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Fang H, Yang R, Guo J, Ren X, Chang X, Kang L, Zhu Y. Using Bland-Altman plot-based harmonization algorithm to optimize the harmonization for immunoassays. Clin Chem Lab Med 2024; 62:2205-2214. [PMID: 38742665 DOI: 10.1515/cclm-2024-0187] [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: 09/15/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Harmonization has been recommended by the International Organization for Standard (ISO) to achieve equivalent results across in vitro diagnostic measurement devices (IVD-MDs). We aim to evaluate the effectiveness of Bland-Altman plot-based harmonization algorithm (BA-BHA) created in this study and compare it with weighted Deming regression-based harmonization algorithm (WD-BHA) proposed in ISO 21151:2020. METHODS Eighty patient sera were used as the harmonization reference material (HRM) to develop IVD-MD-specific harmonization algorithms. Another panel of 40 patient sera was used to validate the effectiveness of harmonization algorithms. We compared regression slopes, intercepts, Bland-Altman plot layouts, percent differences, limits of agreement (LoAs), between-method coefficients of variation (CV) before and after harmonization. RESULTS After harmonization by WD-BHA, acceptable slopes and intercepts between measured values and HRM targets were observed in weighted Deming regression, but not in Passing-Bablok analysis. Mean differences were -5.5 to 5.0 % and differences at specific levels were -33.9 to 23.9 %. LoAs were -64.6 to 74.6 %. Between-method CV was 22.9 % (±12.9 %). However, after harmonization by BA-BHA, both weighted Deming and Passing-Bablok regressions equations presented harmonized results. Mean differences were -0.3 to 0.2 % and differences at specific levels were -1.1 to 1.6 %. LoAs were -23.3 to 23.2 %. Between-method CV was 8.4 % (±4.0 %). The data points were evenly distributed at both sides of the mean in Bland-Altman plots. CONCLUSIONS The inequivalence of test results between different methods can be improved but unacceptable analytical differences at specific levels may be hidden in terms of an acceptable slope and intercept on WD-BHA. The new protocol BA-BHA may be a viable alternative to optimize the harmonization for immunoassays.
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Affiliation(s)
- Huiling Fang
- Department of Clinical Chemistry and Immunology, Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Ruifeng Yang
- Department of Clinical Laboratory, Peking University Shougang Hospital, Beijing, P.R. China
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, P.R. China
| | - Jiayue Guo
- Department of Clinical Chemistry and Immunology, Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
| | - Xinxin Ren
- Standardization & Performance Evaluation Laboratory, Chemclin Diagnostics Co., LTD, Beijing, P.R. China
| | - Xin Chang
- Standardization & Performance Evaluation Laboratory, Chemclin Diagnostics Co., LTD, Beijing, P.R. China
| | - Lan Kang
- Standardization & Performance Evaluation Laboratory, Chemclin Diagnostics Co., LTD, Beijing, P.R. China
| | - Yuqing Zhu
- Department of Clinical Chemistry and Immunology, Shanghai Center for Clinical Laboratory, Shanghai, P.R. China
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Panteghini M, Camara JE, Delatour V, Van Uytfanghe K, Vesper HW, Zhang T. Feasibility of Metrological Traceability Implementation Using the Joint Committee on Traceability in Laboratory Medicine Database Entries Including the Fulfillment of "Fit-for-Purpose" Maximum Allowable Measurement Uncertainty. Clin Chem 2024:hvae131. [PMID: 39316470 DOI: 10.1093/clinchem/hvae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/16/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND In previous publications, the Task Force on Reference Measurement System Implementation proposed a procedural approach combining a critical review of entries available in the Joint Committee on Traceability in Laboratory Medicine (JCTLM) database with a comparison of this information against analytical performance specifications for measurement uncertainty (MU) and applied it to a group of 13 measurands. CONTENT Here we applied this approach to 17 additional measurands, of which measurements are frequently requested. The aims of the study were (a) to describe the main characteristics for implementing traceability and the potential to fulfill the maximum allowable MU (MAU) at the clinical sample level of certified reference materials and reference measurement procedures listed in the JCTLM database; (b) to discuss limitations and obstacles, if any, to the achievement of the required quality of laboratory measurements; and (c) to provide a gap analysis by highlighting what is still missing in the database. Results were integrated with those obtained in the previous study, therefore offering an overview of where we are and what is still missing in the practical application of the metrological traceability concept to 30 common biochemical tests employed in laboratory medicine. SUMMARY Our analysis shows that for 28 out of 30 measurands, conditions exist to correctly implement metrological traceability to the International System of units and fulfill at least the MAU of the minimum quality level derived according to internationally recommended models. For 2 measurands (serum albumin and chloride), further improvements in MU of higher-order references would be necessary.
