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Yu S, Shin KH, Shin S, Lee H, Yoo SJ, Jun KR, Shin H, Kim S. Practical delta check limits for tumour markers in different clinical settings. Clin Chem Lab Med 2023; 61:1829-1840. [PMID: 36994761 DOI: 10.1515/cclm-2022-1098] [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: 10/31/2022] [Accepted: 03/19/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Few studies have reported on delta checks for tumour markers, even though these markers are often evaluated serially. Therefore, this study aimed to establish a practical delta check limit in different clinical settings for five tumour markers: alpha-fetoprotein, cancer antigen 19-9, cancer antigen 125, carcinoembryonic antigen, and prostate-specific antigen. METHODS Pairs of patients' results (current and previous) for five tumour markers between 2020 and 2021 were retrospectively collected from three university hospitals. The data were classified into three subgroups, namely: health check-up recipient (subgroup H), outpatient (subgroup O), and inpatient (subgroup I) clinics. The check limits of delta percent change (DPC), absolute DPC (absDPC), and reference change value (RCV) for each test were determined using the development set (the first 18 months, n=179,929) and then validated and simulated by applying the validation set (the last 6 months, n=66,332). RESULTS The check limits of DPC and absDPC for most tests varied significantly among the subgroups. Likewise, the proportions of samples requiring further evaluation, calculated by excluding samples with both current and previous results within the reference intervals, were 0.2-2.9% (lower limit of DPC), 0.2-2.7% (upper limit of DPC), 0.3-5.6% (absDPC), and 0.8-35.3% (RCV99.9%). Furthermore, high negative predictive values >0.99 were observed in all subgroups in the in silico simulation. CONCLUSIONS Using real-world data, we found that DPC was the most appropriate delta-check method for tumour markers. Moreover, Delta-check limits for tumour markers should be applied based on clinical settings.
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Affiliation(s)
- Shinae Yu
- Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kyung-Hwa Shin
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sunghwan Shin
- Department of Laboratory Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Hyeyoung Lee
- Department of Laboratory Medicine, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Republic of Korea
| | - Soo Jin Yoo
- Department of Laboratory Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Kyung Ran Jun
- Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hangsik Shin
- Department of Digital Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sollip Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Gül BÜ, Özcan O, Doğan S, Arpaci A. Designing and validating an autoverification system of biochemical test results in Hatay Mustafa Kemal University, clinical laboratory. Biochem Med (Zagreb) 2022; 32:030704. [PMID: 35966256 PMCID: PMC9344865 DOI: 10.11613/bm.2022.030704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Autoverification (AV) is a postanalytical tool that uses algorithms to validate test results according to specified criteria. The Clinical and Laboratory Standard Institute (CLSI) document for AV of clinical laboratory test result (AUTO-10A) includes recommendations for laboratories needing guidance on implementation of AV algorithms. The aim was to design and validate the AV algorithm for biochemical tests. Materials and methods Criteria were defined according to AUTO-10A. Three different approaches for algorithm were used as result limit checks, which are reference range, reference range ± total allowable error, and 2nd and 98th percentile values. To validate the algorithm, 720 cases in middleware were tested. For actual cases, 3,188,095 results and 194,520 reports in laboratory information system (LIS) were evaluated using the AV system. Cohen’s kappa (κ) was calculated to determine the degree of agreement between seven independent reviewers and the AV system. Results The AV passing rate was found between 77% and 85%. The highest rates of AV were in alanine transaminase (ALT), direct bilirubin (DBIL), and magnesium (Mg), which all had AV rates exceeding 85%. The most common reason for non-validated results was the result limit check (41%). A total of 328 reports evaluated by reviewers were compared to AV system. The statistical analysis resulted in a κ value between 0.39 and 0.63 (P < 0.001) and an agreement rate between 79% and 88%. Conclusions Our improved model can help laboratories design, build, and validate AV systems and be used as starting point for different test groups.
