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Hazen YJJM, Noordzij PG, Geuzebroek GSC, Koets J, Somers T, Gerritse BM, Scohy TV, Vernooij LM, van Gammeren A, Thelen MHM, Meester DJ, Sarton EY, van der Meer NJM, Rettig TCD. Abnormal Iron Status and Adverse Outcome After Elective Cardiac Surgery: A Prospective, Observational Multicenter Study. J Cardiothorac Vasc Anesth 2024; 38:667-674. [PMID: 38233243 DOI: 10.1053/j.jvca.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To investigate the incidence of preoperative abnormal iron status and its association with packed red blood cell (PRBC) transfusion, postoperative major complications, and new onset of clinically significant disability in patients undergoing elective cardiac surgery. DESIGN A prospective, observational multicenter cohort study. SETTING Three cardiac surgical centers in the Netherlands between 2019 and 2021. Recruitment was on hold between March and May 2020 due to COVID-19. PATIENTS A total of 427 patients aged 60 years and older who underwent elective on-pump cardiac surgery. MEASUREMENTS AND MAIN RESULTS The primary endpoint was a 30-day PRBC transfusion. Secondary endpoints were postoperative major complications within 30 days (eg, acute kidney injury, sepsis), and new onset of clinically significant disability within 120 days of surgery. Iron status was evaluated before surgery. Abnormal iron status was present in 45.2% of patients (n = 193), and most frequently the result of iron deficiency (27.4%, n = 117). An abnormal iron status was not associated with PRBC transfusion (adjusted relative risk [ARR] 1.2; 95% CI 0.9-1.8: p = 0.227) or new onset of clinically significant disability (ARR 2.0; 95% CI 0.9-4.6: p = 0.098). However, the risk of postoperative major complications was increased in patients with an abnormal iron status (ARR 1.7; 95% CI 1.1-2.5: p = 0.012). CONCLUSIONS An abnormal iron status before elective cardiac surgery was associated with an increased risk of postoperative major complications but not with PRBC transfusion or a new onset of clinically significant disability.
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Affiliation(s)
- Yannick J J M Hazen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands; Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Koets
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Tim Somers
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan M Gerritse
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands
| | - Thierry V Scohy
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands
| | - Lisette M Vernooij
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Adriaan van Gammeren
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands
| | - Marc H M Thelen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands
| | - Daan J Meester
- Department of Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Elise Y Sarton
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands.
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Thelen MHM, van Schrojenstein Lantman M, Boursier G, Vanstapel F, Panteghini M. In reply to: Limitations in using the EFLM WG-A/ISO approach for assessment of reagent lot variability. Clin Chem Lab Med 2023; 61:e218-e220. [PMID: 37261942 DOI: 10.1515/cclm-2023-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Marc H M Thelen
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Foundation for Quality Assurance in Laboratory Medicine (SKML), Nijmegen, the Netherlands
| | | | - Guilaine Boursier
- Department of Genetics, Rare Diseases and Personalized, Medicine Rare Diseases and Autoinflammatory Unit, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Florent Vanstapel
- Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
- Department of Public Health, Laboratory Medicine, Biomedical Sciences Group, University Hospital Leuven, Leuven, Belgium
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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van Mil D, Kieneker LM, Evers-Roeten B, Thelen MHM, de Vries H, Hemmelder MH, Dorgelo A, van Etten RW, Heerspink HJL, Gansevoort RT. Participation rate and yield of two home-based screening methods to detect increased albuminuria in the general population in the Netherlands (THOMAS): a prospective, randomised, open-label implementation study. Lancet 2023; 402:1052-1064. [PMID: 37597522 DOI: 10.1016/s0140-6736(23)00876-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) has a rising global prevalence and is expected to become the fifth leading cause of death by 2030. Increased albuminuria defines the early stages of CKD and is among the strongest risk factors for progressive CKD and