Publications by authors named "Sara Pasqualetti"

38 Publications

Letter to the Editor: Serum Albumin in COVID-19: A Good Example in Which Analytical and Clinical Performance of a Laboratory Test Are Strictly Intertwined.

Hepatology 2021 Mar 4. Epub 2021 Mar 4.

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

We read with interest the paper by Hundt et al. describing the behaviour of common liver tests in COVID-19 and their association with poor outcomes (1). Among presented data, we were surprised to see that serum albumin (ALB) concentrations during hospitalization did not significantly predict patient death at the multivariate analysis (MA), even if 86.6% of patients showed ALB values <35 g/L, i.e. the lower reference limit. In a similar COVID-19 population enrolled in our national reference center for infectious diseases, we recently analysed a group of common biochemistry tests, including ALB, as major predictor of COVID-19 severity (2). Although the patient rate showing an ALB <35 g/L was quite similar (89%) to that of Hundt's study, at MA low ALB concentrations remained significantly associated (P=0.003) with higher odds of death, ALB values ≤18 g/L giving a positive likelihood ratio of 12.2 for predicting in-hospital death. In terms of absolute ALB levels in the respective populations, it is however somewhat difficult to compare our results with those of Hundt et al. as the authors do not mention the methodology used to determine ALB in their hospital network. It is known that immunoturbidimetric assays for ALB determination, such as the one in use in our institution, are specific for the ALB measurement contrary to nonspecific colorimetric methods, which are in use in the majority of U.S. healthcare institutions, also reacting with proteins other than ALB (3). The well-known lack of specificity of the latter methods, especially at low ALB and high globulin (including "acute phase reactants") concentrations, i.e. the typical COVID-19 situation, may have influenced the Hundt's results. Figure 1 depicts ALB distribution in our COVID-19 patients showing that even survivors displayed a median (interquartile range) [28 g/L (25-32)] quite lower that patients with severe COVID-19 enrolled by Hundt et al. Therefore, we cannot exclude that the inability of ALB to predict death in the Hundt's study was due to spuriously higher ALB values measured with non-specific methods in the evaluated COVID-19 patients. The accuracy of ALB methods may become critical in COVID-19 cases, where ALB is decreased but acute-phase proteins are increased, and thus use of immunological assays should be preferred in this condition (4).
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http://dx.doi.org/10.1002/hep.31791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014241PMC
March 2021

Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients.

Clin Chem Lab Med 2020 11 19;59(2):433-440. Epub 2020 Nov 19.

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.

Objectives: Procalcitonin (PCT) has been proposed for differentiating viral vs. bacterial infections. In COVID-19, some preliminary results have shown that PCT testing could act as a predictor of bacterial co-infection and be a useful marker for assessment of disease severity.

Methods: We studied 83 COVID-19 hospitalized patients in whom PCT was specifically ordered by attending physicians. PCT results were evaluated according to the ability to accurately predict bacterial co-infections and death in comparison with other known biomarkers of infection and with major laboratory predictors of COVID-19 severity.

Results: Thirty-three (39.8%) patients suffered an in-hospital bacterial co-infection and 44 (53.0%) patients died. In predicting bacterial co-infection, PCT showed a relatively low accuracy (area under receiver-operating characteristic [ROC] curve [AUC]: 0.757; 95% confidence interval [CI]: 0.651-0.845), with a strength for detecting the outcome not significantly different from that of white blood cell count and C-reactive protein (CRP). In predicting patient death, PCT showed an AUC of 0.815 (CI: 0.714-0.892), not better than those of other more common laboratory tests, such as blood lymphocyte percentage (AUC: 0.874, p=0.19), serum lactate dehydrogenase (AUC: 0.860, p=0.47), blood neutrophil count (AUC: 0.845, p=0.59), and serum albumin (AUC: 0.839, p=0.73).

Conclusions: Procalcitonin (PCT) testing, even when appropriately ordered, did not provide a significant added value in COVID-19 patients when compared with more consolidated biomarkers of infection and poor clinical outcome. The major application of PCT in COVID-19 is its ability, associated with a negative predictive value >90%, to exclude a bacterial co-infection when a rule-out cut-off (<0.25 μg/L) is applied.
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http://dx.doi.org/10.1515/cclm-2020-1361DOI Listing
November 2020

Serum potassium concentrations in COVID-19.

Clin Chim Acta 2021 01 22;512:26-27. Epub 2020 Nov 22.

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy.

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http://dx.doi.org/10.1016/j.cca.2020.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680631PMC
January 2021

Linking lactate dehydrogenase to the severity of COVID-19 cannot ignore the employed methodology.

