Performance Evaluation and Comparison of the Fully Automated Urinalysis Analyzers UX-2000 and Cobas 6500

Advances and Progress in Automated Urine Analyzers

The clinical analysis of urine has classically focused on conventional chemical-based urinalysis and urine microscopy. Contemporary advances in both analysis subsets have started to employ new technologies such as automated image analysis, flow cytometry, and mass spectrometry. In addition to new detection technologies, current analyzers have incorporated more advanced imaging, automated sample handing, and machine learning analyses into their workflow. The most advanced semiautomated analyzers can be interfaced with hospital medical record systems, and in the point-of-care setting, smartphones can be used for image analysis. This review will discuss current technological advancements in the field of urinalysis and urine microscopy.

Diagnostic Utility of Urine Microscopy in Kidney Diseases

Urine sediment analysis is a highly valuable yet underutilized test in today's advanced medical landscape. The analysis of urine sediment is a simple, cost-effective, and powerful diagnostic tool in the hands of a skilled nephrologist, generally in all kidney diseases and particularly more so in the setting of acute kidney injury (AKI). The impact of AKI is far-reaching and encompasses elevated mortality rates, increased morbidity, longer hospital stays, and higher overall healthcare expenses. Timely and compartmental diagnosis of AKI with the use of a simple urine sediment analysis leads to targeted therapeutic strategies and also serves as a prognostic guide. The widespread use of automated analysis in recent times has its own set of limitations, as it fails to identify pathological casts, crystals, and dysmorphic red blood cells (RBCs). Hence, it is the need of the hour to learn this time-honored art of urine sediment analysis, to provide comprehensive patient care.

Evaluation of the Atellica® UAS 800: a new member of the automated urine sediment analyzer family

BACKGROUND

In 2017 the Atellica^® UAS 800 urine sediment analyzer was introduced by Siemens Healthineers. We investigated its applicability in the standardization and automation of the laboratory urinalysis workflow, including the prediction of urine culture outcome and glomerular pathology.

METHODS

We evaluated the performance characteristics of the Atellica^® UAS 800 and its correlation with the iQ200 (Beckman Coulter). In addition, we studied the agreement between Atellica^® UAS 800 and CLINITEK Novus^® and determined the predictive value of bacteria and leukocyte counts for urine culture outcome. Furthermore, we investigated the ability of Atellica^® UAS 800 to identify pathological casts and dysmorphic erythrocytes in comparison to manual microscopy.

RESULTS

Erythrocyte and leukocyte analyses indicated high intra- and inter-run precisions and good correlations with the iQ200. We found that the Atellica^® UAS 800 detects bacteria with higher sensitivity than the iQ200. The Atellica^® UAS 800 and CLINITEK Novus^® showed a high degree of conformity. We determined seven combinations of clinical cut-off values of bacteria and leukocytes for predicting urine culture outcome with sensitivity, specificity, and negative predictive values of 95%, 52%, and 93%, respectively. Using the Atellica^® UAS 800, hyaline casts, erythrocyte casts, leukocyte casts, and dysmorphic erythrocytes were correctly recognized in 76%, 22%, 2%, and 39% of the samples, respectively.

CONCLUSIONS

The Atellica^® UAS 800 is a robust, fast, and user-friendly analyzer, which accurately quantifies erythrocytes, leukocytes, bacteria and squamous epithelial cells, and may be utilized for predicting positive urine cultures. The detection of clinically important pathological casts and dysmorphic erythrocytes proved insufficient.

The Article COMPARISON OF LX-8000R AND URISED 2 FULL-AUTOMATED URINE ANALIZERS WITH MANUAL MICROSCOPIC EXAMINATION

Background

Urinalysis has an important place in evaluating kidney and urinary tract infections. Automated urine analyzers enhance productivity and turnover in laboratories and economize time and labor required for analysis. In the present study, we evaluated and compared analytic and diagnostic performance of UriSed2 with LX-8000R, which is a novel image-based automated urine sediment analyzer.

