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Price MA, Fast PE, Mshai M, Lambrick M, Machira YW, Gieber L, Chetty P, Muturi-Kioi V. Region-specific laboratory reference intervals are important: A systematic review of the data from Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000783. [PMID: 36962599 PMCID: PMC10021479 DOI: 10.1371/journal.pgph.0000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Abstract
Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, screening, enrollment procedures and definition of age strata varied across studies. The most common type of RIs reported were hematology (66, 83%); 14 studies (18%) included flow cytometry and/or T cell counts. Other common tests or panels included liver function assays (32, 40%), renal function assays (30, 38%), lipid chemistries (17, 21%) and serum electrolytes (17, 21%). The number of parameters characterized ranged from only one (three studies characterized either CD4+ counts, D-dimer, or hemoglobin), to as many as 40. Statistical methods for calculating RIs varied. 56 (70%) studies compared their results to international RI databases. Though most presented their data side-by-side with international data with little accompanying analysis, nearly all reported deviation from comparator RI data, sometimes with half or more of otherwise healthy participants having an "out of range" result. We found there is limited local RI data available in sub-Saharan Africa. Studies to fill this gap are warranted, including efforts to standardize statistical methods to derive RIs, methods to compare with other RIs, and improve representative participant selection.
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Affiliation(s)
- Matt A. Price
- IAVI, New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Patricia E. Fast
- IAVI, New York City, New York, United States of America
- Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, United States of America
| | | | | | | | - Lisa Gieber
- IAVI, New York City, New York, United States of America
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Gu X, Sha L, Zhang S, Shen D, Zhao W, Yi Y. Neutrophils and Lymphocytes Can Help Distinguish Asymptomatic COVID-19 From Moderate COVID-19. Front Cell Infect Microbiol 2021; 11:654272. [PMID: 34722325 PMCID: PMC8554189 DOI: 10.3389/fcimb.2021.654272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Asymptomatic coronavirus disease 2019 (COVID-19) and moderate COVID-19 may be the most common COVID-19 cases. This study was designed to develop a diagnostic model for patients with asymptomatic and moderate COVID-19 based on demographic, clinical, and laboratory variables. Methods This retrospective study divided the subjects into 2 groups: asymptomatic COVID-19 (without symptoms, n = 15) and moderate COVID-19 (with symptoms, n = 57). Demographic characteristics, clinical data, routine blood tests, other laboratory tests, and inpatient data were collected and analyzed to compare patients with asymptomatic COVID-19 and moderate COVID-19. Results Comparison of the asymptomatic COVID-19 group with the moderate COVID-19 group yielded the following results: the patients were younger (P = 0.045); the cluster of differentiation (CD)8+ (cytotoxic) T cell level was higher (P = 0.017); the C-reactive protein (CRP) level was lower (P = 0.001); the white blood cell (WBC, P < 0.001), neutrophil (NEU, P = 0.036), lymphocyte (LYM, P = 0.009), and eosinophil (EOS, P = 0.036) counts were higher; and the serum iron level (P = 0.049) was higher in the asymptomatic COVID-19 group. The multivariate analysis showed that the NEU count (odds ratio [OR] = 2.007, 95% confidence interval (CI): 1.162 - 3.715, P = 0.014) and LYM count (OR = 9.380, 95% CI: 2.382 - 36.934, P = 0.001) were independent factors for the presence of clinical symptoms after COVID-19 infection. The NEU count and LYM count were diagnostic predictors of asymptomatic COVID-19. This diagnostic prediction model showed high discriminatory power, consistency, and net clinical benefits. Conclusions The proposed model can distinguish asymptomatic COVID-19 from moderate COVID-19, thereby helping clinicians identify and distinguish patients with potential asymptomatic COVID-19 from those with moderate COVID-19.