Am J Emerg Med 2021 07 2;45:652-653. Epub 2020 Nov 2.

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy.

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http://dx.doi.org/10.1016/j.ajem.2020.10.077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605753PMC
July 2021

Improving measurement uncertainty of plasma electrolytes: a complex but not impossible task.

Clin Chem Lab Med 2020 Oct 13. Epub 2020 Oct 13.

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.

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http://dx.doi.org/10.1515/cclm-2020-1399DOI Listing
October 2020

Further improvement of the quality of tube transportation system is needed to prevent 'seasonal' pseudohyperkalaemia.

Clin Chim Acta 2020 Nov 14;510:644-646. Epub 2020 Aug 14.

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.

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http://dx.doi.org/10.1016/j.cca.2020.08.021DOI Listing
November 2020

A Comprehensive Appraisal of Laboratory Biochemistry Tests as Major Predictors of COVID-19 Severity.

Arch Pathol Lab Med 2020 12;144(12):1457-1464

From the Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy (Aloisio, Chibireva, Serafini, Pasqualetti, Falvella, Dolci, Panteghini).

Context.—: A relevant portion of coronavirus disease 2019 (COVID-19) patients develop severe disease with negative outcomes. Several biomarkers have been proposed to predict COVID-19 severity, but no definite interpretative criteria have been established to date for stratifying risk.

Objective.—: To evaluate 6 serum biomarkers (C-reactive protein, lactate dehydrogenase, D-dimer, albumin, ferritin, and cardiac troponin T) for predicting COVID-19 severity and to define related cutoffs able to aid clinicians in risk stratification of hospitalized patients.

Design.—: A retrospective study of 427 COVID-19 patients was performed. Patients were divided into groups based on their clinical outcome: nonsurvivors versus survivors and patients admitted to an intensive care unit versus others. Receiver operating characteristic curves and likelihood ratios were employed to define predictive cutoffs for evaluated markers.

Results.—: Marker concentrations at peak were significantly different between groups for both selected outcomes. At univariate logistic regression analysis, all parameters were significantly associated with higher odds of death and intensive care. At the multivariate analysis, high concentrations of lactate dehydrogenase and low concentrations of albumin in serum remained significantly associated with higher odds of death, whereas only low lactate dehydrogenase activities remained associated with lower odds of intensive care admission. The best cutoffs for death prediction were greater than 731 U/L for lactate dehydrogenase and 18 g/L or lower for albumin, whereas a lactate dehydrogenase activity lower than 425 U/L was associated with a negative likelihood ratio of 0.10 for intensive treatment.

Conclusions.—: Our study identifies which biochemistry tests represent major predictors of COVID-19 severity and defines the best cutoffs for their use.
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http://dx.doi.org/10.5858/arpa.2020-0389-SADOI Listing
December 2020

The internal quality control in the traceability era.

Clin Chem Lab Med 2020 Apr 28;59(2):291-300. Epub 2020 Apr 28.

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

To be accurate and equivalent, laboratory results should be traceable to higher-order references. Furthermore, their quality should fulfill acceptable measurement uncertainty (MU) as defined to fit the intended clinical use. With this aim, in vitro diagnostics (IVD) manufacturers should define a calibration hierarchy to assign traceable values to their system calibrators. Medical laboratories should know and verify how manufacturers have implemented the traceability of their calibrators and estimate the corresponding MU on clinical samples. Accordingly, the internal quality control (IQC) program should be redesigned to permit IVD traceability surveillance through the verification by medical laboratories that control materials, provided by the manufacturer as a part of measuring systems, are in the clinically suitable validation range (IQC component I). Separately, laboratories should also monitor the reliability of employed IVD measuring systems through the IQC component II, devoted to estimation of MU due to random effects and to obtaining MU of provided results, in order to apply prompt corrective actions if the performance is worsening when compared to appropriate analytical specifications, thus jeopardizing the clinical validity of test results.
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http://dx.doi.org/10.1515/cclm-2020-0371DOI Listing
April 2020

Traceability validation of six enzyme measurements on the Abbott Alinity c analytical system.

