Comparison of two portable clinical analyzers to one stationary analyzer for the determination of blood gas partial pressures and blood electrolyte concentrations in horses

Performance of the non-invasive point-of-care device, EzeCheck, for haemoglobin assessment in adults and children in community and institutional care settings

Anaemia is a major public health problem, especially in resource constrained settings. Dependency on assessment of blood hemoglobin (Hgb) concentration impedes anemia detection, risk stratification and intervention. Thus, valid, frugal and scalable technologies are needed. EzeCheck is a noninvasive portable device developed in India for predicting hemoglobin levels in human beings aged 4 years and above using a finger-tip biosensor. In this assessment, we aimed to: (i) evaluate EzeCheck's performance with an automated whole blood hemato-analyzer (Sysmex XN 1000) as the gold standard, and (ii) estimate EzeCheck's agreement with Sahli's method and HemoCue (Hb-301) in real-world primary and higher care facilities. Paired assessments were done at five sites across India i.e., Bhubaneshwar, Shimla, Solan and Mashobra and Ulhasnagar. Participants across all age groups (4 years and above) were assessed. We used a range of statistical tests to evaluate the performance of EzeCheck. It was found that EzeCheck performed well across age and gender categories with convincing validity, concordance, precision and accuracy, and acceptable bias. While comparing EzeCheck with Hemato-analyzer, no statistically significant systematic bias was found. However, EzeCheck showed significant systematic bias when compared to Sahli's method and HemoCue. We concluded that EzeCheck could detect anemia (as per WHO Hgb cut-offs) in 'real-world settings' and 'across age and gender categories', with high sensitivity, specificity and accuracy, and can serve as a replacement to traditional methods of hemoglobin assessment. Further, for countries with higher prevalence of anemia where universal screening may be mandated, the positive predictive value of EzeCheck will be higher. The likelihood ratios also indicated that the device had moderate-to-good utility. EzeCheck is suitable for embedment into program and out-patient health care settings in resource constrained contexts as a spot-check hemoglobinometer.

Analytical Performance Evaluation of the New GEM® Premier™ 5000 in Comparison to the Epoc® Blood Gas Analyzer in Horses

Different blood gas analyzers are used in equine practice. Every machine needs to be validated, as they have not been designed for use in horses. The aim of this study was to compare the newly marketed GEM5000 machine to the formerly validated epoc machine for blood gas analysis in horses. In this prospective, non-blinded, comparative laboratory analyzer study, 43 equine blood samples were analyzed on both analyzers and values were compared between the two machines via Lin's concordance analysis, Passing-Bablok regression analysis and Bland-Altman plots. Duplicate measurements were conducted on the GEM5000 machine to evaluate precision. The GEM5000 failed to achieve the required precision for tHb, Hct and iCa²⁺, but achieved acceptable precision for all other parameters. Concordance correlation analysis revealed poor correlation for Na⁺, Cl^-, iCa²⁺, K⁺, Hct and tHb, while there was an at least moderate agreement for all other parameters. Passing-Bablok regression revealed significant constant bias for pCO₂, pO₂, Cl^-, and iCa²⁺ and significant proportional bias for pCO₂, iCa²⁺ and SO₂. Bland-Altman analysis revealed significant systematic bias for Na⁺, Cl^-, iCa²⁺, K⁺, Hct, tHb and SO₂. This study shows that while precision of the GEM5000 is good, values should not be used interchangeably with data obtained from other blood gas analyzers.

Blood Inflammatory, Hydro-Electrolytes and Acid-Base Changes in Belgian Blue Cows Developing Parietal Fibrinous Peritonitis or Generalised Peritonitis after Caesarean Section

This study aimed to describe the inflammation, hydro-electrolyte and acid-base imbalances caused by generalised peritonitis (GP) and parietal fibrinous peritonitis (PFP) after caesarean section. After clinical examination, blood was sampled from 11 cows with PFP, 30 with GP and 14 healthy cows. Serum and plasma refractometry and glutaraldehyde tests were used to evaluate the inflammation level, while hydro-electrolytes and acid-base parameters were assessed using an EPOC® device. In addition to clinical signs of dehydration (>10%), blood analysis showed a high fibrinogen concentration (PFP: 8.64 ± 8.82 g/L; GP: 7.83 ± 2.45 g/L) and fast glutaraldehyde coagulation (<3 min) indicative of severe inflammation in both diseases compared to the control group (p < 0.05). Moreover, a severe decrease in electrolytes concentration (Na+: 126.93 ± 5.79 mmol/L; K+: 3.7 ± 1.3 mmol/L; Ca++: 0.89 ± 0.12 mmol/L; Cl−: 82.38 ± 6.45 mmol/L) and a significant increase in bicarbonate (30.87 ± 8.16 mmol/L), base excess (5.71 ± 7.42 mmol/l), L-lactate (8.1 ± 4.85 mmol/L) and creatinine (3.53 ± 2.30 mg/dL) were observed in cows with GP compared to the control group (p < 0.05). In contrast, few major perturbations were noticed in PFP, where only K+ (3.64 ± 0.25 mmol/L) and Ca++ (1.06 ± 0.09 mmol/L) were significantly modified (p < 0.05). In conclusion, a high dehydration and severe inflammation are induced by PFP and GP. Nevertheless, GP causes more electrolytes and acid-base disturbances than PFP.

