patients with an initial diagnosis of acute coronary syndrome in the emergency department. Based on a definitive diagnosis, these patients were classified into 3 groups: ST-elevation myocardial infarction (STEMI), NSTE-ACS, and NCCP. RESULTS Plasma SCUBE1 levels were significantly higher in the STEMI group when compared with those of the other groups (P < .05). They were also significantly higher in the NSTE-ACS group when compared with those of the NCCP group (P < .01). Troponin I, creatinine kinase, and creatinine kinase MB levels were significantly different in the NSTE-ACS group when compared with those of the NCCP group (P < .05). CONCLUSION High rates of SCUBE1 were found both in the STEMI and NSTE-ACS patients. Furthermore, in the study group, SCUBE1 was an adequate marker for distinguishing NSTE-ACS from NCCP.
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Affiliation(s)
- Ertan Sonmez
- Bezmialem Vakıf University, Department of Emergency Medicine, İstanbul, Turkey.
| | | | - Mustafa Karabacak
- Isparta State Hospital, Department of Emergency Medicine, Isparta, Turkey.
| | - Cemil Civelek
- Bezmialem Vakıf University, Department of Emergency Medicine, İstanbul, Turkey.
| | - Cahit Yilmaz
- Bezmialem Vakıf University, Department of Emergency Medicine, İstanbul, Turkey.
| | - Omer Faruk Ozer
- Bezmialem Vakıf University, Department of Emergency Medicine, İstanbul, Turkey.
| | - Umut Yücel Çavuş
- Dişkapi Yildirim Beyazit Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey.
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Aldous S, Mark Richards A, George PM, Cullen L, Parsonage WA, Flaws D, Florkowski CM, Troughton RW, O'Sullivan JW, Reid CM, Bannister L, Than M. Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction. Int J Cardiol 2014; 177:182-6. [DOI: 10.1016/j.ijcard.2014.09.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
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Asha SE, Cooke A, Walter E, Weaver J. Three-month outcome of patients with suspected acute coronary syndrome using point-of-care cardiac troponin-T testing compared with laboratory-based cardiac troponin-T testing: a randomised trial. Emerg Med J 2014; 32:601-7. [PMID: 25261004 DOI: 10.1136/emermed-2014-203958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/09/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this randomised trial was to determine clinical outcomes in patients suspected of an acute coronary syndrome (ACS) who had cardiac troponin-T measured by point-of-care (POC) compared with laboratory-based cardiac troponin-T testing. A secondary aim was to describe the correlation between the two troponin assays. METHODS Adults suspected of ACS were allocated to have troponin processed by POC or laboratory analyser. The primary outcome was a composite of acute myocardial infarction, coronary revascularisation, cardiac arrest and mortality at 3 months. Paired troponins taken on participants allocated to POC were used to determine correlation between troponin values obtained from laboratory and POC analysers. RESULTS There were 452 participants. 30 (13.1%) of 229 participants allocated to POC had at least one primary outcome event compared with 29 (13.0%) of 223 allocated to laboratory testing, a difference of 0.1% (95% CI -6.2% to 6.4%, p=0.98). Of 215 available paired troponins results, both analysers gave congruent results in 196 (91%) cases. The POC troponin was negative when the laboratory sample was positive in 16 (7%) cases. The POC troponin was positive when the laboratory sample was negative in 3 (1%) samples. Passing-Bablok regression analysis demonstrated both a constant and proportional difference between the two analytic methods. CONCLUSIONS Among patients suspected of an ACS, we found no evidence for a difference in adverse outcome when POC troponin was used in comparison with laboratory troponin. Due to the small sample size, an absolute difference of up to 6% in adverse outcome is possible. TRIAL REGISTRATION NUMBER ANZCTR#12612000319875.