cardiovascular disease. The value of population screening for albuminuria to detect CKD in an early phase has yet to be studied. We aimed to evaluate the effectiveness of two home-based albuminuria population screening methods. METHODS Towards Home-based Albuminuria Screening (THOMAS) was a prospective, randomised, open-label implementation study that invited Dutch adults aged 45-80 years for albuminuria screening. Individuals were randomly assigned (1:1) to screening by applying either a urine collection device (UCD) that was sent by post to a central laboratory for measurement of the albumin-to-creatinine ratio (ACR) by immunoturbidimetry or to screening via a smartphone application that measures the ACR with a dipstick method at home. Randomisation was done with a four-block method via a web-based system and was stratified by age, sex, and socioeconomic status. If two or more individuals per household were invited to participate, these individuals were randomly assigned to the same group. In case of confirmed increased albuminuria at home, participants were invited for an elaborate screening in a regional hospital (Amphia Hospital, Breda, Netherlands) for CKD and cardiovascular risk factors. When abnormalities were found, participants were referred to their general practitioner for treatment. The primary outcomes were the participation rate and yield of the home-based screening and elaborate screening. Participation rate was assessed in the intention-to-screen population (ie, all participants who were invited for the home-based screening or elaborate screening). Yield was assessed in the per-protocol population (ie, all individuals who participated in the home-based screening or elaborate screening). An exploratory analysis assessed the sensitivity and specificity of both home-based screening methods. To this end, an additional quantitative ACR test was performed among people participating in the elaborate screening, and a substudy was performed among participants with a first negative home-based screening test, who were invited for an additional test. The study is registered with ClinicalTrials.gov, NCT04295889. FINDINGS 15 074 participants were enrolled between Nov 14, 2019, and March 19, 2021. 7552 (50·1%) were randomly assigned to home-based albuminuria screening by the UCD method and 7522 (49·9%) were assigned to albuminuria screening by the smartphone application method. The participation rate of the home-based screening was 4484 (59·4% [95% CI 58·3-60·5]) of the 7552 invited individuals for the UCD method and 3336 (44·3% [43·2-45·5]) of 7522 invited individuals for the smartphone application method (p<0·0001). Increased ACR was confirmed by home-based testing in 150 (3·3% [95% CI 2·9-3·9]) of 4484 individuals for the UCD method and 171 (5·1% [4·4-5·9]) of 3336 indivduals for the smartphone application method. 124 (82·7% [95% CI 75·8-87·9]) of 150 individuals assigned to the UCD method and 142 (83·0% [76·7-87·9]) of 171 participants assigned to the smartphone application method attended the elaborate screening. Sensitivity to detect increased ACR was 96·6% (95% CI 91·5-99·1) for the UCD method and 98·1% (89·9-99·9) for the smartphone application method, and specificity was 97·3% (94·7-98·8) for the UCD method and 67·9% (62·0-73·3) for the smartphone application method, indicating that the test characteristics of only the UCD method were sufficient for screening. Albuminuria, hypertension, hypercholesterolaemia, and decreased kidney function were newly diagnosed in 77 (62·1%), 44 (35·5%), 30 (24·2%), and 27 (21·8%) of 124 participants for the UCD method, respectively. Of the 124 participants assigned to the UCD method who completed elaborate screening, 111 (89·5%) were referred to their general practitioner for treatment because of newly diagnosed CKD or cardiovascular disease risk factors or known risk factors outside the target range. INTERPRETATION Home-based screening of the general population for increased ACR using a UCD had a high participation rate and correctly identified individuals with increased albuminuria and yet unknown or known but outside target range CKD and cardiovascular risk factors. By contrast, the smartphone application method had a lower at-home participation rate than the UCD method and the test specificity was too low to accurately assess individuals for risk factors during the elaborate screening. The UCD screening strategy could allow for an early start of treatment to prevent progressive kidney function loss and cardiovascular disease in patients with CKD. FUNDING Dutch Kidney Foundation, Top Sector Life Sciences & Health of the Dutch Ministry of Economic Affairs.