Clin Chem Lab Med 2020 07;58(8):1250-1256

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

Background Laboratory professionals should independently verify the correct implementation of metrological traceability of commercial measuring systems and determine if their performance is fit for purpose. We evaluated the trueness, uncertainty of measurements, and transferability of six clinically important enzyme measurements (alanine aminotransferase [ALT], alkaline phosphatase [ALP], aspartate aminotransferase [AST], creatine kinase [CK], γ-glutamyltransferase [γGT], and lactate dehydrogenase [LDH]) performed on the Abbott Alinity c analytical system. Methods Target values and associated uncertainties were assigned to three pools for each enzyme by using the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference measurement procedures (RMPs) and the pools were then measured on the Alinity system. Bias estimation and regression studies were performed, and the uncertainty associated with Alinity measurements was also estimated, using analytical performance specifications (APS) derived from biological variability of measurands as goals. Finally, to validate the transferability of the obtained results, a comparison study between two Alinity systems located in Milan, Italy, and Bydgoszcz, Poland, was carried out. Results Correct implementation of traceability to the IFCC RMPs and acceptable measurement uncertainty fulfilling desirable (ALP, AST, LDH) or optimal APS (ALT, CK, γGT) was verified for all evaluated enzymes. An optimal alignment between the two Alinity systems located in Milan and Bydgoszcz was also found for all enzyme measurements. Conclusions We confirmed that measurements of ALT, ALP, AST, CK, γGT, and LDH performed on the Alinity c analytical system are correctly standardized to the IFCC reference measurement systems and the system alignment is consistent between different platforms.
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http://dx.doi.org/10.1515/cclm-2020-0015DOI Listing
July 2020

Highly sensitive troponin T measurement after pneumatic tube transportation: The sample type can make the difference.

Clin Chim Acta 2020 Apr 31;503:231-232. Epub 2019 Oct 31.

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.

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http://dx.doi.org/10.1016/j.cca.2019.10.014DOI Listing
April 2020

Clinical Governance Remains a Priority in Total Laboratory Automation Era.

J Appl Lab Med 2019 07 11;4(1):130-132. Epub 2019 Jan 11.

Clinical Pathology Unit ASST Fatebenefratelli-Sacco Milan, Italy.

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http://dx.doi.org/10.1373/jalm.2018.028035DOI Listing
July 2019

Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss.

Clin Chem Lab Med 2019 Oct;57(11):1721-1729

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.

Background Blood loss for laboratory testing may contribute to hospital-acquired anemia. When implementing the core laboratory (core-lab) section, we consolidated first-line tests decreasing the number of tubes previously dispatched to different sites. Here, hypothesized benefits of the amount of blood volume drawn were explored. Methods We retrieved, using a laboratory information system (LIS), the number of tubes received by laboratories interested in the change from all clinical wards in a year-based period, i.e. 2013 for pre-core-lab and 2015 for core-lab system, respectively. Data were expressed as the overall number of tubes sent to laboratories, the corresponding blood volume, and the number of laboratory tests performed, normalized for the number of inpatients. Results After consolidation, the average number of blood tubes per inpatient significantly decreased (12.6 vs. 10.7, p < 0.001). However, intensive care units (ICUs) did not reduce the number of tubes per patient, according to the needs of daily monitoring of their clinical status. The average blood volume sent to laboratories did not vary significantly because serum tubes for core-lab required higher volumes for testing up to 55 analytes in the same transaction. Finally, the number of requested tests per patient during the new osystem slightly decreased (-2.6%). Conclusions Total laboratory automation does not automatically mean reducing iatrogenic blood loss. The new system affected the procedure of blood drawing in clinical wards by significantly reducing the number of handled tubes, producing a benefit in terms of costs, labor and time consumption. Except in ICUs, this also slightly promoted some blood saving. ICUs which engage in phlebotomizing patients daily, did not take advantage from the test consolidation.
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http://dx.doi.org/10.1515/cclm-2019-0133DOI Listing
October 2019

Implementation of an internal quality control programme for the photometric determination of icteric index.

J Clin Pathol 2018 09 1;71(9):851-852. Epub 2018 Jun 1.

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.

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http://dx.doi.org/10.1136/jclinpath-2017-204937DOI Listing
September 2018

Offering Aspartate Aminotransferase as a Reflex Test: An Easy but Effective Way to Improve Appropriateness of Laboratory Requests.

Am J Clin Pathol 2018 03;149(5):456-457

Clinical Pathology Unit, ASST Fatebenefratelli-Sacco Milan, Italy.

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http://dx.doi.org/10.1093/ajcp/aqy015DOI Listing
March 2018

The role of external quality assessment in the verification of in vitro medical diagnostics in the traceability era.

Clin Biochem 2018 Jul 9;57:23-28. Epub 2018 Feb 9.