Methods

A total of 178 urine samples sent to our laboratory were evaluated by the two urine analyzers and standard manual microscopy. Precision and comparison studies were done in accordance with CLSI guidelines.

Results

Sensitivity assessment revealed similar outcomes with both UriSed2 and LX-8000R devices for erythrocyte count (RBC), whereas UriSed2 device yielded higher outcomes for leukocyte count (WBC) and epithelial cells (EPI) than LX-8000R analyzer. Specificity of UriSed2 for WBC and RBC was higher than that of LX-8000R device. According to Gamma statistics, both urine analyzers showed perfect consistency for WBC, RBC and EPI cell counts. Manuel microscopy revealed statistically significant correlation between LX-8000R and UriSed2 in terms of WBC and RBC. Manual evaluation by Bland-Altman analysis demonstrated lower WBC and RBC values and higher EPI as compared to both UriSed2 and LX-8000R devices. As the result of Passing-Bablok regression analysis, both devices were found to be inconsistent with manual microscopy.

Conclusions

We think that evaluation of automated urine analyzers will be more meaningful when they are evaluated together with urine samples and patient clinical findings in addition to comparing with manual microscopy.

Comparison of IDEXX SediVue Dx® urine sediment analyzer to manual microscopy for detection of casts in canine urine

BACKGROUND

Detection of urinary casts is difficult due to their intermittent presence and deterioration in urine samples.

OBJECTIVE

To compare the performance of the IDEXX SediVue Dx^® Urine Sediment Analyzer (SediVue) with manual microscopy for the detection of urinary casts. We hypothesized that the SediVue analyzer would perform similarly to manual microscopy in cast detection.

ANIMALS

Four hundred forty-three samples from 420 dogs from a hospital population.

METHODS

This is a prospective, cross-sectional study. For SediVue analysis (software version [SW] 1.0.1.3), uncentrifuged urine was pipetted into a disposable cartridge. Seventy images were captured and processed by an onboard algorithm. For manual microscopy, urine was centrifuged to obtain sediment. Any cast identified by either method was considered a positive result (>0/low-power field [LPF]). SediVue images were evaluated if casts were detected by either methodology. A revised sensitivity and specificity were calculated after image review and when using a threshold of >1 cast/LPF.

RESULTS

The sensitivity of the SediVue analysis for the detection of urinary casts was 53.7% (43.85%-63.35%), and specificity was 86.0% (81.78%-89.51%). After image review, the revised sensitivity/specificity was 52.0% (42.89%-61.02%) and 90.6% (86.81%-93.54%), respectively. When using a more clinically relevant threshold of >1/LPF, the sensitivity was 52.6% (35.82%-69.02%) and specificity was 99.3% (97.85%-99.85%).

CONCLUSIONS AND CLINICAL IMPORTANCE

The SediVue provides moderate agreement to manual methodology for detection of casts in urine.

Prediction of urine culture results by automated urinalysis with digital flow morphology analysis

To investigate the association between the results of urinalysis and those of concurrent urine cultures, and to construct a prediction model for the results of urine culture. A total of 42,713 patients were included in this study. Patients were divided into two independent groups including training and test datasets. A novel prediction algorithm, designated the UTOPIA value, was constructed with the training dataset, based on an association between the results of urinalysis and those of concurrent urine culture. The diagnostic performance of the UTOPIA value was validated with the test dataset. Six variables were selected for the equation of the UTOPIA value: age of higher UTI risk [odds ratio (OR), 2.069125], female (OR, 1.400648), nitrite (per 1 grade; OR, 3.765457), leukocyte esterase (per 1 grade; OR, 1.701586), the number of WBCs (per 1 × 10⁶/L; OR, 1.000121), and the number of bacteria (per 1 × 10⁶/L; OR, 1.004195). The UTOPIA value exhibited an area under the curve value of 0.837 when validated with the independent test dataset. The UTOPIA value displayed good diagnostic performance for predicting urine culture results, which would help to reduce unnecessary culture. Different cutoffs can be used according to the clinical indication.