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Affiliation(s)
- Dominique van Mil
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lyanne M Kieneker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Marc H M Thelen
- Result Laboratory for Clinical Chemistry, Amphia Hospital, Breda, Netherlands; Radboud University, Nijmegen, Netherlands
| | - Hanne de Vries
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht Universal Medical Center and Cardiovascular Research Institute University Maastricht, Maastricht, Netherlands
| | | | | | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; The George Institute for Global Health, Sydney, NSW, Australia
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
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van Mil D, Kieneker LM, Evers-Roeten B, Thelen MHM, de Vries H, Hemmelder MH, Dorgelo A, van Etten RW, Heerspink HJL, Gansevoort RT. Protocol for a randomized study assessing the feasibility of home-based albuminuria screening among the general population: The THOMAS study. PLoS One 2022; 17:e0279321. [PMID: 36548281 PMCID: PMC9778938 DOI: 10.1371/journal.pone.0279321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a rising public health problem that may progress to kidney failure, requiring kidney replacement therapy. It is also associated with an increased incidence of cardiovascular disease (CVD). Because of its asymptomatic nature, CKD is often detected in a late stage. Population screening for albuminuria could allow early detection of people with CKD who may benefit from preventive treatment. In case such screening is performed in a general practitioner (GP) setting, this will result in relatively high costs. Home-based screening might be an effective and cost-effective alternative. AIM The THOMAS study (Towards HOMe-based Albuminuria Screening) is designed to prospectively investigate two methods for home-based population screening for increased albuminuria to detect yet undiagnosed CKD and risk factors for progression and CVD. METHODS This investigator initiated, randomized population-based study will include 15.000 individuals aged 45-80 years, who will be randomly assigned to be invited for a home-based screening test for albuminuria with a more conventional urine collection device or an innovative smartphone application. If the test result is positive upon confirmation (i.e., elevated albuminuria), participants are invited to a central screening facility for an elaborate screening for CKD and CVD risk factors. Participants are referred to their GP for appropriate treatment, if abnormalities are found. Primary endpoints are the participation rate, yield, and cost-effectiveness of the home-based screening and elaborate screening. CONCLUSIONS The THOMAS study will evaluate the effectiveness and cost-effectiveness of home-based albuminuria screening in the general population for the early detection of CKD and CVD risk factors. It will provide insight into the willingness to participate in population screening for CKD and into the compliance of the general population to a corresponding screening protocol and compliance to participate. Thus, it may help to develop an attractive novel screening strategy for the early detection of CKD. TRIAL REGISTRATION ClinicalTrials.gov, registration number NCT04295889, registered 05 March 2020. https://www.google.com/search?client=firefox-b-d&q=NCT04295889.
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Affiliation(s)
- Dominique van Mil
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lyanne M. Kieneker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Marc H. M. Thelen
- Result Laboratory and Clinical Chemistry, Amphia Hospital, Breda, The Netherlands
| | - Hanne de Vries
- Department of Internal Medicine, Jeroen Bosch Hospital, ’s-Hertogenbosch, The Netherlands
| | - Marc H. Hemmelder
- Department of Internal Medicine, CARIM Cardiovascular Research Institute, Maastricht University Medical Center, University Maastricht, Maastricht, The Netherlands
| | | | | | - Hiddo J. L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
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van Schrojenstein Lantman M, Thelen MHM. The impact of measurement uncertainty on the uncertainty of ordinal medical scores based on continuous quantitative laboratory results. Clin Chem Lab Med 2021; 59:e309-e312. [PMID: 33761579 DOI: 10.1515/cclm-2020-1890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Marith van Schrojenstein Lantman
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.,Laboratory for Clinical Chemistry, Part of Result Laboratorium, Amphia Hospital, Breda, The Netherlands.,SKML, Organisation for Quality Assurance of Medical Laboratory Diagnostics, Radboud University, Nijmegen, The Netherlands
| | - Marc H M Thelen
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.,Laboratory for Clinical Chemistry, Part of Result Laboratorium, Amphia Hospital, Breda, The Netherlands.,SKML, Organisation for Quality Assurance of Medical Laboratory Diagnostics, Radboud University, Nijmegen, The Netherlands
