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Larcher R, Lottelier M, Badiou S, Dupuy AM, Bargnoux AS, Cristol JP. Analytical Performances of the Novel i-STAT Alinity Point-of-Care Analyzer. Diagnostics (Basel) 2023; 13:diagnostics13020297. [PMID: 36673107 PMCID: PMC9857650 DOI: 10.3390/diagnostics13020297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
Many Point-of-Care devices have been released over the past decade. However, data regarding their analytical performances in real-world situations remains scarce. Herein, we aimed to assess the analytical performances of the i-STAT Alinity system. We conducted an analytical performances study with the i-STAT Alinity device using cartridges CG4+ (pH, Pco2, Po2, lactate, bicarbonate and base excess); CHEM8+ (Na, K, Cl, ionized Ca, urea, creatinine, glucose, hematocrit and hemoglobin) and PT/INR (prothrombin time and international normalized ratio). We assessed the imprecision and compared the results to those obtained on existing instruments in the central laboratory. We found that the within-lab coefficients of variation (CV) were very low (<2%) or low (2−5%), except for creatinine and PT (CV = 5.2% and CV = 6.3%, respectively). For almost all the parameters, the results were strongly (R2 = 90−95%) or very strongly (R2 > 95%) correlated with those of the existing laboratory instruments, and the biases were very low (<2%) or low (2−5%). However, correlations of the PT and INR measurements with existing instruments were lower (R2 = 86.0% and 89.7%), and biases in the Po2 (7.9%), creatinine (5.4%) and PT (−6.6%) measurements were higher. The i-STAT Alinity appeared as a convenient device for measurements of numerous parameters. However, clinicians should interpret Po2, creatinine and PT results with caution.
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Affiliation(s)
- Romaric Larcher
- Biochemistry and Hormonology Department, Montpellier University Hospital, PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34000 Montpellier, France
- Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France
- Correspondence: ; Tel.: +33-466-68-41-49
| | - Maxence Lottelier
- Biochemistry and Hormonology Department, Montpellier University Hospital, 34000 Montpellier, France
| | - Stephanie Badiou
- Biochemistry and Hormonology Department, Montpellier University Hospital, PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34000 Montpellier, France
| | - Anne-Marie Dupuy
- Biochemistry and Hormonology Department, Montpellier University Hospital, 34000 Montpellier, France
| | - Anne-Sophie Bargnoux
- Biochemistry and Hormonology Department, Montpellier University Hospital, PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34000 Montpellier, France
| | - Jean-Paul Cristol
- Biochemistry and Hormonology Department, Montpellier University Hospital, PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34000 Montpellier, France
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Ciccone EJ, Kabugho L, Baguma E, Muhindo R, Juliano JJ, Mulogo E, Boyce RM. Rapid Diagnostic Tests to Guide Case Management of and Improve Antibiotic Stewardship for Pediatric Acute Respiratory Illnesses in Resource-Constrained Settings: a Prospective Cohort Study in Southwestern Uganda. Microbiol Spectr 2021; 9:e0169421. [PMID: 34817224 PMCID: PMC8612158 DOI: 10.1128/spectrum.01694-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
Pediatric acute respiratory illness (ARI) is one of the most common reasons for evaluation at peripheral health centers in sub-Saharan Africa and is frequently managed based on clinical syndrome alone. Although most ARI episodes are likely caused by self-limited viral infections, the majority are treated with antibiotics. This overuse contributes to the development of antimicrobial resistance. To evaluate the preliminary feasibility and potential impact of adding pathogen-specific and clinical biomarker diagnostic testing to existing clinical management algorithms, we conducted a prospective, observational cohort study of 225 children presenting with malaria-negative, febrile ARI to the outpatient department of a semi-urban peripheral health facility in southwestern Uganda from October 2019 to January 2020. In addition to routine clinical evaluation, we performed influenza and Streptococcus pneumoniae antigen testing and measured levels of C-reactive protein, procalcitonin, and lactate in the clinic's laboratory, and conducted a follow-up assessment by phone 7 days later. Almost one-fifth of participants (40/225) tested positive for influenza. Clinical biomarker measurements were low with C-reactive protein of >40 mg/L in only 11% (13/222) of participants and procalcitonin >0.25 ng/mL in only 13% (16/125). All but two children received antibiotic treatment; only 3% (7/225) were admitted. At follow-up, 59% (118/201) of caregivers reported at least one persistent symptom, but fever had resolved for all children. Positive influenza testing was associated with persistent symptoms. In summary, we demonstrate that simple, rapid pathogen-specific testing and biomarker measurement are possible in resource-limited settings and could improve syndromic management and, in turn, antibiotic stewardship. IMPORTANCE Globally, respiratory illness is one of the most common reasons that children seek care. It is often treated inappropriately with antibiotics, which can drive the development of antibiotic resistance. In resource-rich settings, testing for specific pathogens or measurement of clinical biomarkers, such as procalcitonin and C-reactive protein, is often employed to help determine which children should receive antibiotics. However, there are limited data on the use of these tests in resource-constrained, outpatient contexts in sub-Saharan Africa. We enrolled children with respiratory illness presenting to a clinic in southwestern Uganda and performed testing for influenza, Streptococcus pneumoniae, C-reactive protein, and procalcitonin on-site. Almost all children received antibiotics. We demonstrate that employing clinical algorithms that include influenza and clinical biomarker testing could significantly decrease antibiotic prescriptions. Our study therefore provides preliminary data to support the feasibility and potential utility of diagnostics to improve management of respiratory illness in resource-constrained settings.