A comparison of automated urine analyzers cobas 6500, UN 3000-111b and iRICELL 3000 with manual microscopic urinalysis

Objectives

Microscopic examination is essential in urine analysis. This is a simple way to collect informative data but it is also labor-intensive, time-consuming, and requires experienced staff for accurate results and interpretation. Several automated urine analyzers have been introduced for urine analysis in medical laboratories. The aim of this study was to assess and compare the performance of the most common three automated urine analyzers, Cobas 6500, UN3000-111b and iRICELL 3000.

Design

and Methods: A total of 100 routine urine samples were used in the study. Results from the three machines were compared with the routine procedure results including physical, chemical and sediment analysis.

Results

There was good correlation of urine physical and chemical analyses between the three analyzers with an overall concordance level of more than 80%. For sediment analysis, the degree of concordance between manual analysis and the three instruments was very good to good for white blood cells, red blood cells and epithelial cells, and moderate for bacteria. There were fair to good agreements between manual microscopy and the three instruments, Cobas 6500, UN3000-111b and iRICELL 3000, for casts (Cohen's kappa 0.42, 0.38 and 0.62, respectively).

Conclusions

The three automated urine analyzers showed similar performances and good correlation with manual microscopy. The results of this study indicate that automated urine analyzers could be used for initial urine testing to reduce high workloads and to save time, but manual microscopic analysis by experienced staff is still necessary to classify urine sediments for confirmation, especially in pathologic specimens.

Improved efficiency of urine cell image segmentation using droplet microfluidics technology

Recent advances in the recognition of biological samples using machine vision have made this technology increasingly important in research and detection. Image segmentation is an important step in this process. This study focuses on how to reduce the interference factors such as the overlap between different types (or within the same type) of urine cells according to microfluidics and improve the machine vision segmentation accuracy for cell images. In this study, we demonstrate that the platform can realize this hypothesis using urine cell image segmentation as an example application. We first discuss the reported urine cell droplet microfluidic chip system, which can realize the test conditions in which urine cells are encapsulated in the droplet and isolated from salt crystallization and/or bacteria and other urine-formed elements. Then, based on the analysis conditions set in the aforementioned experiment, the proportions of red blood cells, white blood cells, and squamous epithelial cells covered by various formed elements in the total urine cells in the same urine sample are measured. We simultaneously analyze the percentage of urine cells covered by salt crystallization and the incidence of overlapping between urine cells. Finally, the Otsu algorithm is used to segment the urine cell images encapsulated by the droplet and the urine cell images not encapsulated by the droplet, and the Dice, Jaccard, precision, and recall values are calculated. The results suggest that the method of encapsulating single cells based on droplets can improve the image segmentation effect without optimizing the algorithm.

Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment

Background While the introduction of automated urine analyzers is expected to reduce the labor involved, turnaround time and potential assay variations, microscopic examination remains the "gold standard" for the analysis of urine sediments. In this study, we evaluated the analytical and diagnostic performance of five recently introduced automated urine sediment analyzers. Methods A total of 1016 samples were examined using five automated urine sediment analyzers and manual microscopy. Concordance of results from each automated analyzer and manual microscopy were evaluated. In addition, image and microscopic review rates of each system were investigated. Results The proportional bias for red blood cells (RBCs), white blood cells (WBCs) and squamous epithelial cells in the automated urine sediment analyzers were within ±20% of values obtained using the manual microscope, except in the cases of RBCs and WBCs analyzed using URiSCAN PlusScope and Iris iQ200SPRINT, respectively. The sensitivities of Roche Cobas® u 701 and Siemens UAS800 for pathologic casts (73.6% and 81.1%, respectively) and crystals (62.2% and 49.5%, respectively) were high, along with high image review rates (24.6% and 25.2%, respectively). The detection rates for crystals, casts and review rates can be changed for the Sysmex UF-5000 platform according to cut-off thresholds. Conclusions Each automated urine sediment analyzer has certain distinct features, in addition to the common advantages of reducing the burden of manual processing. Therefore, laboratory physicians are encouraged to understand these features, and to utilize each system in appropriate ways, considering clinical algorithms and laboratory workflow.