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Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD, United States
| | | | - Katleen Van Uytfanghe
- Ref4U-Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Hubert W Vesper
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tianjiao Zhang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
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3
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Elzieny M, Maine GN, Carey-Ballough RA, Sun Q. Discrepancies between two total IgE assays and difference in reference intervals in healthy adults. J Immunol Methods 2024; 531:113711. [PMID: 38878960 DOI: 10.1016/j.jim.2024.113711] [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: 02/21/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE To compare total immunoglobulin (Ig) E assay performance characteristics between Abbott Architect and Siemens Immulite test systems. Reference intervals were also determined for both platforms in an American population of healthy adults. METHODS Agreement of the two total IgE assays was evaluated in a cohort of 331 subjects with normal complete blood count (CBC) and comprehensive metabolic panel (CMP) results. Reference intervals were established in 302 subjects after exclusion of atopic individuals on the Abbott Architect and Siemens Immulite test systems. RESULTS We demonstrated a 32% positive bias for total IgE quantitation on the Siemens Immulite platform compared to the Abbott Architect, despite both methods calibrated against the same WHO international reference material (75/502), Furthermore, the upper limit of the reference interval (95th percentile) was determined to be higher for the Siemens Immulite assay compared to the Abbott Architect (132 and 102 IU/mL, respectively). CONCLUSION Despite the use of a common WHO reference material for total IgE assay calibration, significant differences in quantitation was observed between two FDA-cleared test systems. Given that, it is warranted for clinical laboratories to verify vendor established reference intervals and adjust accordingly based on internal assessment of the normal range.
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Affiliation(s)
- Mai Elzieny
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Gabriel N Maine
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA; Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Robin A Carey-Ballough
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Qian Sun
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA; Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA.
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4
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Theodorsson E, Meijer P, Badrick T. External quality assurance in the era of standardization. Clin Chim Acta 2024; 557:117876. [PMID: 38493945 DOI: 10.1016/j.cca.2024.117876] [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: 02/18/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Metrology in clinical chemistry aims to ensure the equivalence of measurement results from different in-vitro diagnostic measurement devices (IVD MD) for use in healthcare. The metrological traceability of measurement results to higher-order references is the cornerstone to achieving equivalent results. However, other fundamentals are also needed, including the commutability of reference materials and external quality assessment (EQA) materials for monitoring the equivalence of measurement results at the end-user level. This manuscript summarizes the findings and opinions expressed at the Joint Community for Traceability in Laboratory Medicine (JCTLM) workshop held on December 4-5, 2023. The workshop explored the relationship between EQA/proficiency testing and metrological traceability to higher-order references. EQA monitors the equivalence of measurement results from end-user IVD MDs. The workshop discussed the role and challenges of using EQA to improve and maintain the equivalence of measurement results. It also elucidated current developments in establishing the clinical suitability of laboratory results expressed as analytical performance specifications (APS).
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Affiliation(s)
- Elvar Theodorsson
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden.
| | - Piet Meijer
- ECAT Foundation, Voorschoten, The Netherlands
| | - Tony Badrick
- RCPA Quality Assurance Programs, St Leonards, Sydney, Australia
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5
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Coskun A. Bias in Laboratory Medicine: The Dark Side of the Moon. Ann Lab Med 2024; 44:6-20. [PMID: 37665281 PMCID: PMC10485854 DOI: 10.3343/alm.2024.44.1.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Physicians increasingly use laboratory-produced information for disease diagnosis, patient monitoring, treatment planning, and evaluations of treatment effectiveness. Bias is the systematic deviation of laboratory test results from the actual value, which can cause misdiagnosis or misestimation of disease prognosis and increase healthcare costs. Properly estimating and treating bias can help to reduce laboratory errors, improve patient safety, and considerably reduce healthcare costs. A bias that is statistically and medically significant should be eliminated or corrected. In this review, the theoretical aspects of bias based on metrological, statistical, laboratory, and biological variation principles are discussed. These principles are then applied to laboratory and diagnostic medicine for practical use from clinical perspectives.
