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Lefèvre CR, Le Divenah F, Collet N, Pelletier R, Robert E, Ropert M, Pawlowski M, Gicquel T, Bendavid C. Avoiding falsely low creatinine concentrations measured in patients treated with N-acetylcysteine for acetaminophen intoxication using enzymo-amperometric method - An in vitro and in vivo study. Clin Chim Acta 2023; 551:117611. [PMID: 37865270 DOI: 10.1016/j.cca.2023.117611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Circulating creatinine is a biomarker of paramount importance in clinical practice. In cases of acetaminophen (APAP) intoxication, the antidote, N-acetylcysteine (NAC), interferes with commonly used creatininase-peroxidase methods. This study aimed to assess whether creatininase-amperometric methods were affected in this context. METHODS This study includes in vitro interference tests, involving four creatinine assays using NAC-spiked plasma pools and an in vivo retrospective study comparing creatininase-peroxidase and creatininase-amperometric measurements in patients presenting with NAC-treated APAP poisoning. RESULTS Creatininase-peroxidase method was impacted by NAC interference in a clinically-significant manner at therapeutic NAC levels (basal value recovery of 80 % and 70 % for 500 and 1000 mg.L-1 of NAC, respectively), surpassing the desirable Reference Change Value (RCV%). Enzymo-amperometric methods were not impacted. Among patients, a mean bias of -45.2 ± 28.0 % was observed for the peroxidase detection method compared to the amperometric in those who received NAC prior plasma sampling and -2.7 ± 5.4 % in those who did not. CONCLUSIONS Our findings indicate that enzymo-amperometric creatinine assays remain unaffected by NAC interference due to the absence of the peroxidase step in the analytical process. Therefore, these methods are suitable to prevent spurious hypocreatininemia in APAP intoxicated patients undergoing NAC therapy.
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Affiliation(s)
- Charles R Lefèvre
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France.
| | - Felipe Le Divenah
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Nicolas Collet
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Romain Pelletier
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - Eric Robert
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Martine Ropert
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - Maxime Pawlowski
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France
| | - Thomas Gicquel
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
| | - Claude Bendavid
- Clinical Biochemistry and Toxicology Laboratory, Rennes University Hospital Centre, Rennes, France; Univ Rennes, Inserm, INRAE, Institut NuMeCan (Nutrition, Metabolism and Cancer) - UMR_A 1341, UMR_S 1317, F-35000 Rennes, France
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Optimization of Patient Management in the Gynecology Emergency Department Using Point-of-Care Beta hCG. Diagnostics (Basel) 2022; 12:diagnostics12071670. [PMID: 35885574 PMCID: PMC9318004 DOI: 10.3390/diagnostics12071670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Point-of-care testing (POCT) provides shorter turn-around times and, in many cases, potentially improves medical decision making. The AQT90 FLEX® benchtop immunoanalyzer (Radiometer Medical ApS, Copenhagen, Denmark) allows for the determination of beta-human chorionic gonadotropin (βhCG) in 18 min. The main aim of this study was to evaluate the impact of measuring βhCG using the AQT90 analyzer in the gynecology emergency department (ED) compared to the standard practice of using central laboratory blood testing on the patient length of stay (LOS). Methods: The evaluation consisted of two parts. The first one, conducted in the central laboratory, focused on the analytical performances of the AQT βhCG assay. The second one, conducted in the ED, aimed at determining the impact of POCT βhCG implementation on the timeframe in which ED patients require βhCG assessment. Results: The within-lab imprecisions at the mean values of 17 and 287 IU/L were 2.7% and 3.7%, respectively. Using Deming regression (n = 60), the following equation was obtained in the central lab: AQT90 βhCG = 1.1 Roche βhCG—12.9 (r = 0.997). The implementation of POCT βhCG in the ED significantly reduced patient LOS (145 (90−212) min vs. 205 (155−265) with and without AQT90, respectively, p < 0.001). At the 2 IU/L decision level, a 99.7% agreement with the Roche assay was reported (kappa statistics, 0.99). Conclusions: We confirm that the analytical qualities of the AQT 90 were in line with those obtained in the central lab. The implementation of the POCT βhCG is associated with a shorter LOS in the ED due to the faster availability of the results and the faster decision-making possibilities.