Automated urinalysis combining physicochemical analysis, on-board centrifugation, and digital imaging in one system: A multicenter performance evaluation of the cobas 6500 urine work area

BACKGROUND

We evaluated the analytical performance of the fully automated cobas® 6500 urine work area and its automated components-cobas u 601 and cobas u 701.

DESIGN AND METHODS

The study was conducted at three European centers using un-centrifuged surplus routine urine samples; all measurements were performed within 2 h of sample collection. Precision, sample carry-over, and method comparisons were evaluated per Clinical and Laboratory Standards Institute guidelines. Method comparisons: cobas u 601 versus Urisys 2400 and cobas u 411 urine test strips; and cobas u 701 versus KOVA® visual microscopy and iQ200 analyzer. Operability and functionality were assessed using questionnaires.

RESULTS

Precision of the entire cobas 6500 system was within predefined acceptance limits and no significant carry-over was observed. Erythrocytes, leukocytes, nitrites, and protein were in good agreement (≥93%) with cobas u 411 reflectometry. High correlation was shown between the cobas u 701 analyzer and KOVA visual microscopy for red blood cells (RBC; slope, 0.89; Pearson's r, 0.95) and white blood cells (WBC; slope, 0.96; Pearson's r, 0.96), demonstrating equivalence of test results. The 97.5% percentile reference values on the cobas u 701 analyzer were 5.3 cells/μL (RBC) and 6.2 cells/μL (WBC). The cobas 6500 system showed good sensitivity for small bacteria (>1 μm) and pathological casts, and the user interface, maintenance wizards, and system design were highly rated by operators.

CONCLUSIONS

The fully automated workflow, high precision, and high throughput of the cobas 6500 system have the potential to facilitate standardization of urine screening.

Performance of automated urine analyzers using flow cytometric and digital image-based technology in routine urinalysis

The purpose of this study was to evaluate the analytical performances of Sysmex UF-5000 and Dirui FUS-200 and to compare the results with manual microscopy and between each other. Two hundred fifty urine samples were analyzed for evaluation. Mid-stream specimens were studied sequentially using Dirui FUS-200 and Sysmex UF-5000, and also with manual microscopy within one hour. The physical and chemical components of urinalysis, and sediment results were investigated. The precision results of the FUS-200 and UF-5000 for WBCs, RBCs, and ECs were acceptable. The both analyzers demonstrated good linearity (r > 0.97), with no carry-over. The comparisons of FUS-200 and UF-5000 with manual microscopy for RBCs, WBCs, and ECs on 250 samples exhibited good agreement with little bias (R > 0.780). Only, the moderate agreements were obtained for calcium oxalate for both analyzers (R = 0.512, and 0.648, respectively). The sensitivities of the FUS-200 and UF-5000 were 75.8% and 86.8%, with specificities of 92.3% and 87.8% for WBCs, for RBCs the sensitivities were 91.1%, and 84.4% with specificities of 82.2%, and 89.6% for both analyzers. Kappa values of the UF-5000 were higher than FUS-200 for WBCs, RBCs, ECs, and calcium oxalate. The FUS-200 and UF-5000 urine analyzers, are both accurate, very precise systems and can be safely used in clinical laboratories. However, due to the technological characteristics of the UF-5000 analyzer, its positive impacts on the morphologic recognition and enumeration of RBCs and WBCs should be taken into account, particularly in university hospital laboratories with high patient volumes.