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Affiliation(s)
- Stephen Edward Asha
- Emergency Department, St George Hospital, Sydney, New South Wales, Australia Emergency Department, St George Hospital, Sydney, New South Wales, Australia
| | - Andrew Cooke
- Emergency Department, St George Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Walter
- Emergency Department, St George Hospital, Sydney, New South Wales, Australia
| | - James Weaver
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Cardiology Department, St George Hospital, Sydney, New South Wales, Australia
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Lu Y, Leong W, Wei B, Yu P, Wang C, Ying Y, Wang T, Tong J, Zhu D, Ye J. An Evaluation of Laboratory Efficiency in Shanghai Emergency by Turn Around Times Level. J Clin Lab Anal 2014; 29:334-41. [PMID: 25130759 PMCID: PMC6807059 DOI: 10.1002/jcla.21775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022] Open
Abstract
Objective China launched a health care reform policy due to the aging population and rapid urbanization. However, emergency overcrowding is not improved. We assessed the laboratory efficiency of emergency department (ED) in Shanghai hospitals. Methods We recorded the turn around times for processing laboratory biomarkers to assess laboratory efficiency at 17 EDs in national/regional hospitals. We compared TAT between national and regional hospitals and between central and ED laboratories to analyze the relationship between the laboratory efficiency and the ED overcrowding. Results All the participating hospitals have an emergency laboratory. The median TAT for c‐TNT was 61 min (46–76 min) at regional EDs compared with 64 min (46–87 min) at national EDs; therefore, the TAT at regional EDs were more efficient (P < 0.05). The TAT were longer (65 min (53–85 min)) at ED labs than (60 min (42–83 min)) at central labs (P < 0.05), independent of the hospital tier and working period. We discovered that only 9% of investigated samples at Tier II EDs and 5% at Tier III EDs were assayed by point‐of‐care (POC) instruments. Conclusion Our TAT level is approaching the recommended international standard. However, the TAT evaluation from ED laboratories demonstrates that their existence does not decrease the waiting time for laboratory reports compared to central laboratory. Thus, they have not yet approached a level to share the burden of the ED overcrowding. Further arrangement should be assigned to separate the function of emergency laboratory and central laboratory. It is worth deploying the POC assay in the ED, which will save twice the TAT level. The idea of evaluating routine laboratory efficiency by TAT at ED is fast, convenient, although it does not represent the general level of laboratory efficiency.
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Affiliation(s)
- Yiming Lu
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Waiian Leong
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bohua Wei
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ping Yu
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cuicui Wang
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yilin Ying
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tingsong Wang
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianjing Tong
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dingliang Zhu
- Joint laboratory of Vascular Biology of Health Science Center and Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Ye
- Emergency Department, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Martínez Lomakin F, Tobar C. Accuracy of point-of-care serum creatinine devices for detecting patients at risk of contrast-induced nephropathy: a critical overview. Crit Rev Clin Lab Sci 2014; 51:332-43. [PMID: 25033794 DOI: 10.3109/10408363.2014.937794] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Contrast-induced nephropathy (CIN) is a common event in hospitals, with reported incidences ranging from 1 to 30%. Patients with underlying kidney disease have an increased risk of developing CIN. Point-of-care (POC) creatinine devices are handheld devices capable of providing quantitative data on a patient's kidney function that could be useful in stratifying preventive measures. This overview aims to synthesize the current evidence on diagnostic accuracy and clinical utility of POC creatinine devices in detecting patients at risk of CIN. Five databases were searched for diagnostic accuracy studies or clinical trials that evaluated the usefulness of POC devices in detecting patients at risk of CIN. Selected articles were critically appraised to assess their individual risk of bias by the use of standard criteria; 13 studies were found that addressed the diagnostic accuracy or clinical utility of POC creatinine devices. Most studies incurred a moderate to high risk of bias. Overall concordance between POC devices and reference standards (clinical laboratory procedures) was found to be moderate, with 95% limits of agreement often lying between -35.4 and +35.4 µmol/L (-0.4 and +0.4 mg/dL). Concordance was shown to decrease with worsening kidney function. Data on the clinical utility of these devices were limited, but a significant reduction in time to diagnosis was reported in two studies. Overall, POC creatinine devices showed a moderate concordance with standard clinical laboratory creatinine measurements. Several biases could have induced optimism in these estimations. Results obtained from these devices may be unreliable in cases of severe kidney failure. Randomized trials are needed to address the clinical utility of these devices.
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Affiliation(s)
- Felipe Martínez Lomakin
- Centro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso , Valparaíso , Chile
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Troponine dosée avec un test de haute sensibilité : éléments de réponse aux questions fréquemment posées. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim TK, Oh SW, Hong SC, Mok YJ, Choi EY. Point-of-care fluorescence immunoassay for cardiac panel biomarkers. J Clin Lab Anal 2014; 28:419-27. [PMID: 24652617 DOI: 10.1002/jcla.21704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/08/2013] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Myoglobin, creatine kinase-MB isoenzyme (CK-MB), and cardiac troponin I (cTnI) are cardiac biomarkers that are widely used to assist in the early and late diagnoses of acute myocardial infarction (AMI). Here, we present a clinically applicable fluorescence (FL) immunoassay for cardiac biomarkers. METHODS Whole blood was mixed with FL-labeled detector Ab (antibody) and then loaded onto a capture Ab-immobilized strip in a test cartridge. The FL intensities at test and control line on the strip were obtained and converted in a laser FL scanner to determine the concentration of biomarker. The analytical performance of immunoassay system was evaluated by linearity and imprecision tests. The comparability of the FL immunoassay method was examined with a reference method. RESULTS FL intensities and the levels of myoglobin, CK-MB, and cTnI displayed good linearity and high correlations (r = 0.999, 0.998, and 0.989, respectively). The coefficient of variations (CVs) of imprecision for all cardiac biomarkers were less than 8% in both intra- and interassays. When the results from the developed method and bioMerieux VIDAS assay were analyzed by Bland-Altman plot and Passing-Bablok plot, the two assay methods were in good agreement. CONCLUSION The FL immunoassay system can provide a platform for point-of-care testing (POCT), and it is an easy, fast, and reliable method for the quantification of cardiac biomarkers.