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El-Khoury JM, Hoenig MP, Jones GRD, Lamb EJ, Parikh CR, Tolan NV, Wilson FP. AACC Guidance Document on Laboratory Investigation of Acute Kidney Injury. J Appl Lab Med 2021; 6:1316-1337. [PMID: 33973621 DOI: 10.1093/jalm/jfab020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a sudden episode of kidney damage or failure affecting up to 15% of hospitalized patients and is associated with serious short- and long-term complications, mortality, and health care costs. Current practices to diagnose and stage AKI are variable and do not factor in our improved understanding of the biological and analytical variability of creatinine. In addition, the emergence of biomarkers, for example, cystatin C, insulin-like growth factor binding protein 7, and tissue inhibitor of metalloproteinases 2, and electronic notification tools for earlier detection of AKI, highlights the need for updated recommendations to address these developments. CONTENT This AACC Academy guidance document is intended to provide laboratorians and clinicians up-to-date information regarding current best practices for the laboratory investigation of AKI. Topics covered include: clinical indications for further investigating potential AKI, analytical considerations for creatinine assays, the impact of biological variability on diagnostic thresholds, defining "baseline" creatinine, role of traditional markers (urine sodium, fractional excretion of sodium, fractional excretion of urea, and blood urea-to-creatinine ratio), urinary microscopic examination, new biomarkers, improving AKI-associated test utilization, and the utility of automated AKI alerts. SUMMARY The previous decade brought us a significant number of new studies characterizing the performance of existing and new biomarkers, as well as potential new tools for early detection and notification of AKI. This guidance document is intended to inform clinicians and laboratorians on the best practices for the laboratory investigation of AKI, based on expert recommendations where the preponderance of evidence is available.
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Affiliation(s)
- Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Melanie P Hoenig
- Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Edmund J Lamb
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - F Perry Wilson
- Program of Applied Translational Research, Yale School of Medicine, New Haven, CT, USA
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Bargnoux AS, Kuster N, Sutra T, Laroche L, Rodriguez A, Morena M, Chenine L, Chalabi L, Dupuy AM, Badiou S, Cristol JP. Evaluation of a new point-of-care testing for creatinine and urea measurement. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:290-297. [PMID: 33908840 DOI: 10.1080/00365513.2021.1914344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Point of care testing makes it possible to obtain results in an extremely short time. Recently, radiometer has expanded the panel of tests available on its ABL90 FLEX PLUS blood gas analyzer (ABL90) by adding urea and creatinine. The aim of this study was to verify the performance of these new parameters. This included assessment of imprecision, linearity, accuracy by comparison with central laboratory standard assays and interferences. In addition, clinical utility in a dialysis center was evaluated. Within-lab coefficients of variation were close to 2%. The mean and limits of agreement (mean ± 1.96 SD) of the difference between ABL90 and Roche enzymatic assays on cobas 8000 were 0.5 (from -1.4 to 2.3) mmol/L and -0.9 (from -19.5 to 17.8) µmol/L for urea and creatinine, respectively. The ABL90 enzymatic urea and creatinine assays met the acceptance criteria based on biological variation for imprecision and showed good agreement with central laboratory. The two assays were unaffected by hematocrit variation between 20 and 70%, hemolysis and icterus interferences. It should be noted that the relationship between lab methods and ABL90 was conserved even for high pre-dialysis values allowing easy access to dialysis adequacy parameters (Kt/V) and muscle mass evaluation (creatinine index). Rapid measurement of creatinine and urea using whole blood specimens on ABL90 appears as a fast and convenient method. Analytical performances were in accordance with our expectations without any significant interferences by hemolysis or icterus.