Evaluation of the analytical performances of Cobas 6500 and Sysmex UN series automated urinalysis systems with manual microscopic particle counting

Introduction

Automated urinalysis systems are valuable tools in clinical laboratories, especially those with a high work load. The objective of this study was to compare the analytical performance of Sysmex UN series urine analyser, which may become a new one in our laboratory, with the Cobas 6500 automated urine analyser, which is used in our laboratory for a long time. For comparisons, manual microscopical examination was accepted as reference method.

Materials and methods

A total of 470 urine samples were tested in the two automated urinalysis systems, and urine sediment testing with manual microscopy was applied to a 100 pathological samples of the total 470. The diagnostic performance of the two automated urine analysers was compared with each other and manual microscopy.

Results

Differences were determined between automated and manual microscopy in some pathological samples. The resultant regression equations were as follows. Comparison of Cobas U701 with Sysmex UF-5000: y = - 0.57 (- 0.85 to - 0.29) + 0.95 (0.92 to 0.99) x for RBC, and y = - 0.11 (- 0.54 to 0.29) + 0.89 (0.84 to 0.98) x for WBC; comparison of Cobas U701 with manual microscopy: y = - 0.45 (- 0.85 to 0.21) + 1.00 (0.92 to 1.07) x for WBC; and comparison of Sysmex UF-5000 with manual microscopy: y = - 0.74 (- 1.09 to - 0.57) + 0.87 (0.85 to 0.91) x for WBC.

Conclusions

We can conclude that the new Sysmex UN series urine analyser can be safely used in our laboratory. Although the results showed good to moderate concordance, the microscopy results of the automated platforms should be confirmed by manual microscopy, particularly in pathological samples.

Progress in Automated Urinalysis

New technological advances have paved the way for significant progress in automated urinalysis. Quantitative reading of urinary test strips using reflectometry has become possible, while complementary metal oxide semiconductor (CMOS) technology has enhanced analytical sensitivity and shown promise in microalbuminuria testing. Microscopy-based urine particle analysis has greatly progressed over the past decades, enabling high throughput in clinical laboratories. Urinary flow cytometry is an alternative for automated microscopy, and more thorough analysis of flow cytometric data has enabled rapid differentiation of urinary microorganisms. Integration of dilution parameters (e.g., creatinine, specific gravity, and conductivity) in urine test strip readers and urine particle flow cytometers enables correction for urinary dilution, which improves result interpretation. Automated urinalysis can be used for urinary tract screening and for diagnosing and monitoring a broad variety of nephrological and urological conditions; newer applications show promising results for early detection of urothelial cancer. Concomitantly, the introduction of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) has enabled fast identification of urinary pathogens. Automation and workflow simplification have led to mechanical integration of test strip readers and particle analysis in urinalysis. As the information obtained by urinalysis is complex, the introduction of expert systems may further reduce analytical errors and improve the quality of sediment and test strip analysis. With the introduction of laboratory-on-a-chip approaches and the use of microfluidics, new affordable applications for quantitative urinalysis and readout on cell phones may become available. In this review, we present the main recent developments in automated urinalysis and future perspectives.

The development and validation of different decision-making tools to predict urine culture growth out of urine flow cytometry parameter

Objective

Patients presenting with suspected urinary tract infection are common in every day emergency practice. Urine flow cytometry has replaced microscopic urine evaluation in many emergency departments, but interpretation of the results remains challenging. The aim of this study was to develop and validate tools that predict urine culture growth out of urine flow cytometry parameter.

Methods

This retrospective study included all adult patients that presented in a large emergency department between January and July 2017 with a suspected urinary tract infection and had a urine flow cytometry as well as a urine culture obtained. The objective was to identify urine flow cytometry parameters that reliably predict urine culture growth and mixed flora growth. The data set was split into a training (70%) and a validation set (30%) and different decision-making approaches were developed and validated.