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van der Hagen EAE, Cobbaert CM, Meijer R, Thelen MHM. Fast 0/1-h algorithm for detection of NSTEMI: are current high-sensitivity cardiac troponin assays fit for purpose? An EQA-based evaluation. Clin Chem Lab Med 2020; 57:1999-2007. [PMID: 31326959 DOI: 10.1515/cclm-2019-0253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
Background High-sensitivity cardiac troponin T/I (hs-cTnT/I) assays have improved analytical sensitivity for the detection of myocardial infarction (MI). To gain clinical specificity and sensitivity, interpretation of changes in cTn concentrations over time is crucial. The 2015 ESC NSTEMI guideline defines absolute delta values as additional rule-in and rule-out criteria for MI. A critical assumption for application of this rule is that total analytical imprecision within the delta period, including inter-instrument bias, is comparable to analytical imprecision in the validation studies. Methods Data from the Dutch External Quality Assessment Scheme (EQAS) were used to calculate inter-instrument bias and estimate imprecision for the measuring range where the proposed delta values are relevant: for Roche Elecsys hs-cTnT, 5-52 and 5-12 ng/L; for Abbott Architect hs-cTnI, 2-52 and 2-5 ng/L for rule-in and rule-out, respectively. Results For Elecsys, the median inter-instrument bias is 0.3 ng/L (n = 33 laboratories), resulting in reference change values (RCVs) of 3.0 and 1.7 ng/L, respectively, for rule-in and rule-out with imprecision as claimed by the manufacturer. With RCVs smaller than the guideline's delta thresholds, 100% of the laboratories have adequate specifications. RCVs for rule-in/rule-out increased to 4.6 ng/L/2.5 ng/L, respectively, with individual imprecisions as estimated from EQA data, resulting in 64% and 82% of laboratories with adequate specifications. For Architect, 40% of instruments (n = 10) might falsely qualify the result as clinically relevant; hence, inter-instrument bias could not be determined. Conclusions We advise laboratories that use the fast 0/1-h algorithm to introduce stringent internal quality procedures at the relevant/low concentration level, especially when multiple analyzers are randomly used.
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Affiliation(s)
- Eline A E van der Hagen
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands.,Department of Clinical Chemistry, Queen Beatrix Hospital, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands, Phone: +31 543544774
| | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ron Meijer
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands
| | - Marc H M Thelen
- Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands.,Department of Clinical Chemistry and Haematology, Amphia Hospital, Breda, The Netherlands
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Kurstjens S, van der Horst A, Herpers R, Geerits MWL, Kluiters-de Hingh YCM, Göttgens EL, Blaauw MJT, Thelen MHM, Elisen MGLM, Kusters R. Rapid identification of SARS-CoV-2-infected patients at the emergency department using routine testing. Clin Chem Lab Med 2020; 58:1587-1593. [PMID: 32598302 DOI: 10.1515/cclm-2020-0593] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/21/2020] [Indexed: 01/08/2023]
Abstract
Objectives The novel coronavirus disease 19 (COVID-19), caused by SARS-CoV-2, spreads rapidly across the world. The exponential increase in the number of cases has resulted in overcrowding of emergency departments (ED). Detection of SARS-CoV-2 is based on an RT-PCR of nasopharyngeal swab material. However, RT-PCR testing is time-consuming and many hospitals deal with a shortage of testing materials. Therefore, we aimed to develop an algorithm to rapidly evaluate an individual's risk of SARS-CoV-2 infection at the ED. Methods In this multicenter retrospective study, routine laboratory parameters (C-reactive protein, lactate dehydrogenase, ferritin, absolute neutrophil and lymphocyte counts), demographic data and the chest X-ray/CT result from 967 patients entering the ED with respiratory symptoms were collected. Using these parameters, an easy-to-use point-based algorithm, called the corona-score, was developed to discriminate between patients that tested positive for SARS-CoV-2 by RT-PCR and those testing negative. Computational sampling was used to optimize the corona-score. Validation of the model was performed using data from 592 patients. Results The corona-score model yielded an area under the receiver operating characteristic curve of 0.91 in the validation population. Patients testing negative for SARS-CoV-2 showed a median corona-score of 3 vs. 11 (scale 0-14) in patients testing positive for SARS-CoV-2 (p<0.001). Using cut-off values of 4 and 11 the model has a sensitivity and specificity of 96 and 95%, respectively. Conclusions The corona-score effectively predicts SARS-CoV-2 RT-PCR outcome based on routine parameters. This algorithm provides the means for medical professionals to rapidly evaluate SARS-CoV-2 infection status of patients presenting at the ED with respiratory symptoms.
