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Yassen K, Omer N, Alsahaf F, Al Amer F, Alhamad F, Alherz I, Bushehab A, Alniniya F, Alwabari M. Comparing Non-Invasive Spectrophotometry to Hematology Analysis for Hemoglobin Measurements in Sickle Cell Disease Patients. J Clin Med 2023; 12:7517. [PMID: 38137588 PMCID: PMC10744205 DOI: 10.3390/jcm12247517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Patients with sickle cell disease (SCD) require repeated blood sampling for hemoglobin (Hb) concentration measurements. The primary aim of this study was to compare non-invasive spectrophotometric hemoglobin (SpHb, g/dL) measurements to those taken via an automated hematology analyzer (Hb, g/dL) in patients with SCD visiting outpatient clinics and to investigate the correlations and agreements between both measurement techniques. Secondarily, we aimed to identify the SpHb cut-off concentration for the diagnosis of anemia and to monitor the effects of the pleth variability index (PVI, %) and perfusion index (PI) on SpHb measurements. The results gained from the examination of one hundred and fifty-eight patients indicated that the SpHb measurements overestimated the lab Hb concentrations, with a mean (SpHb-Hb) bias of 0.82 g/dL (SD 1.29). The SpHb measurements were positively correlated with the Hb measurements (Kendall's tau correlation (τ), n = 158, τ = 0.68, p < 0.001), with an intra-class correlation (ICC) of 0.67 and a 95% CI from 0.57 to 0.74 (p = 0.000). The SpHb cut-off concentration to diagnose anemia was 11.4 and 11.7 g/dL for males and females, respectively. SpHb sensitivity was low for males and females at 64.4% and 57.1%; however, the specificity was higher at 90.9% and 75%, with positive predictive values (PPVs) of 95.6 and 85.7, respectively. No correlation existed between SpHb measurements and the PVI (%) in contrast with a moderate correlation with the PI (r = 0.049, p = 0.54, and r = 0.36, p < 0.001, respectively). The mean PI was low at 2.52 ± 1.7. In conclusion, the SpHb measurements were consistently higher than the lab Hb concentrations, with a positive correlation. The sensitivity and precision of the SpHb measurements were lower than expected. However, the SpHb specificity and its positive predictive values (PPVs) indicated that it is less likely for a patient with a positive SpHb test result for anemia to be non-anemic. These results will allow SpHb measurement to play a role in excluding the presence of anemia. In light of the low PI values determined, the SpHb measurements were challenging to take and, thus, require further technological improvements.
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Affiliation(s)
- Khaled Yassen
- Anesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia
| | - Nawal Omer
- Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Fatimah Alsahaf
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Fatima Al Amer
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Fatimah Alhamad
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Imran Alherz
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (I.A.); (F.A.)
| | - Abdulaziz Bushehab
- Nursing Services, Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Fatma Alniniya
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (I.A.); (F.A.)
| | - Maryam Alwabari
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
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Alwabari M, Alhamad F, Alsahaf F, Al Amer F, Alniniya F, Alherz I, Omer N, Bushehab A, Yassen K. Can Non-Invasive Spectrophotometric Hemoglobin Replace Laboratory Hemoglobin Concentrations for Preoperative Anemia Screening? A Diagnostic Test Accuracy Study. J Clin Med 2023; 12:5733. [PMID: 37685800 PMCID: PMC10488634 DOI: 10.3390/jcm12175733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Preoperative assessment of hemoglobin concentration in blood is important to diagnose anemia. The primary aim of this prospective diagnostic test accuracy study was to monitor non-invasive spectrophotometric hemoglobin (SpHb, g/dL) concentrations among adults prior to elective surgery and to investigate the correlation and agreement of SpHb with laboratory hemoglobin (Hb, g/dl). A secondary aim was to identify the anemia cut-off values for SpHb based on the World Health Organization (WHO) definitions for anemia. This study included 151 consecutive patients (age ≥ 18 year) presenting for preoperative evaluation prior to scheduled elective general or orthopedic surgery. Results identified the mean ± SD of SpHb at 11.43 ± 2.01 g/dL, which underestimated the mean laboratory Hb (12.64 ± 2.29 g/dL, p < 0.001). A bias mean difference (SpHb-Hb) of -1.21 g/dL, with a SD of 1.76, was reported. This bias (SpHb-Hb) was inversely correlated with the mean Hb concentrations. A positive correlation existed between SpHb and Hb, with a good degree of reliability and a significant Intra Class Correlation (ICC). SpHb diagnosed anemia in 32.3% and 60.3% of males and females, respectively. The SpHb cut-off values to identify anemia were 11.3 and 10.2 g/dL for males and females, respectively, with a sensitivity of 83.3% for males and only 62.9% for females. The specificity for males and females were 81% and 91.3%, respectively. SpHb sensitivity allows for anemia diagnosis among males, but not females. However, the specificity allows SpHb to rule out anemia for both.