Comparison of the bovine blood gas parameters produced with three types of portable blood gas analyzers

Background

A definite diagnosis should be made in the bovine practice field, however, it was difficult to perform laboratory analysis immediately. Currently, three types of portable blood gas analyzers are available in Korea.

Objectives

This study aimed to evaluate the correlations among these three analyzers.

Methods

Seventy-two plasma samples from Holstein-Friesian cows were used for blood gas analysis, and three instruments (EDAN i15 Vet, VETSCAN i-STAT, and EPOC) were operated simultaneously. Moreover, plasma calcium levels were compared between these portable analyzers and blood chemistry device, which is usually used in a laboratory environment. Pearson analysis was performed to confirm the correlation of each parameter produced with the three instruments and blood chemistry analyzer.

Results

As results, high correlation was observed in parameters of pH, pO₂, potassium ion, ionized calcium, and glucose (p < 0.001, r > 0.7). In addition, pCO₂ showed a moderate correlation among the three analyzers (p < 0.001, r > 0.5), and there was no correlation among all instruments for sodium ions. There was also a high correlation between ionized calcium from the three portable devices and total calcium from the biochemistry analyzer (p < 0.001, r > 0.9).

Conclusions

In conclusion, there was a high correlation between results from the three different blood gas analyzers used in the bovine clinical field in Korea. Thus, a consistent diagnosis can be made even with different equipment if the operator is aware of the strengths and weaknesses of each piece of equipment and operates it properly.

Continuous Monitoring of the Thermoregulatory Response in Endurance Horses and Trotter Horses During Field Exercise: Baselining for Future Hot Weather Studies

Establishing proper policies regarding the recognition and prevention of equine heat stress becomes increasingly important, especially in the face of global warming. To assist this, a detailed view of the variability of equine thermoregulation during field exercise and recovery is essential. 13 endurance horses and 12 trotter horses were equipped with continuous monitoring devices [gastrointestinal (GI) pill, heartrate (HR) monitor, and global positioning system] and monitored under cool weather conditions during four endurance rides over a total of 80 km (40 km loops) and intense trotter track-based exercise over 1,540 m. Recordings included GI temperature (T c ), speed, HR and pre- and post-exercise blood values. A temperature time profile curve of T c was constructed, and a net area under the curve was calculated using the trapezoidal method. Metabolic heat production and oxygen cost of transport were also calculated in endurance horses. Maximum T c was compared using an independent samples t-test. Endurance horses (mean speed 14.1 ± 1.7 km h-1) reached mean maximum T c (39.0 ± 0.4°C; 2 × 40 km in 8 horses) during exercise at 75% of completion of T c exercise and T c returned to baseline within 60 min into recovery. However, the mean T c was still 38.8 ± 0.4°C at a HR of 60 bpm which currently governs "fit to continue" competition decisions. Trotters (40.0 ± 2.9 km h-1) reached a comparable mean max T c (38.8 ± 0.5°C; 12 horses) always during recovery. In 30% of trotters, T c was still >39°C at the end of recovery (40 ± 32 min). The study shows that horses are individuals and thermoregulation monitoring should reflect this, no matter what type of exercise is performed. Caution is advised when using HR cut-off values to monitor thermal welfare in horses since we have demonstrated how T c can peak quite some time after finishing exercise. These findings have implications for training and management of performance horses to safeguard equine welfare and to maximize performance.

Validation of a Portable Blood Gas Analyzer for Use in Challenging Field Conditions at High Altitude

Background

Novel, portable blood gas analyzers (BGAs) may serve as essential point-of-care tools in remote regions, during air travel or in ambulance services but they have not been extensively validated.

Research Question

We compared accuracy of a portable BGA to a validated stationary device.