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

Once an in-vitro diagnostic (IVD) measuring system has been marketed and introduced into daily practice, the possible sources of degradation of its performance are numerous. It is therefore essential to put in place a continuous post-market surveillance of the quality of performance of the IVD system and of the laboratories that perform measurements in clinical setting. The participation to external quality assessment (EQA) schemes that meet specific metrological criteria is central to the evaluation of performance of clinical laboratories in terms of standardization and clinical suitability of their measurements. In addition to the use of commutable materials, in this type of EQA it is necessary to assign values (and uncertainty) to them with reference procedures and to define and apply clinically permissible analytical performance specifications to substantiate the suitability of laboratory measurements in the clinical setting. Unfortunately, there are still few permanent EQA programs fully covering these requirements because some practical constraints, including technical and economic aspects, which limit their introduction. It is, however, clear that these issues should be quickly overcome, since EQA schemes are in a unique position to add substantial value to the practice of laboratory medicine, by identifying analytes that need improved harmonization and by stimulating and sustaining standardization initiatives that are needed to support clinical practice. Importantly, this will definitively help those manufacturers that produce superior products to demonstrate the superiority of those products and oblige end users (and consequently industry) to abandon assays with demonstrated insufficient quality.
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http://dx.doi.org/10.1016/j.clinbiochem.2018.02.004DOI Listing
July 2018

Random uncertainty of photometric determination of hemolysis index on the Abbott Architect c16000 platform.

Clin Biochem 2018 Jul 16;57:62-64. Epub 2018 Jan 16.

Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy.

Background: Automatic photometric determination of the hemolysis index (HI) on serum and plasma samples is central to detect potential interferences of in vitro hemolysis on laboratory tests. When HI is above an established cut-off for interference, results may suffer from a significant bias and undermine clinical reliability of the test. Despite its undeniable importance for patient safety, the analytical performance of HI estimation is not usually checked in laboratories. Here we evaluated for the first time the random source of measurement uncertainty of HI determination on the two Abbott Architect c16000 platforms in use in our laboratory.

Methods: From January 2016 to September 2017, we collected data from daily photometric determination of HI on a fresh-frozen serum pool with a predetermined HI value of ~100 (corresponding to ~1g/L of free hemoglobin). Monthly and cumulative CVs were calculated.

Results: During 21months, 442 and 451 measurements were performed on the two platforms, respectively. Monthly CVs ranged from 0.7% to 2.7% on c16000-1 and from 0.8% to 2.5% on c16000-2, with a between-platform cumulative CV of 1.82% (corresponding to an expanded uncertainty of 3.64%). Mean HI values on the two platforms were just slightly biased (101.3 vs. 103.1, 1.76%), but, due to the high precision of measurements, this difference assumed statistical significance (p<0.0001).

Conclusions: Even though no quality specifications are available to date, our study shows that the HI measurement on Architect c16000 platform has nice reproducibility that could be considered in establishing the state of the art of the measurement.
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http://dx.doi.org/10.1016/j.clinbiochem.2018.01.009DOI Listing
July 2018

Traceability of alkaline phosphatase measurement may also vary considerably using the same analytical system: the case of Abbott Architect.

Clin Chem Lab Med 2018 05;56(6):e135-e137

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

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http://dx.doi.org/10.1515/cclm-2017-1007DOI Listing
May 2018

Different calibrator options may strongly influence the trueness of serum transferrin measured by Abbott Architect systems.

Clin Chim Acta 2018 Feb 5;477:119-120. Epub 2017 Dec 5.

Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy; Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

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http://dx.doi.org/10.1016/j.cca.2017.12.002DOI Listing
February 2018

Reply to: Hyperuricemia does not seem to be an independent risk factor for coronary heart disease.

Clin Chem Lab Med 2018 02;56(3):e63-e64

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

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http://dx.doi.org/10.1515/cclm-2017-0954DOI Listing
February 2018

Total laboratory automation: Do stat tests still matter?

Clin Biochem 2017 Jul 5;50(10-11):605-611. Epub 2017 Apr 5.

Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan Medical School, Milan, Italy.

During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.
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http://dx.doi.org/10.1016/j.clinbiochem.2017.04.002DOI Listing
July 2017

Pre-analytical and analytical aspects affecting clinical reliability of plasma glucose results.

Clin Biochem 2017 Jul 11;50(10-11):587-594. Epub 2017 Mar 11.

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy.