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Affiliation(s)
- Tae Kyum Kim
- Department of Biomedical Science, Hallym University, Chuncheon, South Korea; BodiTech Med, Inc, Chuncheon, South Korea
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Abstract
OBJECTIVES To evaluate the clinical utility of and demand for the creatine kinase (CK)-MB assay. METHODS We examined the number of CK-MB tests from 2007 through 2013 while we progressively deemphasized their use. We first removed CK-MB from the acute coronary syndrome (ACS) panel and then from the main menu and observed the demand for the test. We also reviewed patient medical records to assess the appropriateness of its use. RESULTS After removing CK-MB from the ACS panel, the test volume dropped from around 12,000 per year to about 150 per year. In reviewing the records of 171 patients who had CK-MB determination done over a 28-month period, we discovered that CK-MB contributed to the diagnosis in only one patient, although it was not essential. Since removing CK-MB from the laboratory menu, two CK-MB tests were ordered in 4 months, and neither added value. CONCLUSIONS CK-MB determinations do not add value to information available from the troponin assay and can be safely removed from the laboratory menu.
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Affiliation(s)
- Gurmukh Singh
- School of Medicine, University of Missouri–Kansas City, Kansas City
- Truman Medical Center, Kansas City, MO
- Heritage Labs International, Olathe, KS
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Measurement of natriuretic peptides at the point of care in the emergency and ambulatory setting: current status and future perspectives. Am Heart J 2013; 166:614-621.e1. [PMID: 24093839 DOI: 10.1016/j.ahj.2013.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/02/2013] [Indexed: 11/21/2022]
Abstract
The measurement of natriuretic peptides (NPs), B-type NP or N-terminal pro-B-type NP, can be an important tool in the diagnosis of acute heart failure in patients presenting to an Emergency Department (ED) with acute dyspnea, according to international guidelines. Studies and subsequent meta-analyses are mixed on the absolute value of routine NP assessment of ED patients. However, levels of NPs are likely to be used also to guide treatment and to assess risk of adverse outcomes in other patients at risk of developing heart failure, including those with pulmonary embolism or diabetes, or receiving chemotherapy. Natriuretic peptide levels, like other biomarkers, can now be measured at the point of care (POC). We have reviewed the current status of NP measurement together with the potential contribution of POC measurement of NPs to clinical care delivery in the emergency and other settings. Several POC systems for measuring NP levels are now available: these produce test results within 15 minutes and appear sufficiently sensitive and robust to be used routinely in diagnostic evaluations. Point-of-care systems could be used to assess NP levels in the ED and community outpatient settings to monitor the risk of acute heart failure. Furthermore, the use of protocol-driven POC testing of NP within the time frame of a patient consultation in the ED may facilitate and accelerate the throughput and disposition of at-risk patients. Appropriately designed clinical trials will be needed to confirm these potential benefits. It is also important that processes of care delivery are redesigned to take full advantage of the faster turnaround times provided by POC technology.
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Kurzbuch D, Somers M, McDonagh C. High efficiency ring-lens supercritical angle fluorescence (SAF) detection for optimum bioassay performance. OPTICS EXPRESS 2013; 21:22070-22075. [PMID: 24104099 DOI: 10.1364/oe.21.022070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a polymer biochip with embedded optics which allows the detection of supercritical angle fluorescence (SAF) without losses due to total internal reflection within the substrate. The chip design comprises structured spherical and aspherical optical elements on the bottom, while the top is chemically functionalized for direct binding of biomolecules. Furthermore, this design facilitates integration in lab-on-a-chip systems with appropriate microfluidics. In the confocal optical setup an ellipsoidal mirror is used for collection of SAF light above the critical angle of the water-polymer interface, which is detected by a photon-counting detector. The work presented here represents a proof of concept for performing sensitive and rapid point-of-care testing, using this low-cost, robust and disposable optical biochip platform. The performance of the platform was validated using direct binding DNA and human IgG assays which yielded low limits of detection 10 pM for DNA and 10 pg/ml for human IgG.
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