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Affiliation(s)
- Anne-Sophie Bargnoux
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Nils Kuster
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibault Sutra
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Laëtitia Laroche
- Département de Biochimie et Hormonologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Annie Rodriguez
- Département de Biochimie et Hormonologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Marion Morena
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Leila Chenine
- Département de Néphrologie, Dialyse et Transplantation, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | | | - Anne-Marie Dupuy
- Département de Biochimie et Hormonologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Stéphanie Badiou
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
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Kidney function testing prior to contrast-enhanced CT: a comparative cost analysis of a personalised risk-stratified pathway versus a test all approach. Clin Radiol 2020; 76:202-212. [PMID: 33109348 DOI: 10.1016/j.crad.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022]
Abstract
AIM To map current contrast-enhanced computed tomography (CT) pathways, develop a risk-stratified pathway, and model associated costs and resource use. MATERIALS AND METHODS Phase 1 comprised multicentre mapping of current practice and development of an alternative pathway, replacing pre-assessment of estimated glomerular filtration rate (eGFR) with a scan-day screening questionnaire for risk stratification and point of care (PoC) creatinine. Phase 2 measured resource use and analysis of routinely collected data, used to populate a model comparing the costs of current and risk-stratified pathways in Phase 3. RESULTS Site variation across a range of processes within the clinical care pathway was identified. Data from a single centre suggested that 78% (n=347/447) could have avoided their pre-scan laboratory test as they did not have post-contrast acute kidney injury (AKI) risk factors. Only 24% of outpatients who underwent computed tomography (CT) would have identified risk factors, which would have prompted a scan-day PoC test. There was a 94% probability that the risk-stratified pathway was cost-saving, with an estimated 5-year potential cost saving of £69,620 (95% CI: -£13,295-£154,603). Although the cost of a laboratory serum creatinine test is cheaper than the PoC equivalent (£5.29 versus £5.96), the screening questionnaire ruled out the need for a large majority of the eGFR measurements specifically for the CT examination. CONCLUSION The present study proposes an alternative pathway, which has the potential to improve the efficiency of the current CT pathway. A multicentre appraisal is required to demonstrate the impact of embedding this new pathway on a wider NHS level, particularly in light of new diagnostic guidance (DG37) published by NICE.
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Mathur N, Lu ZX, MacKay L, Lau T, Kuganesan A, Lau KK. Is point of care renal function testing reliable screening pre-IV contrast administration? Emerg Radiol 2020; 28:77-82. [PMID: 32725604 DOI: 10.1007/s10140-020-01829-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Intravenous iodinated contrast is a commonly used diagnostic aid to improve image quality on computed tomography. There exists a small risk of post-contrast acute kidney injury in patients receiving IV contrast. One of the biggest risk factors for developing PC-AKI is the presence of pre-existing renal dysfunction, making it important to measure the renal function prior to contrast administration. Point of care (POC) devices offer a quick estimation of renal function, potentially improving workflows in radiology departments. METHOD Two POC devices were evaluated, the Nova StatSensor and Abbott iSTAT. Patients undergoing routine radiological investigations had blood collected and analysed by a POC method and the laboratory method (Beckman AU5800). The two values were analysed and compared. Renal function was calculated using eGFR via the CKD-EPI result. eGFR values were stratified as high risk (eGFR < 30), moderate risk (eGFR 30-59) and low risk (eGFR ≥ 60). RESULTS One hundred eighty-six patients were included in the study. One hundred one patients underwent the Abbott iSTAT analysis, 139 patients underwent Nova StatSensor analysis, and 53 had both. Statistical analysis revealed that the StatSensor R2 value was 0.77, and coefficient variation was 10.65%. iSTAT had a R2 value of 0.83 and coefficient variation of 7.36%. The POC devices did not miss any high-risk patients but underreported eGFR values in certain patients. CONCLUSION POC devices are moderately accurate at detecting renal impairment in patients undergoing radiological investigations. They seem to be a good screening tool; however, any low eGFR values should be further examined.