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Affiliation(s)
- Abdurrahman Coskun
- Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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6
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Panteghini M. Developments in reference measurement systems for C-reactive protein and the importance of maintaining currently used clinical decision-making criteria. Clin Chem Lab Med 2023; 61:1537-1539. [PMID: 37267501 DOI: 10.1515/cclm-2023-0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
- Joint Committee for Traceability in Laboratory Medicine (JCTLM) Task Force on Reference Measurement System Implementation, Milan, Italy
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7
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Sang L, Wu C, Chen H, Liu W, Huang D, Yang X, Guo X, Cui R, Wang N, Zhang R, Yue Y, Guo H, Wang M, Miao Y, Wang Q, Zhang S. Commutability evaluation of candidate reference materials and ERM-DA470k/IFCC for immunoglobulin M using two international approaches. J Clin Lab Anal 2023; 37:e24955. [PMID: 37571860 PMCID: PMC10492453 DOI: 10.1002/jcla.24955] [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: 11/19/2022] [Revised: 07/02/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to assess the commutability of frozen pooled human serum (PHS), high concentration of Immunoglobulin M (IgM) pure diluted materials (HPDM), commercialized pure materials (CPM), and dilutions of ERM-DA470k/IFCC in IgM detection using the CLSI and IFCC approaches, to support standardization or harmonization of IgM measurement. METHODS Twenty-four serum samples, relevant reference materials (PHS, HPDM, CPM), and different ERM-DA470k/IFCC dilutions were analyzed in triplicate using six routine methods. The commutability of the relevant reference materials was carried out following CLSI EP30-A and IFCC bias analysis. RESULTS According to the CLSI approach, low, medium, and high concentrations of PHS, HPDM, and CPM were commutable on 10, 13, 15, 13, and 8 of 15 assay combinations, respectively. Using the IFCC approach, low, medium, and high concentrations of PHS, HPDM, and CPM were commutable on 10, 11, 9, 15, and 10 of 15 assay combinations, respectively. The ERM-DA470k/IFCC dilutions with D-PBS and RPMI-1640 Medium were commutable on 13 of 15 assay combinations according to CLSI and were commutable on all 15 assay combinations using IFCC approach. CONCLUSIONS High concentration of PHS were commutable on all six detection systems using the CLSI approach. Low and medium concentration of PHS showed unsatisfied commutability. HPDM, not CPM have good commutability, has the potential to become reference materials. ERM-DA470k/IFCC diluted with different medium showed different commutability.
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Affiliation(s)
- Lu Sang
- Department of Clinical LaboratoryBeijing Huairou HospitalBeijingChina
| | - Chunying Wu
- Department of Clinical Laboratory, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Huijuan Chen
- Department of Clinical LaboratoryBeijing Huairou HospitalBeijingChina
| | - Wei Liu
- Department of Clinical Laboratory, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Dawei Huang
- Department of Clinical LaboratoryBeijing Longfu HospitalBeijingChina
| | - Xi Yang
- Department of Clinical LaboratoryBeijing Huairou HospitalBeijingChina
| | - Xinrui Guo
- Department of Respiratory and Critical Care MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Ruifang Cui
- Department of Clinical LaboratoryHeping Hospital Affiliated to Changzhi Medical CollegeChangzhiChina
| | - Ning Wang
- Department of Clinical Laboratory, Beijing Chaoyang HospitalThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
| | - Rui Zhang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical LaboratoriesThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
| | - Yuhong Yue
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical LaboratoriesThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
| | - Hong Guo
- Department of Clinical LaboratoryHeji Hospital Affiliated to Changzhi Medical CollegeChangzhiChina
| | - Minghao Wang
- Department of Clinical Laboratory, Beijing Chaoyang HospitalThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
| | - Yutong Miao
- Department of Clinical Laboratory, Beijing Chaoyang HospitalThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
| | - Qingtao Wang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical LaboratoriesThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
| | - Shunli Zhang
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Beijing Center for Clinical LaboratoriesThe Third Clinical Medical College of Capital Medical UniversityBeijingChina
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8