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Affiliation(s)
- Steef Kurstjens
- Laboratory for Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 5223 GZ, Den Bosch, the Netherlands
| | - Armando van der Horst
- Laboratory for Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 5223 GZ, Den Bosch, the Netherlands
| | - Robert Herpers
- Laboratory of Clinical Chemistry and Hematology, Bernhoven Hospital, Uden, the Netherlands
| | | | | | - Eva-Leonne Göttgens
- Laboratory of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands
| | | | - Marc H M Thelen
- Laboratory of Clinical Chemistry and Hematology, Amphia Hospital, Breda, the Netherlands.,Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, the Netherlands.,Chair in 'Quality in Medical Laboratory Care', Radboud University, Nijmegen, the Netherlands
| | - Marc G L M Elisen
- Laboratory of Clinical Chemistry and Hematology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands.,Netherlands Society of Clinical Chemistry and Laboratory Medicine (NVKC), Utrecht, the Netherlands
| | - Ron Kusters
- Laboratory for Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 5223 GZ, Den Bosch, the Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Lankhorst S, Baelde HJ, Verstijnen JAMC, Ten Tije AJ, Thelen MHM, Danser AHJ, van den Meiracker AH, Kappers MHW. Cumulative dose of bevacizumab associates with albuminuria rather than podocyturia in cancer patients. ACTA ACUST UNITED AC 2018; 12:e1-e7. [PMID: 29960864 DOI: 10.1016/j.jash.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/06/2018] [Accepted: 06/13/2018] [Indexed: 11/16/2022]
Abstract
Angiogenesis inhibition with bevacizumab, a monoclonal antibody against vascular endothelial growth factor A (VEGF-A), is an anticancer treatment associated with hypertension and renal glomerular toxicity referred to as a preeclampsia-like syndrome. In preeclampsia, podocyturia predates proteinuria and clinical features of preeclampsia, and is regarded as a biomarker of ongoing glomerular injury. Using a quantitative polymerase chain reaction of the podocyte-specific molecules nephrin, podocin, and VEGF-A in the urine, we examined whether podocyturia is present in bevacizumab-treated cancer patients, and whether it relates to proteinuria and the cumulative dose of bevacizumab. Urine samples were cross-sectionally collected from 43 bevacizumab-treated patients, 21 chemotherapy-treated patients, and 7 healthy controls. Urinary protein-to-creatinine ratio (mean and range) was 32.0 mg/mmol (5.2-284.4) in the bevacizumab group, compared with 11.4 mg/mmol (1.1-21.0) in the chemotherapy group and 7.4 mg/mmol (3.9-16.5) (P < .05) in healthy controls, whereas urinary albumin-to-creatinine ratio values in the three groups were, respectively, 18.9 mg/mmol (0.1-227.7), 1.5 mg/mmol (0.2-3.5), and 0.2 mg/mmol (0.1-0.4) (P < .05). The cumulative dose of bevacizumab ranged from 550 to 93,628 mg. Urinary podocin mRNA expression was undetectable in 59% of participants, urinary nephrin mRNA expression per mmol creatinine ranged from 0.0 to 5.3 and urinary VEGF-A mRNA expression from 0.0 to 2.7. Urinary nephrin mRNA expression did not correlate to the albumin-to-creatinine ratio or the cumulative dose of bevacizumab, whereas the latter correlated with the albumin-to-creatinine ratio (r = 0.77; P < .001). Our results demonstrate that the cumulative dose of bevacizumab is closely correlated with albuminuria but not with podocyturia as measured with the quantitative polymerase chain reaction technique, challenging the feasibility of this measurement to monitor ongoing glomerular injury in patients chronically treated with bevacizumab.