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Affiliation(s)
- Namit Mathur
- Emergency Department, Monash Health, Clayton, Victoria, Australia.
| | - Zhong X Lu
- Monash Pathology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa MacKay
- Monash Pathology, Monash Health, Clayton, Victoria, Australia
| | - Theodore Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | | | - Kenneth K Lau
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Monash Imaging, Monash Health, Clayton, Victoria, Australia
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AACC Guidance Document on Management of Point-of-Care Testing. J Appl Lab Med 2020; 5:762-787. [DOI: 10.1093/jalm/jfaa059] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 02/01/2023]
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Broughton-Neiswanger LE, Rivera-Velez SM, Suarez MA, Slovak JE, Piñeyro PE, Hwang JK, Villarino NF. Urinary chemical fingerprint left behind by repeated NSAID administration: Discovery of putative biomarkers using artificial intelligence. PLoS One 2020; 15:e0228989. [PMID: 32053695 PMCID: PMC7018043 DOI: 10.1371/journal.pone.0228989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
Prediction and early detection of kidney damage induced by nonsteroidal anti-inflammatories (NSAIDs) would provide the best chances of maximizing the anti-inflammatory effects while minimizing the risk of kidney damage. Unfortunately, biomarkers for detecting NSAID-induced kidney damage in cats remain to be discovered. To identify potential urinary biomarkers for monitoring NSAID-based treatments, we applied an untargeted metabolomics approach to urine collected from cats treated repeatedly with meloxicam or saline for up to 17 days. Applying multivariate analysis, this study identified a panel of seven metabolites that discriminate meloxicam treated from saline treated cats. Combining artificial intelligence machine learning algorithms and an independent testing urinary metabolome data set from cats with meloxicam-induced kidney damage, a panel of metabolites was identified and validated. The panel of metabolites including tryptophan, tyrosine, taurine, threonic acid, pseudouridine, xylitol and lyxitol, successfully distinguish meloxicam-treated and saline-treated cats with up to 75–100% sensitivity and specificity. This panel of urinary metabolites may prove a useful and non-invasive diagnostic tool for monitoring potential NSAID induced kidney injury in feline patients and may act as the framework for identifying urine biomarkers of NSAID induced injury in other species.
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Affiliation(s)
- Liam E. Broughton-Neiswanger
- Program in Individualized Medicine, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Sol M. Rivera-Velez
- Program in Individualized Medicine, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Martin A. Suarez
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | | | - Pablo E. Piñeyro
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, United States of America
| | - Julianne K. Hwang
- Program in Individualized Medicine, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
| | - Nicolas F. Villarino
- Program in Individualized Medicine, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States of America
- * E-mail:
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van der Heijden C, Roosens L, Cluckers H, Van Craenenbroeck AH, Peeters B. Analytical and clinical performance of three hand-held point-of-care creatinine analyzers for renal function measurements prior to contrast-enhanced imaging. Clin Chim Acta 2019; 497:13-19. [DOI: 10.1016/j.cca.2019.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/04/2019] [Accepted: 06/27/2019] [Indexed: 01/17/2023]
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Snaith B, Harris MA, Shinkins B, Messenger M, Lewington A, Jordaan M, Spencer N. Point of care creatinine testing in diagnostic imaging: A feasibility study within the outpatient computed tomography setting. Eur J Radiol 2019; 112:82-87. [PMID: 30777224 DOI: 10.1016/j.ejrad.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/16/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway. METHOD Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48-72 h. RESULTS 14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25% from baseline) post contrast administration, but no instances of PC-AKI (≥50% from baseline) were identified. CONCLUSION PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment.
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Affiliation(s)
- Beverly Snaith
- Mid Yorkshire NHS Hospitals Trust, Wakefield, UK; University of Bradford, Bradford, UK.
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