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Affiliation(s)
- Bahar Ünlü Gül
- Department of Medical Biochemistry, Kars Harakani Public Hospital, Kars, Turkey
| | - Oğuzhan Özcan
- Department of Medical Biochemistry, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Serdar Doğan
- Department of Medical Biochemistry, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Abdullah Arpaci
- Department of Medical Biochemistry, Hatay Mustafa Kemal University, Hatay, Turkey
- Corresponding author:
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Piccoli GB, Chatrenet A, Cataldo M, Torreggiani M, Attini R, Masturzo B, Cabiddu G, Versino E. Adding creatinine to routine pregnancy tests: a decision tree for calculating the cost of identifying patients with CKD in pregnancy. Nephrol Dial Transplant 2022; 38:148-157. [PMID: 35238937 PMCID: PMC9869858 DOI: 10.1093/ndt/gfac051] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Even in its early stages, chronic kidney disease (CKD) is associated with adverse pregnancy outcomes. The current guidelines for pregnancy management suggest identifying risk factors for adverse outcomes but do not mention kidney diseases. Since CKD is often asymptomatic, pregnancy offers a valuable opportunity for diagnosis. The present analysis attempts to quantify the cost of adding serum creatinine to prenatal screening and monitoring tests. METHODS The decision tree we built takes several screening scenarios (before, during and after pregnancy) into consideration, following the hypothesis that while 1:750 pregnant women are affected by stage 4-5 CKD and 1:375 by stage 3B, only 50% of CKD cases are known. Prevalence of abortions/miscarriages was calculated at 30%; compliance with tests was hypothesized at 50% pre- and post-pregnancy and 90% during pregnancy (30% for miscarriages); the cost of serum creatinine (production cost) was set at 0.20 euros. A downloadable calculator, which makes it possible to adapt these figures to other settings, is available. RESULTS The cost per detected CKD case ranged from 111 euros (one test during pregnancy, diagnostic yield 64.8%) to 281.90 euros (one test per trimester, plus one post-pregnancy or miscarriage, diagnostic yield 87.7%). The best policy is identified as one test pre-, one during and one post-pregnancy (191.80 euros, diagnostic yield 89.4%). CONCLUSIONS This study suggests the feasibility of early CKD diagnosis in pregnancy by adding serum creatinine to routinely performed prenatal tests and offers cost estimates for further discussion.
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Affiliation(s)
| | - Antoine Chatrenet
- Néphrologie et dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, Le Mans, France,Laboratory “Movement, Interactions, Performance” (EA 4334), Le Mans University, Le Mans, France
| | | | - Massimo Torreggiani
- Néphrologie et dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, Le Mans, France
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, University of Torino, Turin, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, University of Torino, Turin, Italy
| | | | - Elisabetta Versino
- Epidemiology, Department of Clinical and Biological Sciences, University of Torino, Turin Italy
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He S, Kang F, Wang W, Chen B, Wang Z. National survey on delta checks in clinical laboratories in China. ACTA ACUST UNITED AC 2020; 58:569-576. [PMID: 31927514 DOI: 10.1515/cclm-2019-1131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/17/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
This study aimed to understand the status quo of delta checks in Chinese clinical laboratories through a nationwide online survey.
Methods
The survey was divided into two parts. The first part was a general situation survey in which clinical laboratories had to provide information about the laboratories, including delta checks used. In the second part, clinical laboratories were asked to record the delta check alerts generated in their laboratories from June 1st, 2019 to June 30th, 2019.
Results
The most frequently used analytes in delta checks were potassium (K), glucose (Glu), creatinine (Cre) for clinical chemistry and hemoglobin (Hgb), platelet (PLT) count and white blood cell (WBC) count for clinical hematology. The median maximum time interval between specimens for all analytes was 5 days. The most commonly used delta check calculation modes in Chinese clinical laboratories were percentage change and absolute change. K and Hgb were the analytes most involved in clinical chemistry and clinical hematology delta check alerts. The most common causes of delta check alerts were that the patients had received treatment, which was followed by the change in the patient’s physiological state and interference from hemolysis, lipemia and icterus. The two most common outcomes of delta check alerts were ‘no problems found, standard report issued’ and ‘no problems found, report issued with comment’.
Conclusions
This study was the first nationwide survey of delta checks in China, the results of which help us to understand the current situation of delta checks in Chinese clinical laboratories.
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Affiliation(s)
- Shukang He
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Fengfeng Kang
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P.R. China
| | - Wei Wang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Bingquan Chen
- Beijing Clinet Information and Technology Co., Ltd, Beijing, P.R. China
| | - Zhiguo Wang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P.R. China
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Lenicek Krleza J, Honovic L, Vlasic Tanaskovic J, Podolar S, Rimac V, Jokic A. Post-analytical laboratory work: national recommendations from the Working Group for Post-analytics on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2019; 29:020502. [PMID: 31223256 PMCID: PMC6559616 DOI: 10.11613/bm.2019.020502] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/14/2019] [Indexed: 12/20/2022] Open
Abstract
The post-analytical phase is the final phase of the total testing process and involves evaluation of laboratory test results; release of test results in a timely manner to appropriate individuals, particularly critical results; and modification, annotation or revocation of results as necessary to support clinical decision-making. Here we present a series of recommendations for post-analytical best practices, tailored to medical biochemistry laboratories in Croatia, which are intended to ensure alignment with national and international norms and guidelines. Implementation of the national recommendations is illustrated through several examples.
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Affiliation(s)
- Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Anja Jokic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Biochemistry, Haematology and Coagulation, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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Affiliation(s)
- Edward W Randell
- Discipline of Laboratory Medicine, Memorial University; Eastern Health Authority, St. John’s, NL, Canada
- Faculty of Medicine, Memorial University; Eastern Health Authority, St. John’s, NL, Canada
| | - Sedef Yenice
- Department of Core Laboratory Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
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