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Affiliation(s)
- Stephanie Lankhorst
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hans J Baelde
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jose A M C Verstijnen
- Department of Oncology, Amphia Hospital, Breda, The Netherlands; Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | | | - Marc H M Thelen
- Clinical Chemical Laboratory, Amphia Hospital, Breda, The Netherlands
| | - A H Jan Danser
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anton H van den Meiracker
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Thelen MHM, Jansen RTP, Weykamp CW, Steigstra H, Meijer R, Cobbaert CM. Expressing analytical performance from multi-sample evaluation in laboratory EQA. Clin Chem Lab Med 2017; 55:1509-1516. [PMID: 28182577 DOI: 10.1515/cclm-2016-0970] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/20/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND To provide its participants with an external quality assessment system (EQAS) that can be used to check trueness, the Dutch EQAS organizer, Organization for Quality Assessment of Laboratory Diagnostics (SKML), has innovated its general chemistry scheme over the last decade by introducing fresh frozen commutable samples whose values were assigned by Joint Committee for Traceability in Laboratory Medicine (JCTLM)-listed reference laboratories using reference methods where possible. Here we present some important innovations in our feedback reports that allow participants to judge whether their trueness and imprecision meet predefined analytical performance specifications. METHODS Sigma metrics are used to calculate performance indicators named 'sigma values'. Tolerance intervals are based on both Total Error allowable (TEa) according to biological variation data and state of the art (SA) in line with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Milan consensus. RESULTS The existing SKML feedback reports that express trueness as the agreement between the regression line through the results of the last 12 months and the values obtained from reference laboratories and calculate imprecision from the residuals of the regression line are now enriched with sigma values calculated from the degree to which the combination of trueness and imprecision are within tolerance limits. The information and its conclusion to a simple two-point scoring system are also graphically represented in addition to the existing difference plot. CONCLUSIONS By adding sigma metrics-based performance evaluation in relation to both TEa and SA tolerance intervals to its EQAS schemes, SKML provides its participants with a powerful and actionable check on accuracy.
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van der Hagen EAE, Fokkert MJ, Kleefman AMD, Thelen MHM, van den Berg SAA, Slingerland RJ. Technical and clinical validation of the Greiner FC-Mix glycaemia tube. Clin Chem Lab Med 2017; 55:1530-1536. [PMID: 28284032 DOI: 10.1515/cclm-2016-0944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/30/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Measurement of adequate glucose concentrations is complicated by in vitro breakdown of glucose due to glycolysis. Unlike the commonly used NaF-EDTA and NaF-oxalate phlebotomy tubes, citrated NaF-EDTA tubes are reported to directly and thereby completely inhibit glycolysis. Recently, Greiner introduced the Vacuette® FC-Mix NaF-EDTA-citrate tube, currently the only NaF-citrate tube without volume-disturbing liquid additions available on the European market. Here we present its potential as alternative for the laborious and therefore unfeasible conditions for glucose sampling as recommended by the World Health Organization (WHO). METHODS The FC-Mix tube was tested against the WHO recommended method of optimal laboratory conditions, both in healthy volunteers and pregnant woman undergoing oral glucose tolerance test (oGTT) for screening of gestational diabetes mellitus (GDM). Glucose concentrations were measured after different incubation times (0-48 h) and temperatures (room temperature, 37 °C), both in uncentrifuged whole blood and centrifuged material. RESULTS Deming regression analysis shows that glucose concentrations measured in the FC-Mix tube correlate to the WHO recommended method. Stability is maintained at room temperature for 48 h and at least 24 h at 37 °C. The use of the FC-Mix tube was also validated in screening for GDM and proved comparable to the WHO recommended method in diagnostic outcome. CONCLUSIONS The new Greiner FC-Mix tube combines the easy handling of a routine tube with dry additive with the ability to immediately inhibit glycolysis as in the WHO method for optimal pre-analytical and analytical conditions and performs equally to those conditions when screening for GDM.