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Affiliation(s)
- Maryam Alwabari
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (M.A.); (F.A.); (I.A.)
| | - Fatimah Alhamad
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.); (F.A.A.)
| | - Fatimah Alsahaf
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.); (F.A.A.)
| | - Fatima Al Amer
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.); (F.A.A.)
| | - Fatma Alniniya
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (M.A.); (F.A.); (I.A.)
| | - Imran Alherz
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (M.A.); (F.A.); (I.A.)
| | - Nawal Omer
- Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Abdulaziz Bushehab
- Nursing Services, Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Khaled Yassen
- Anesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia
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Gao T, Wang Y. Association between white blood cell count to hemoglobin ratio and risk of in-hospital mortality in patients with lung cancer. BMC Pulm Med 2023; 23:305. [PMID: 37596548 PMCID: PMC10436509 DOI: 10.1186/s12890-023-02600-7] [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: 04/14/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate the association between white blood cell count to hemoglobin ratio (WHR) and risk of in-hospital mortality in patients with lung cancer. METHODS In this retrospective cohort study, the medical records of patients with lung cancer were retrieved from the electronic ICU (eICU) Collaborative Research Database between 2014 and 2015. The primary outcome was in-hospital mortality. The secondary outcome was the length of stay in intensive care unit (ICU). The cut-off value for the WHR was calculated by the X-tile software. The Cox model was applied to assess the association between WHR and in-hospital mortality among patients with lung cancer and the linear regression model was used to investigate the association between WHR and length of ICU stay. Subgroup analyses of age (< 65 years or > = 65 years), Acute Physiology and Chronic Health Evaluation (APACHE) score (< 59 or > = 59), gender, ventilation (yes or no), and vasopressor (yes or no) in patients with lung cancer were conducted. RESULTS Of the 768 included patients with lung cancer, 153 patients (19.92%) died in the hospital. The median total follow-up time was 6.88 (4.17, 11.23) days. The optimal cut-off value for WHR was 1.4. ICU lung cancer patients with WHR > = 1.4 had a significantly higher risk of in-hospital mortality [Hazard ratio: (HR): 1.65, 95% confidence interval (CI): 1.15 to 2.38, P = 0.007) and length of stay in ICU (HR: 0.63, 0.01, 95% CI: 1.24 to 0.045, P = 0.045). According to the subgroup analysis, WHR was found to be associated with in-hospital mortality in patients with higher APACHE score (HR: 1.60, 95% CI: 1.06 to 2.41, P = 0.024), in male patients (HR: 1.87, 95% CI: 1.15 to 3.04, P = 0.012), and in patients with the treatment of ventilation (HR: 2.33, 95% CI: 1.49 to 3.64, P < 0.001). CONCLUSION This study suggests the association between WHR and risk of in-hospital mortality in patients with lung cancer and length of stay, which indicates the importance of attention to WHR for patients with lung cancer.
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Affiliation(s)
- Tingting Gao
- Department of Comprehensive Medical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, P.R. China
| | - Yurong Wang
- Department of Clinical Laboratory, Nanjing Jiangbei Hospital Affiliated to Nantong University, 552 Geguan Road, Jiangbei New District, Nanjing, Jiangsu, 210048, P.R. China.
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Mills K, Vermeer JM, Berry WE, Karreman E, Lett CD. Determining the validity of non-invasive spot-check hemoglobin co-oximetry testing to detect anemia in postpartum women at a tertiary care centre, a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:479. [PMID: 37386388 DOI: 10.1186/s12884-023-05783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Spot-check hemoglobin co-oximetry analyzers measure hemoglobin transcutaneously and offer the benefit of a hemoglobin measurement without phlebotomy. The objective of this study was to determine the validity of non-invasive spot-check hemoglobin co-oximetry testing for the detection of postpartum anemia (hemoglobin < 10 g/dL). METHODS Five hundred eighty-four women aged 18 and over were recruited on postpartum day one following a singleton delivery. Two non-invasive spot-check hemoglobin co-oximetry monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value. RESULTS Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland-Altman plots determined a bias of + 2.4 (± 1.2) g/dL with the Pronto and + 2.2 (± 1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for the Pronto and 16% for the Rad-67. Adjusting for the fixed bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%. CONCLUSION A consistent overestimation of hemoglobin by the non-invasive spot-check hemoglobin co-oximetry monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.
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Affiliation(s)
- Kienna Mills
- Health Science Building, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Julie M Vermeer
- Department of Obstetrics and Gynecology, University of Saskatchewan, Reginal General Hospital, 1440 14 Ave, ReginaRegina, Saskatchewan, S4P 0W5, Canada
| | - Warren E Berry
- Saskatchewan Health Authority, 2180 23rd Avenue, Regina, SK, S4S 0A5, Canada
| | - Erwin Karreman
- Saskatchewan Health Authority, 2180 23rd Avenue, Regina, SK, S4S 0A5, Canada
| | - Christine D Lett
- Department of Obstetrics and Gynecology, University of Saskatchewan, Reginal General Hospital, 1440 14 Ave, ReginaRegina, Saskatchewan, S4P 0W5, Canada.
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