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Affiliation(s)
- Emily J. Ciccone
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lydia Kabugho
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rabbison Muhindo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan J. Juliano
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ross M. Boyce
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Dupuy AM, Ruffel L, Bargnoux AS, Badiou S, Cristol JP. Analytical evaluation of the performances of a new procalcitonin immunoassay. Clin Chem Lab Med 2021; 60:77-80. [PMID: 34800089 DOI: 10.1515/cclm-2021-1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Anne Marie Dupuy
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, University Montpellier 1, Montpellier, France
| | - Luna Ruffel
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, University Montpellier 1, Montpellier, France
| | - Anne Sophie Bargnoux
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, University Montpellier 1, Montpellier, France.,Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Montpellier, France
| | - Stéphanie Badiou
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, University Montpellier 1, Montpellier, France.,Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Montpellier, France
| | - Jean Paul Cristol
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, University Montpellier 1, Montpellier, France.,Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Montpellier, France
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Huynh HH, Bœuf A, Pfannkuche J, Schuetz P, Thelen M, Nordin G, van der Hagen E, Kaiser P, Kesseler D, Badrick T, Poggi B, Tiikkainen U, Davies GJ, Kessler A, Plebani M, Vinh J, Delatour V. Harmonization status of procalcitonin measurements: what do comparison studies and EQA schemes tell us? Clin Chem Lab Med 2021; 59:1610-1622. [PMID: 34147043 DOI: 10.1515/cclm-2021-0566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
Sepsis represents a global health priority because of its high mortality and morbidity. The key to improving prognosis remains an early diagnosis to initiate appropriate antibiotic treatment. Procalcitonin (PCT) is a recognized biomarker for the early indication of bacterial infections and a valuable tool to guide and individualize antibiotic treatment. To meet the increasing demand for PCT testing, numerous PCT immunoassays have been developed and commercialized, but results have been questioned. Many comparison studies have been carried out to evaluate analytical performance and comparability of results provided by the different commercially available immunoassays for PCT, but results are conflicting. External Quality Assessment Schemes (EQAS) for PCT constitute another way to evaluate results comparability. However, when making this comparison, it must be taken into account that the variety of EQA materials consist of different matrices, the commutability of which has not yet been investigated. The present study gathers results from all published comparison studies and results from 137 EQAS surveys to describe the current state-of-the-art harmonization of PCT results. Comparison studies globally highlight a significant variability of measurement results that nonetheless seem to have a moderate impact on medical decision-making. For their part, EQAS for PCT provides highly discrepant estimates of the interlaboratory CV. Due to differences in commutability of the EQA materials, the results from different peer groups could not be compared. To improve the informative value of the EQA data, the existing limitations such as non-harmonized conditions and suboptimal and/or unknown commutability of the EQA materials have to be overcome. The study highlights the need for commutable reference materials that could be used to properly evaluate result comparability and possibly standardize calibration, if necessary. Such an initiative would further improve the safe use of PCT in clinical routine.
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Affiliation(s)
- Huu-Hien Huynh
- Laboratoire National de Métrologie et d'Essais, Paris, France
- Biological Mass Spectrometry and Proteomics, SMBP, ESPCI Paris, Université PSL, CNRS, Paris, France
| | - Amandine Bœuf
- Laboratoire National de Métrologie et d'Essais, Paris, France
| | | | - Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Switzerland
- Faculty of medicine, University of Basel, Basel, Switzerland
| | - Marc Thelen
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands
| | - Gunnar Nordin
- External Quality Assurance in Laboratory Medicine in Sweden (Equalis), Uppsala, Sweden
| | - Eline van der Hagen
- MCA laboratory, Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | | | - Dagmar Kesseler
- Quality Control Center Switzerland (CSCQ), Chêne-Bourg, Switzerland
| | - Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP), Sydney, Australia
| | - Bernard Poggi
- ProBioQual, Lyon, France
- Laboratoire de Biochimie des Hospices Civiles de Lyon, Lyon, France
| | | | - Gareth J Davies
- Weqas, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Anja Kessler
- Reference Institute for Bioanalytics (RfB), Bonn, Germany
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Verona, Italy
| | - Joëlle Vinh
- Biological Mass Spectrometry and Proteomics, SMBP, ESPCI Paris, Université PSL, CNRS, Paris, France
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Bioanalytical Performance of a New Particle-Enhanced Method for Measuring Procalcitonin. Diagnostics (Basel) 2020; 10:diagnostics10070461. [PMID: 32646054 PMCID: PMC7400370 DOI: 10.3390/diagnostics10070461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/17/2022] Open
Abstract
We report the analytical performances of two particle-enhanced (PETIA) methods for measuring procalcitonin (PCT), the Diazyme PCT and the new DiaSys PCT assay, and their concordance of values with BRAHMS PCT Kryptor©. The total imprecisions onto two control levels and one serum pool were for DiaSys 5.42%, 3.3% and 7.53% and for Diazyme 10.7%, 2.9% and 13.23%, respectively. The limit of blank, limit of detection and limit of quantification were under the 0.25 cut-off for the two methods. The linearity in the lower range was acceptable for both methods. No significant effect on PCT determination was observed for DiaSys’ assay upon addition of interfering substances. With the Diazyme assay, significant effects were seen with rheumatoid factor (RF), lipid and hemoglobin. Correlation studies on 136 sera showed a good correlation between PCT measurements using DiaSys assay against the Kryptor system, while only a poor correlation was observed between the Diazyme assay, especially for low values. The novel PETIA PCT assay from DiaSys shows analytical performances acceptable for clinical use and the concordance with Kryptor method was fine at all clinical cut-offs. In contrast, despite comparable analytical performances, the Diazyme PETIA method exhibited a poor concordance with the Kryptor method.
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