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Henny J, Vassault A, Boursier G, Vukasovic I, Brguljan PM, Lohmander M, Ghita I, Andreu FAB, Kroupis C, Sprongl L, Thelen MHM, Vanstapel FJLA, Vodnik T, Huisman W, Vaubourdolle M. Corrigendum to: Recommendation for the review of biological reference intervals in medical laboratories. Clin Chem Lab Med 2017; 55:470. [PMID: 28161692 DOI: 10.1515/cclm-2016-0793_c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Henny J, Vassault A, Boursier G, Vukasovic I, Mesko Brguljan P, Lohmander M, Ghita I, Andreu FAB, Kroupis C, Sprongl L, Thelen MHM, Vanstapel FJLA, Vodnik T, Huisman W, Vaubourdolle M. Recommendation for the review of biological reference intervals in medical laboratories. Clin Chem Lab Med 2016; 54:1893-1900. [PMID: 27748267 DOI: 10.1515/cclm-2016-0793] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/15/2016] [Indexed: 11/15/2022]
Abstract
This document is based on the original recommendation of the Expert Panel on the Theory of Reference Values of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), updated guidelines were recently published under the auspices of the IFCC and the Clinical and Laboratory Standards Institute (CLSI). This document summarizes proposals for recommendations on: (i) The terminology, which is often confusing, noticeably concerning the terms of reference limits and decision limits. (ii) The method for the determination of reference limits according to the original procedure and the conditions, which should be used. (iii) A simple procedure allowing the medical laboratories to fulfill the requirements of the regulation and standards. The updated document proposes to verify that published reference limits are applicable to the laboratory involved. Finally, the strengths and limits of the revised recommendations (especially the selection of the reference population, the maintenance of the analytical quality, the choice of the statistical method used…) will be briefly discussed.
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van den Berg SAA, van Thiel SW, Thelen MHM. Updating pregnancy diabetes guidelines: is (y)our laboratory ready? Clin Chem Lab Med 2016; 54:e225-7. [PMID: 26812793 DOI: 10.1515/cclm-2015-1111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/08/2015] [Indexed: 11/15/2022]
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Thelen MHM, Vanstapel FJLA, Kroupis C, Vukasovic I, Boursier G, Barrett E, Bernabeu Andreu F, Brguljan PM, Brugnoni D, Lohmander M, Sprongl L, Vodnik T, Ghita I, Vaubourdolle M, Huisman W. Flexible scope for ISO 15189 accreditation: a guidance prepared by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group Accreditation and ISO/CEN standards (WG-A/ISO). Clin Chem Lab Med 2016; 53:1173-80. [PMID: 26055950 DOI: 10.1515/cclm-2015-0257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/04/2015] [Indexed: 11/15/2022]
Abstract
The recent revision of ISO15189 has further strengthened its position as the standard for accreditation for medical laboratories. Both for laboratories and their customers it is important that the scope of such accreditation is clear. Therefore the European co-operation for accreditation (EA) demands that the national bodies responsible for accreditation describe the scope of every laboratory accreditation in a way that leaves no room for doubt about the range of competence of the particular laboratories. According to EA recommendations scopes may be fixed, mentioning every single test that is part of the accreditation, or flexible, mentioning all combinations of medical field, examination type and materials for which the laboratory is competent. Up to now national accreditation bodies perpetuate use of fixed scopes, partly by inertia, partly out of fear that a too flexible scope may lead to over-valuation of the competence of laboratories, most countries only use fixed scopes. The EA however promotes use of flexible scopes, since this allows for more readily innovation, which contributes to quality in laboratory medicine. In this position paper, the Working Group Accreditation and ISO/CEN Standards belonging to the Quality and Regulation Committee of the EFLM recommends using an approach that has led to successful introduction of the flexible scope for ISO15189 accreditation as intended in EA-4/17 in The Netherlands. The approach is risk-based, discipline and competence-based, and focuses on defining a uniform terminology transferable across the borders of scientific disciplines, laboratories and countries.
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van den Berg SAA, de Groot MJM, Salden LPW, Draad PJGJ, Dijkstra IM, Lunshof S, van Thiel SW, Boonen KJM, Thelen MHM. Pregnancy diabetes: A comparison of diagnostic protocols based on point-of-care, routine and optimized laboratory conditions. Sci Rep 2015; 5:16302. [PMID: 26542612 PMCID: PMC4635356 DOI: 10.1038/srep16302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/09/2015] [Indexed: 12/16/2022] Open
Abstract
In vitro glycolysis poses a problem during diabetes screening, especially in remote laboratories. Point-of-care analysis (POC) may provide an alternative. We compared POC, routine and STAT analysis and a feasible protocol during glucose tolerance test (GTT) for pregnancy diabetes (GDM) screening. In the routine protocol, heparin tubes were used and turn-around-time (TAT) was unsupervised. In the STAT protocol, tubes were processed immediately. The feasible protocol comprised of citrated tubes with a TAT of 1 hour. Outcome was defined as glucose concentration and clinical diagnosis. Glucose measured by POC was higher compared to routine analysis at t = 0 (0.25 mM) and t = 120 (1.17 mM) resulting in 17% more GDM diagnoses. Compared to STAT analysis, POC glucose was also higher, although less pronounced (0.06 and 0.9 mM at t = 0 and t = 120 minutes, respectively) and misclassification was only 2%. Glucose levels and clinical diagnosis were similar using the feasible protocol and STAT analysis (0.03 mM and −0.07 mM at t = 0 and t = 120, 100% identical diagnoses). POC is an viable alternative for STAT glucose analysis in GDM screening (sensitivity: 100%, specificity: 98%). A feasible protocol (citrated phlebotomy tubes with a TAT of 60 minutes) resulted in 100% identical outcome and provides the best alternative.