Results

Relevant urine culture growth (respectively mixed flora growth) was found in 40.2% (7.2% respectively) of the 613 patients included. The number of leukocytes and bacteria in flow cytometry were highly associated with urine culture growth, but mixed flora growth could not be sufficiently predicted from the urine flow cytometry parameters. A decision tree, predictive value figures, a nomogram, and a cut-off table to predict urine culture growth from bacteria and leukocyte count were developed, validated and compared.

Conclusions

Urine flow cytometry parameters are insufficient to predict mixed flora growth. However, the prediction of urine culture growth based on bacteria and leukocyte count is highly accurate and the developed tools should be used as part of the decision-making process of ordering a urine culture or starting an antibiotic therapy if a urogenital infection is suspected.

UriSed 3 and UX-2000 automated urine sediment analyzers vs manual microscopic method: A comparative performance analysis

BACKGROUND

Fully automated urine analyzers now play an important role in routine urinalysis in most laboratories. The recently introduced UriSed 3 has a new automated digital imaging urine sediment analyzer with a phase contrast feature. The aim of this study was to compare the performance of the UriSed 3 and UX-2000 automated urine sediment analyzers with each other and with the results of the manual microscopic method.

METHODS

Two hundred seventy-seven (277) samples of leftover fresh urine from our hospital's central laboratory were evaluated by two automated urine sediment analyzers-UriSed 3 and UX-2000. The results of urine sediment analysis were compared between the two automated analyzers and against the results of the manual microscopic method.

RESULTS

Both devices demonstrated excellent agreement for quantitative measurement of red blood cells and white blood cells. UX-2000 had a lower coefficient correlation and demonstrated slightly lower agreement for squamous epithelial cells. Regarding semiquantitative analysis, both machines demonstrated very good concordance, with all applicable rates within one grade difference of the other machine. UriSed 3 had higher sensitivity for small round cells, while UX-2000 showed greater sensitivity for detecting bacteria and hyaline casts. UriSed 3 demonstrated slightly better specificity, especially in the detection of hyaline and pathological casts.

CONCLUSIONS

Both instruments had nearly similar performance for red blood cells and white blood cells measurement. UriSed 3 was more reliable for measuring squamous epithelial cells and small round cells, while the UX-2000 was more accurate for detecting bacteria and hyaline casts.

Performance evaluation of the new fully automated urine particle analyser UF-5000 compared to the reference method of the Fuchs-Rosenthal chamber

BACKGROUND

UF-5000 is the new fully automated urine particle analyser. We validated its performance.

METHODS

736 urines were analysed and results were compared by two pathologists on uncentrifuged samples, using Fuchs-Rosenthal chamber.

RESULTS

AUC of ROC curve ranged between 0.86 and 0.99. Sensitivity was >0.90 for all the elements and similar for RBC and yeasts. Specificity ranged between 0.74 and 0.89 for total cast, epithelial/non-squamous/renal-tubular cells and RBC. For all the other parameters specificity was >0.90. Comparison with Fuchs-Rosenthal chamber was very good for all the parameters; r ranged between 0.52 and 0.99 except for pathological cast because of the lack of the pathological samples in medium and higher ranges. Linearity performance (R²) was 1.00, 1.00 and 0.99 respectively for RBC, WBC and epithelial cells (EC). No carry-over was observed. The within-run imprecision was 25.42%,13.81%,1.36% for RBC; 37.50%,10.16%,1.41% for WBC and 35.25%, 17.85%,6.30% for EC at low, near the cut off level and high concentrations, respectively. The between-run imprecision was 6.90%,1.60% for RBC, 4.10%,1.90% for WBC and 7.60%,7.30% for EC, using low and high positive quality controls, respectively.

CONCLUSION

UF-5000 is an analyser of great interest to detect urine particle related to pathological process of kidney and urinary tract.