Methods

In healthy individuals and patients with chronic obstructive pulmonary disease participating in clinical field studies at different altitudes, arterial blood samples were obtained at rest and during exercise in a hospital at 760 m and in a high altitude clinic at 3100 m. Paired measurements by a portable BGA (EPOC, Siemens Healthcare) and a stationary BGA (Rapidpoint500, Siemens Healthcare) were performed to compute bias (mean difference) and limits of agreement (95% CI of bias).

Results

Of 105 individuals, 248 arterial blood samples were analyzed, 108 at 760 m, 140 at 3100 m. Ranges of values measured by portable BGA were: pH 7.241−7.473, PaCO₂ 21.5−52.5 mmHg, and PaO₂ 45.5−107.1 mmHg. Bias (95% CI) between devices were: pH 0.007 (−0.029 to 0.044), PaCO₂ −0.3 mmHg (−4.8 to 4.2), and PaO₂ −0.2 mmHg (−9.1 to 4.7). For pH, agreement between devices was improved by the equation to correct pH by portable BGA = −1.37 + pH_measured × 1.19; bias after correction −0.007 (−0.023 to 0.009). The portable BGA was easily handled and worked reliably.

Interpretation

Accuracy of blood gas analysis by the portable BGA in comparison to the reference BGA was adequate for clinical use. Because of portability and ease of handling, portable BGA are valuable diagnostic tools for use in everyday practice as well as under challenging field conditions.

Agreement of 2 electrolyte analyzers for identifying electrolyte and acid-base disorders in sick horses

BACKGROUND

Use of different analyzers to measure electrolytes in the same horse can lead to different interpretation of acid-base balance when using the simplified strong ion difference (sSID) approach.

OBJECTIVE

Investigate the level of agreement between 2 analyzers in determining electrolytes concentrations, sSID variables, and acid-base disorders in sick horses.

ANIMALS

One hundred twenty-four hospitalized horses.

METHODS

Retrospective study using paired samples. Electrolytes were measured using a Beckman Coulter AU480 Chemistry analyzer (PBMA) and a Nova Biomedical Stat Profile (WBGA), respectively. Calculated sSID variables included strong ion difference, SID₄ ; unmeasured strong ions, USI; and total nonvolatile buffer ion concentration in plasma (A_tot ). Agreement between analyzers was explored using Passing-Bablok regression and Bland-Altman analysis. Kappa (κ) test evaluated the level of agreement between analyzers in detecting acid-base disorders.

RESULTS

Methodologic differences were identified in measured Na⁺ and Cl^- and calculated values of SID₄ and USI. Mean bias (95% limits of agreement) for Na⁺ , Cl^- , SID₄ , and USI were: -1.2 mmol/L (-9.2 to 6.8), 4.4 mmol/L (-4.4 to 13), -5.4 mmol/L (-13 to 2), and -6.2 mmol/L (-14 to 1.7), respectively. The intraclass correlation coefficient for SID₄ and USI was .55 (95%CI: -0.2 to 0.8) and .2 (95%CI: -0.15 to 0.48), respectively. There was a poor agreement between analyzers for detection of SID₄ (κ = 0.20, 95%CI, 0.1 to 0.31) or USI abnormalities (κ = -0.04, 95%CI, -0.11 to 0.02).

CONCLUSIONS AND CLINICAL IMPORTANCE

Differences between analyzer methodology in measuring electrolytes led to a poor agreement between the diagnosis of acid-base disorders in sick horses when using the sSID approach.

Peripartum findings and blood gas analysis in newborn foals born after spontaneous or induced parturition

Induction of parturition in horses is still not well accepted due to the potential peripartum complications for mares and newborn foals. We assessed differences after spontaneous and induced parturition with low doses of oxytocin (OX) in 1) incidence of peripartum complications in mares; 2) viability, behavioral, physical, and venous blood gas analyses in foals. In this study 61 mares were included; 45/61 were enrolled in the spontaneous foaling group (SF) and 16/61 in the induced foaling group (IF). In the IF group, when the calcium in mammary secretion reached concentrations of ≥250 ppm, mares received a single injection of 2.5 IU of oxytocin IV once a day until foaling. Mares' breed, age, parity, gestational and stage II length, and peripartum complications were recorded. Foal maturity, vital (Apgar score), behavioral and physical parameters were assessed at birth, and the foal clinical condition was monitored for one week. A jugular venous blood sample was collected at birth for blood gas analysis, acid-base status, and lactate assessment. The median gestational length was within the reference interval in all the mares included and did not differ between the two groups. No statistical differences in the II stage length nor in incidence of peripartum complications were observed between the two groups. All the foals were born alive and showed no signs of prematurity/dysmaturity. No statistical differences were found in foal viability between the two groups. Time to stand and nurse from the mare, and body temperature were significantly higher in the IF compared to the SF group. Venous blood pH, SO₂% and BE were lower, while pCO₂ and lactate were higher in the IF than in the SF group. All the foals in both groups remained clinically healthy during the observation period. In conclusion, at term induction of parturition with a low dose of oxytocin does not have adverse effects on peripartum in mares. Our findings suggest that at term induced foals suffer slightly greater, but not clinically significant, hypoxia, hypercapnia and acidosis than spontaneously delivered foals.