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Affiliation(s)
| | | | - Lorenzo P W Salden
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Patrick J G J Draad
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Ineke M Dijkstra
- Dept. of Clinical Chemistry, Sint Anthonius Hospital, Nieuwegein, The Netherlands
| | - Simone Lunshof
- Dept. of Gynaecology, Amphia Hospital, Breda, The Netherlands
| | | | - Kristel J M Boonen
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
| | - Marc H M Thelen
- Dept. of Clinical Chemistry and Hematology, Amphia Hospital, Breda, The Netherlands
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Joosen AMCP, Boonen K, Hulsman N, Schuitemaker FJ, Thelen MHM. Hypernatraemia in disguise. Clin Chem Lab Med 2015; 52:e231-4. [PMID: 24897406 DOI: 10.1515/cclm-2014-0474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/04/2014] [Indexed: 11/15/2022]
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Kranenburg LC, Thelen MHM, Westermann CM, de Graaf-Roelfsema E, van der Kolk JH. Use of desmopressin eye drops in the treatment of equine congenital central diabetes insipidus. Vet Rec 2011; 167:790-1. [PMID: 21262613 DOI: 10.1136/vr.c5125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L C Kranenburg
- Department of Equine Sciences, Medicine Section, Faculty of Veterinary Medicine, University of Utrecht, Yalelaan 114, 3508 TD Utrecht, The Netherlands.
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Harteveld CL, Thelen MHM, Rutten JJA, Leuverman J, Akkermans N, van Delft P, Arkesteijn S, Giordano PC. Hb Geldrop St. Anna [β94(FG1)Asp→Tyr]: a New Hemoglobin Variant Observed in a Diabetic Patient. Hemoglobin 2010. [DOI: 10.1081/hem-58574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Harteveld CL, Thelen MHM, Rutten JJA, Leuverman J, Akkermans N, van Delft P, Arkesteijn S, Giordano PC. Hb Geldrop St. Anna [beta94(FG1)Asp --> Tyr]: a new hemoglobin variant observed in a diabetic patient. Hemoglobin 2005; 29:107-12. [PMID: 15921162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
An abnormal hemoglobin (Hb) fraction was observed during a high performance liquid chromatographic (HPLC) Hb A1c control for diabetes mellitus in a 56-year-old north European woman. Family analyses revealed the abnormal fraction in three of her five siblings and in her son. Elevated Hb and packed cell volume (PCV) values and red blood cell (RBC) counts were present in all carriers. No histories of anemia, hemolytic or circulatory episodes were reported. The abnormal Hb fraction estimated at 40%, migrated just below Hb F on alkaline electrophoresis and overlapped the Hb A2 peak on cation exchange HPLC. Direct sequencing of the beta-globin genes revealed a new GAC --> TAC transversion in heterozygous form at codon 94 of the beta-globin gene. Based on the hematological/biochemical data and the decreased P50 value, we conclude that the new variant is a stable Hb associated with a slightly elevated oxygen affinity.
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Affiliation(s)
- Cornelis L Harteveld
- The Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Thelen MHM, van Bezu J, Kok A, Schutgens RBH. Disclosure of hidden free light chains by immunosubtraction. Clin Chem 2002; 48:2044-5. [PMID: 12406991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- Marc H M Thelen
- Department of Clinical Chemistry, Vrije Universiteit Medical Centre, Amsterdam, Postbus 7057, 1007 MB Amsterdam, The Netherlands.
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