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Dikaios I, Althaus H, Angles-Cano E, Ceglarek U, Coassin S, Cobbaert CM, Delatour V, Dieplinger B, Grimmler M, Hoofnagle AN, Kostner GM, Kronenberg F, Kuklenyik Z, Lyle AN, Prinzing U, Ruhaak LR, Scharnagl H, Vesper HW, Deprez L. Commutability Assessment of Candidate Reference Materials for Lipoprotein(a) by Comparison of a MS-based Candidate Reference Measurement Procedure with Immunoassays. Clin Chem 2023; 69:262-272. [PMID: 36644921 DOI: 10.1093/clinchem/hvac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/02/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Elevated concentrations of lipoprotein(a) [Lp(a)] are directly related to an increased risk of cardiovascular diseases, making it a relevant biomarker for clinical risk assessment. However, the lack of global standardization of current Lp(a) measurement procedures (MPs) leads to inconsistent patient care. The International Federation for Clinical Chemistry and Laboratory Medicine working group on quantitating apolipoproteins by mass spectrometry (MS) aims to develop a next-generation SI (International system of units)-traceable reference measurement system consisting of a MS-based, peptide-calibrated reference measurement procedure (RMP) and secondary serum-based reference materials (RMs) certified for their apolipoprotein(a) [apo(a)] content. To reach measurement standardization through this new measurement system, 2 essential requirements need to be fulfilled: a sufficient correlation among the MPs and appropriate commutability of future serum-based RMs. METHODS The correlation among the candidate RMP (cRMP) and immunoassay-based MPs was assessed by measuring a panel of 39 clinical samples (CS). In addition, the commutability of 14 different candidate RMs was investigated. RESULTS Results of the immunoassay-based MPs and the cRMPs demonstrated good linear correlations for the CS but some significant sample-specific differences were also observed. The results of the commutability study show that RMs based on unspiked human serum pools can be commutable with CS, whereas human pools spiked with recombinant apo(a) show different behavior compared to CS. CONCLUSIONS The results of this study show that unspiked human serum pools are the preferred candidate secondary RMs in the future SI-traceable Lp(a) Reference Measurement System.
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Affiliation(s)
- Ioannis Dikaios
- European Commission, Joint Research Centre (JRC), Geel, Belgium
| | - Harald Althaus
- Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany
| | - Eduardo Angles-Cano
- French Institute of Health and Medical Research (INSERM) Université Paris Cité, Paris, France
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
- LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Division Clinical Mass Spectrometry of the German Society of Clinical Chemistry and Laboratory Medicine (DGKL), Berlin, Germany
| | - Stefan Coassin
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Benjamin Dieplinger
- Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz and Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | | | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, USA
| | - Gerhard M Kostner
- Division of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Zsusanna Kuklenyik
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Alicia N Lyle
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | - L Renee Ruhaak
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert Scharnagl
- Division of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Hubert W Vesper
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Liesbet Deprez
- European Commission, Joint Research Centre (JRC), Geel, Belgium
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Liu H, Ng CY, Liu Q, Teo TL, Loh TP, Wong MS, Sethi SK, Tan JG, Heng PY, Saw S, Lam LCW, Lee JMY, Khaled KB, Phyu HP, Ong NWT. Commutability assessment of human urine certified reference materials for albumin and creatinine on multiple clinical analyzers using different statistical models. Anal Bioanal Chem 2023; 415:787-800. [PMID: 36562812 DOI: 10.1007/s00216-022-04472-y] [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: 09/13/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
Urine albumin concentration and albumin-creatinine ratio are important for the screening of early-stage kidney damage. Commutable urine certified reference materials (CRMs) for albumin and creatinine are necessary for standardization of urine albumin and accurate measurement of albumin-urine ratio. Two urine CRMs for albumin and creatinine with certified values determined using higher-order reference measurement procedures were evaluated for their commutability on five brands/models of clinical analyzers where different reagent kits were used, including Roche Cobas c702, Roche Cobas c311, Siemens Atellica CH, Beckman Coulter AU5800, and Abbott Architect c16000. The commutability study was conducted by measuring at least 26 authentic patient urine samples and the human urine CRMs using both reference measurement procedures and the routine methods. Both the linear regression model suggested by the Clinical and Laboratory Standard Institute (CLSI) guidelines and log-transformed model recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Commutability Working Group were used to evaluate the commutability of the human urine CRMs. The commutability of the human urine CRMs was found to be generally satisfactory on all five clinical analyzers for both albumin and creatinine, suggesting that they are suitable to be used routinely by clinical laboratories as quality control or for method validation of urine albumin and creatinine measurements.