Electrolyte measurements differ between point-of-care and reference analysers in dogs with hypoadrenocorticism

INTRODUCTION

Dogs treated for hypoadrenocorticism are monitored through analysis of their blood electrolytes. This is routinely performed with point-of-care analysers and doses of medications are adjusted based on the results.

OBJECTIVES

To investigate the performance of two point-of-care analysers (IDEXX Catalyst Dx and IDEXX VetStat) against a reference laboratory method for the measurement of blood sodium, potassium and chloride concentrations, as well as sodium: potassium ratios, in dogs diagnosed with and treated for hypoadrenocorticism.

METHODS

Forty-eight dogs were enrolled into a prospective cross-sectional study. Paired blood samples were taken and tested on two point-of-care analysers and at a reference laboratory. Statistical analysis was then performed with Bland-Altman analysis and Passing-Bablok regression. The clinical effects of inaccurate electrolyte analysis were investigated.

RESULTS

In total, 329 samples were tested on the Catalyst analyser, while another 72 samples were tested on the VetStat. Passing-Bablok regression identified both proportional and constant bias for some analytes. There was poor agreement between sodium and chloride concentrations on both analysers. Both analysers tended to give higher results than the reference method for all analytes, except for potassium when measured on the VetStat.

CLINICAL SIGNIFICANCE

There are inherent differences between the electrolyte concentrations measured by these two point-of-care analysers and reference laboratory methods in dogs with hypoadrenocorticism.

Point-of-Care Diagnostics in Equine Practice

Point-of-care testing (POCT) refers to benchtop diagnostic modalities that have been translated into portable and easy-to-use formats suitable for patient-side use. Recent advances in diagnostic technology have allowed the development of a growing collection of POCT assays available to equine practitioners. Advantages include rapid results that reduce initial guesswork and promote diagnosis-targeted patient care, which may ultimately provide better clinical outcomes. Small handheld devices comprise most POCT technologies, providing qualitative or quantitative determination of an increasing range of analytes, including critical care analyzers and, more recently, hematology and immunology analyzers. This article discusses commercially available equine POCT.

Traditional and quantitative analysis of acid-base and electrolyte imbalances in horses competing in cross-country competitions at 2-star to 5-star level

Background

Early recognition and management of acid‐base, fluid, and electrolyte disorders are crucial for the maintenance of health and performance in equine athletes.

Objectives

To analyze changes in acid‐base and electrolyte status associated with exercise during cross‐country competitions at different levels using traditional and quantitative approaches.

Animals

Thirty‐eight eventing horses.

Methods

Prospective observational study. Jugular venous blood samples were collected before and after the cross‐country test of 25 international eventing competitions ranging from 2‐star (formerly 1‐star) to 5‐star (formerly 4‐star) level. Blood gas analysis was performed to determine pH, pCO₂, Na⁺, Cl⁻, and K⁺ and calculate HCO₃⁻, tCO₂ base excess (BE_ECF), anion gap (AG), strong ion difference calculated from Na⁺, K⁺, Cl⁻, and lactate⁻ (SID₄), strong ion difference calculated from Na⁺, K⁺, and Cl⁻ (SID₃), strong ion gap (SIG), and total nonvolatile weak buffer concentration (A_tot). Postexercise acid‐base imbalances, diagnosed on the basis of the traditional approach, and the simplified strong ion model were compared.

Results

Significant decreases in pH, Cl⁻, SID₄, pCO₂, HCO₃⁻, tCO₂, and BE_ECF as well as increases in K⁺, SID₃, AG, TP, and A_tot were observed between pre‐ and postexercise samples. The changes in acid‐base parameters were significantly affected by the competition level. Using the strong ion approach, a higher proportion of horses was diagnosed with postexercise metabolic acidosis.

Conclusions and Clinical Importance

Regarding the complex acid‐base changes in horses competing at cross‐country competitions, the quantitative approach provided a more detailed analysis of the different factors contributing to acid‐base balance than did the traditional approach.