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Affiliation(s)
- Xuefeng Gu
- Medical School, Southeast University, Nanjing, China.,Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ling Sha
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shaofeng Zhang
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Duo Shen
- Medical School, Southeast University, Nanjing, China.,Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Zhao
- Medical School, Southeast University, Nanjing, China.,Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yongxiang Yi
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Establishment of Hematological Reference Values among Healthy Adults in Bamenda, North West Region of Cameroon. Anemia 2021; 2021:6690926. [PMID: 33708443 PMCID: PMC7932772 DOI: 10.1155/2021/6690926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
The use of the reference range of values of a laboratory test is highly significant in diagnostic accuracy. However, race and ethnic variations may affect the safe use of reference ranges from a different setting/population. Because the establishment of reference ranges for the Cameroonian population will possibly improve the quality of health care, this study was designed to establish hematological reference ranges among healthy adults in Bamenda, North West region of Cameroon. This was a cross-sectional study carried out within the period of five months from February 2020 to June 2020, at the Bamenda Regional Hospital. A total of 350 (139 females and 211 males) study participants who met the inclusion criteria were included in the study. The Urit 3300 autoanalyzer (Urit Medical Electronic (Group) Co., Ltd, Guilin, China) was used to analyze the hematological parameters. The general health questionnaire for donors, for verification of reference range study and laboratory tests, was used for data collection. Descriptive statistics were used to calculate reference ranges, means, and medians at 95% confidence intervals. Maximum and minimum reference ranges were computed at 97.5th and 2.5th percentiles. The nonparametric test (Mann–Whitney test) was used to determine the significance of the difference in hematological values between the male and female groups. Three (MID%, LYM#, and MID#) out of the 19 hematological parameters were verified, while sixteen (WBC, LYM%, GRAN%, GRAN#, RBC, HGB, HCT%, MCV, MCH, MCHC, RDW_CV, RDW_SD, PLT, MPV, PDW, and PCT%) were established. The currently used reference intervals do not represent the population of the North West region. Therefore, other regional hospitals in Cameroon should establish reference intervals applicable to their respective regions.
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Fondoh VN, Fondoh RM, Awasom CN, Edith PL, Ntungwen WA, Roland B, Enow-Tanjong R, Njukeng P, Shang J, Egbengu EP, Maruta T, Etheline A, Leke R, Leo A, Nsame D. Haematological reference intervals for healthy adults in Bamenda, Cameroon. Afr J Lab Med 2020; 9:1193. [PMID: 33392055 PMCID: PMC7756783 DOI: 10.4102/ajlm.v9i1.1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In the era of evidence-based medicine, haematological reference intervals are essential for the interpretation of data for clinical decision-making, monitoring of treatment and research. It is not uncommon that reference intervals used in most African countries have been obtained from published scientific literature, textbooks, reagent/instrument manuals. OBJECTIVE The aim of this study was to determine haematological reference intervals of healthy adults in Bamenda, Cameroon. METHODS This was a cross-sectional study conducted between June and November 2015. Participants were voluntary blood donors at the Blood Bank Service of the Regional Hospital Bamenda aged between 18 and 65 years. The mean, median and standard deviation of the mean were calculated for each haematological parameter. The 95th percentile reference intervals were determined using the 2.5th and 97.5th percentile. The differences between gender for all the parameters were evaluated using the Kruskal-Wallis test. Significance was determined at the 95% confidence level. RESULTS Out of a total of 340 participants, 202 (59.4%) were men and 138 (40.6%) were women. The median red blood cell, haemoglobin, haematocrit and mean cell haemoglobin concentration were significantly higher in men than women (p < 0.001). The median white blood cell, absolute lymphocytes count, absolute granulocytes and platelet counts for men were significantly lower than those for women (p < 0.011). CONCLUSION We propose that the present established haematological reference intervals in this study should be used for clinical management of patients and interpretation of laboratory data for research in Bamenda.
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Affiliation(s)
- Victor N Fondoh
- Administration/Quality Management, Bamenda Regional Hospital Laboratory, Regional Hospital Bamenda, Bamenda, Cameroon
- Department of Medical Laboratory Sciences, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
- Department of Health Economics Policy and Management, Faculty of Business Management, University of Cameroon, Bamenda, Cameroon
| | - Richard M Fondoh
- Administration/Pharmaceutical Management, North-West Regional Fund for Health Promotion, Bamenda, Cameroon
| | - Charles N Awasom
- Department of Anatomy, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Pefoule L Edith
- Bamenda Regional Hospital Laboratory, Regional Hospital Bamenda, Cameroon
| | | | - Bong Roland
- Product Safety/Quality Control Mangement, Geochim Sarl, Cameroon
| | - Rebeca Enow-Tanjong
- Department of Medical Laboratory Science, School of Health and Medical Sciences , Catholic University of Cameroon, Bamenda, Cameroon
| | | | - Judith Shang
- Laboratory Service, Center for Disease Control and Prevention, Yaoundé, Cameroon
| | - Egbe P Egbengu
- Department of Medicine and Surgery, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Talkmore Maruta
- East Central and Southern Africa Health Community, Arusha, United Republic of Tanzania
| | - Akazong Etheline
- Department of Biochemistry, University of Dschang, Dschang, Cameroon
| | - Robert Leke
- Department of Medicine and Surgery, School of Health and Medical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
| | - Ayuk Leo
- TB-Department, Regional Hospital Bamenda, Bamenda, Cameroon
| | - Denis Nsame
- Administration/Management, Regional Hospital Bemenda, Bamenda, Cameroon
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