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Affiliation(s)
- Hong Liu
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore
| | - Cheng Yang Ng
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore
| | - Qinde Liu
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore.
| | - Tang Lin Teo
- Chemical Metrology Division, Applied Sciences Group, Health Sciences Authority, 1 Science Park Road, #01-05/06, The Capricorn, Singapore Science Park II, Singapore, 117528, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Moh Sim Wong
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sunil Kumar Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Jun Guan Tan
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Ping Ying Heng
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sharon Saw
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Khairee Bin Khaled
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Hnin Pwint Phyu
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Noel Wan Ting Ong
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
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10
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Zhang L, Long Q, Zhang J, Zeng Q, Zhao H, Chen W, Zhang T, Zhang C. A candidate reference method and multiple commutable control materials for serum 25-hydroxyvitamin D measurement. J Clin Lab Anal 2022; 36:e24756. [PMID: 36371780 PMCID: PMC9756985 DOI: 10.1002/jcla.24756] [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: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of the current study was to establish a reliable candidate reference method for serum 25-hydroxyvitamin D [25(OH)D] measurement and to assess the commutability of multiple control materials among liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods. METHODS Serum 25-hydroxyvitamin D2 [25(OH)D2] and 25-hydroxyvitamin D3 [25(OH)D3] together with spiked internal standards were extracted with a one-step approach and then analyzed by LC-MS/MS. The commutability assessment for 25(OH)D was conducted according to the Clinical and Laboratory Standards Institute (CLSI) EP14-A3 protocol. 25(OH)D concentrations in 5 levels of unprocessed serum pools, 7 levels of serum pools spiked with 25(OH)D3 or 25(OH)D2, 3 levels of commercial control materials, 2 levels of spiked bovine serum, and 4 levels of external quality assessment (EQA) materials were measured along with 30 single-donor samples using the candidate reference method and two routine LC-MS/MS methods. RESULTS The candidate reference method could separate 25(OH)D2 and 25(OH)D3 from 14 potential interfering compounds completely within a 9-min analysis time. Good method precision was obtained, and measurement results on certified reference material NIST SRM 972a were within the uncertainty of the certified values. All candidate materials were assessed commutable for LC-MS/MS methods. CONCLUSIONS The candidate reference method for serum 25(OH)D measurement is precise, accurate, and robust against interferences and can provide an accuracy base for routine methods. The multiple alternative control materials with commutability among LC-MS/MS methods will facilitate the further standardization for serum 25(OH)D measurement.
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Affiliation(s)
- Li Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory MedicineChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qichen Long
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory MedicineChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiangtao Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of GerontologyBeijing Engineering Research Center of Laboratory MedicineBeijingChina
| | - Qingzhang Zeng
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory MedicineChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Haijian Zhao
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of GerontologyBeijing Engineering Research Center of Laboratory MedicineBeijingChina
| | - Wenxiang Chen
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of GerontologyBeijing Engineering Research Center of Laboratory MedicineBeijingChina
| | - Tianjiao Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of GerontologyBeijing Engineering Research Center of Laboratory MedicineBeijingChina
| | - Chuanbao Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of GerontologyBeijing Engineering Research Center of Laboratory MedicineBeijingChina
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11
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Miller WG, Myers G, Cobbaert CM, Young IS, Theodorsson E, Wielgosz RI, Westwood S, Maniguet S, Gillery P. Overcoming challenges regarding reference materials and regulations that influence global standardization of medical laboratory testing results. Clin Chem Lab Med 2022; 61:48-54. [PMID: 36239374 DOI: 10.1515/cclm-2022-0943] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardized results for laboratory tests are particularly important when their interpretation depends on fixed medical practice guidelines or common reference intervals. The medical laboratory community has developed a roadmap for an infrastructure to achieve standardized test results described in the International Organization for Standardization standard 17511:2020 In vitro diagnostic medical devices - Requirements for establishing metrological traceability of values assigned to calibrators, trueness control materials and human samples. Among the challenges to implementing metrological traceability are the availability of fit-for-purpose matrix-based certified reference materials (CRMs) and requirements for regulatory review that differ among countries. A workshop in December 2021 focused on these two challenges and developed recommendations for improved practices. DISCUSSION The participants agreed that prioritization of measurands for standardization should be based on their impact on medical decisions in a clinical pathway. Ensuring that matrix-based CRMs are globally available for more measurands will enable fit-for-purpose calibration hierarchies for more laboratory tests. Regulation of laboratory tests is important to ensure safety and effectiveness for the populations served. Because regulations are country or region specific, manufacturers must submit recalibration changes intended to standardize results for regulatory review to all areas in which a measuring system is marketed. RECOMMENDATIONS A standardization initiative requires collaboration and planning among all interested stakeholders. Global collaboration should be further developed for prioritization of measurands for standardization, and for coordinating the production and supply of CRMs worldwide. More uniform regulatory submission requirements are desirable when recalibration is implemented to achieve internationally standardized results.
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Affiliation(s)
- W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ian S Young
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Science, Clinical Chemistry, Linköping University, Linköping, Sweden
| | - Robert I Wielgosz
- Bureau International des Poids et Mesures (BIPM), Sèvres Cedex, France
| | - Steven Westwood
- Bureau International des Poids et Mesures (BIPM), Sèvres Cedex, France
| | | | - Philippe Gillery
- Laboratory of Biochemistry-Pharmacology-Toxicology, University Hospital of Reims, Reims, France
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12
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Woo S, Rosli N, Choi S, Kwon HJ, Yoon YA, Ahn S, Lee JY, Hong SP, Jeong JS. Development of Certified Reference Material for Amino Acids in Dried Blood Spots and Accuracy Assessment of Disc Sampling. Anal Chem 2022; 94:10127-10134. [PMID: 35802862 PMCID: PMC9310008 DOI: 10.1021/acs.analchem.2c01349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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To achieve the measurement reliability of amino acids
used as diagnostic
markers in clinical fields, establishing a reference measurement system
is required, in which certified reference materials (CRMs) are an
essential step in the hierarchy of measurement traceability. This
study describes the development of dried blood spot (DBS) CRMs for
amino acid analysis with complete measurement traceability to the
International System of Units (SI). Six essential amino acids—proline,
valine, isoleucine, leucine, phenylalanine, and tyrosine—were
analyzed using isotope-dilution liquid chromatography–mass
spectrometry (ID-MS). For minimizing measurement bias and uncertainty
overestimation, whole spots with 50 μL of whole blood were adopted
in the certification. The between-spot homogeneities by whole spot
sampling were lower than 2.1%. The relative expanded uncertainties
of the six amino acids in the developed DBS CRMs were lower than 5.7%
at 95% confidence. The certified values are traceable to SI through
both gravimetric preparation and the primary method in certification,
ID-MS. Comparison among DBS testing laboratories revealed discrepancies
between the whole spot and disc sampling methods. The actual sampling
volume was accurately estimated by weighing, which revealed the possibility
of underestimation in routine DBS testing. The candidate CRMs can
support the standardization of DBS testing for amino acids through
the qualification and validation of many kinds of measurement procedures
to compensate the measurement bias caused by matrix-specific sampling
error.
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Affiliation(s)
- Sangji Woo
- Biometrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea.,Department of Oriental Pharmaceutical Sciences, College of Pharmacy, KyungHee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 16954, Republic of Korea
| | - Nordiana Rosli
- Biometrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea.,Department of Bio-Analytical Science, University of Science and Technology, 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea.,Training Division Ministry of Health Malaysia, Level 6 Menara Prisma, Presint 3, 62675 Putrajaya, Malaysia
| | - Seohyun Choi
- Biometrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea.,Department of Bio-Analytical Science, University of Science and Technology, 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea
| | - Ha-Jeong Kwon
- Biometrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea
| | - Young Ahn Yoon
- Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang Univerisity College of Medicine, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 130-701, Republic of Korea
| | - Sunhyun Ahn
- Seoul Clinical Laboratories, 13, Heungdeok 1-ro, Giheung-gu, Yongin-si, Gyeonggi-do 34113, Republic of Korea
| | - Ji Youn Lee
- Biometrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea
| | - Seon-Pyo Hong
- Department of Oriental Pharmaceutical Sciences, College of Pharmacy, KyungHee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 16954, Republic of Korea
| | - Ji-Seon Jeong
- Biometrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science, 267 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea.,Department of Bio-Analytical Science, University of Science and Technology, 217 Gajeong-ro, Yuseong-gu, Daejeon 34113, Republic of Korea
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13
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Rosli N, Kwon H, Lim J, Yoon YA, Jeong J. Measurement comparability of insulin assays using conventional immunoassay kits. J Clin Lab Anal 2022; 36:e24521. [PMID: 35622611 PMCID: PMC9279959 DOI: 10.1002/jcla.24521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The standardization of measurement aims to achieve comparability of results regardless of the analytical methods and the laboratory where analyses are carried out. In this paper, a comparison of results from several immunoassay-based insulin analysis kits is described, and the steps necessary to improve comparability are discussed. METHODS Four manual enzyme-linked immunosorbent assay (ELISA) kits produced by Mercodia, Alpco, Epitope Diagnostics, and Abcam, and three automated chemiluminescent (CLIA) insulin assay kits (Siemens Centaur XP, Unicel Dxl800, Cobas e801) were compared by analyzing human serum samples and certified reference materials for human insulin. RESULTS The seven evaluated assay kits showed substantial discrepancies in the results, with relative standard deviation ranges between 1.7% and 23.2%. We find that the traceability chains and the unit conversion factors are not yet harmonized, and current reference materials for insulin are not applicable for immunoassay-based method validation due to the use of different matrices. CONCLUSIONS The findings suggest the need to fine tune insulin analysis methods, measurement traceability, and any conversion factor used in post-analysis steps in accordance with the necessity for standardization.
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Affiliation(s)
- Nordiana Rosli
- Biometrology Group, Division of Chemical and Biological MetrologyKorea Research Institute of Standards and ScienceDaejeonSouth Korea
- Department of Bio‐Analytical ScienceUniversity of Science and TechnologyDaejeonSouth Korea
- Training DivisionMinistry of Health MalaysiaPutrajayaMalaysia
| | - Ha‐Jeong Kwon
- Biometrology Group, Division of Chemical and Biological MetrologyKorea Research Institute of Standards and ScienceDaejeonSouth Korea
| | - Jinsook Lim
- Department of Laboratory MedicineChungnam National University HospitalDaejeonSouth Korea
| | - Young Ahn Yoon
- Department of Laboratory Medicine, Soonchunhyang University Cheonan HospitalSoonchunhyang University College of MedicineCheonanSouth Korea
| | - Ji‐Seon Jeong
- Biometrology Group, Division of Chemical and Biological MetrologyKorea Research Institute of Standards and ScienceDaejeonSouth Korea
- Department of Bio‐Analytical ScienceUniversity of Science and TechnologyDaejeonSouth Korea
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14
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Gillery P. IFCC Scientific Division: A conductor of standardization in laboratory medicine. Clin Chim Acta 2021; 522:184-186. [PMID: 34364854 DOI: 10.1016/j.cca.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Gillery
- International Federation of Clinical Chemistry and Laboratory Medicine, Scientific Division, Chair, Italy; University Hospital of Reims, Department of Biochemistry-Pharmacology-Toxicology, Reims, France; University of Reims Champagne-Ardenne, UMR CNRS/URCA N°7369 MEDyC, Faculty of medicine, Laboratory of Medical Biochemistry and Molecular Biology, Reims, France.
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