The measurement of plasma glucose (PG) plays a central role in recognizing disturbances in carbohydrate metabolism, with established decision limits that are globally accepted. This requires that PG results are reliable and unequivocally valid no matter where they are obtained. To control the pre-analytical variability of PG and prevent in vitro glycolysis, the use of citrate as rapidly effective glycolysis inhibitor has been proposed. However, the commercial availability of several tubes with studies showing different performance has created confusion among users. Moreover, and more importantly, studies have shown that tubes promptly inhibiting glycolysis give PG results that are significantly higher than tubes containing sodium fluoride only, used in the majority of studies generating the current PG cut-points, with a different clinical classification of subjects. From the analytical point of view, to be equivalent among different measuring systems, PG results should be traceable to a recognized higher-order reference via the implementation of an unbroken metrological hierarchy. In doing this, it is important that manufacturers of measuring systems consider the uncertainty accumulated through the different steps of the selected traceability chain. In particular, PG results should fulfil analytical performance specifications defined to fit the intended clinical application. Since PG has tight homeostatic control, its biological variability may be used to define these limits. Alternatively, given the central diagnostic role of the analyte, an outcome model showing the impact of analytical performance of test on clinical classifications of subjects can be used. Using these specifications, performance assessment studies employing commutable control materials with values assigned by reference procedure have shown that the quality of PG measurements is often far from desirable and that problems are exacerbated using point-of-care devices.
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http://dx.doi.org/10.1016/j.clinbiochem.2017.03.009DOI Listing
July 2017

Clinical impact of glycolysis inhibition on plasma glucose results requires caution.

Ann Clin Biochem 2017 Mar 20;54(2):302-303. Epub 2016 Jul 20.

Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.

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http://dx.doi.org/10.1177/0004563216659091DOI Listing
March 2017

Are blood ammonia concentrations dependent on γ-glutamyl-transferase levels in plasma?

J Clin Pathol 2016 Jun 27;69(6):551-2. Epub 2016 Apr 27.

Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy.

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http://dx.doi.org/10.1136/jclinpath-2015-203520DOI Listing
June 2016

Cystatin C provides a better estimate of the effect of glomerular filtration rate on serum human epididymis protein 4 concentrations.

Clin Chem Lab Med 2016 Oct;54(10):1629-34

Background: We evaluated the effect of kidney glomerular function on serum concentrations of human epididymis protein 4 (HE4) using creatinine (Cr), cystatin C (CysC) and related chronic kidney disease epidemiology collaboration (CKD-EPI) equations.

Methods: We enrolled 101 women aged ≤56 years with a glomerular filtration rate (GFR) (estimated by CKD-EPI eGFRCr) ranging from 60 to 120 mL/min/1.73 m2, free of any disease and biological and life-style factors known to influence serum HE4 concentrations, and we measured serum Cr, CysC and HE4 concentrations. Cr and CysC values were included in the three CKD-EPI equations to obtain GFR estimates.

Results: A statistically significant increase in HE4 median concentrations was detected in subjects with an eGFRCr between 60 and 74 mL/min/1.73 m2 when compared with those with an eGFR >90 mL/min/1.73 m2 (54.2 vs. 42.2 pmol/L, p=0.003). Regression models showed that CysC measurement per se and eGFRCysC were the most sensitive markers to catch HE4 increases due to a mild decrease in renal function [adjusted r2, 0.38 (p=0.00003) and 0.37 (p=0.0004), respectively]. By assuming baseline CysC and eGFRCysC at 0.80 mg/L and 101.5 mL/min/1.73 m2, an increase of 0.10 mg/L in CysC concentrations and a decrease of 10 mL/min of eGFRCysC implied an average (±SE) increase in serum HE4 concentrations of 9.2 (±1.2) and 8.8 (±1.1) pmol/L, respectively.

Conclusions: Our study shows that a better estimate of the effect of GFR on serum HE4 is obtained by measuring CysC in serum or using CKD-EPI eGFRCysC equation.
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http://dx.doi.org/10.1515/cclm-2015-1272DOI Listing
October 2016

Heparinate but not serum tubes are susceptible to hemolysis by pneumatic tube transportation.

Clin Chem Lab Med 2016 May;54(5):785-9

Background: Pneumatic tube transportation (PTT) may induce hemolysis (H) in blood samples. We aimed to compare the H degree before and after PTT implementation in our hospital.

Methods: Hemolysis indices (HI) for all lithium-heparin plasma samples (P) drawn by the Emergency Department in 2-month periods were retrospectively collected and pre- (n=3579) and post-PTT (n=3469) results compared. The impact of PTT introduction was investigated on LDH [HI threshold (HIt), 25], conjugated bilirubin (cBIL) (HIt, 30), K (HIt, 100) and ALT (HIt, 125). In addition, HI retrieved for P and paired serum samples collected in silica clot activator tubes (S) from the same venipuncture were compared in pre- (n=501) and post-PTT (n=509) periods.

Results: Median (5-95th percentile) HI in P was significantly higher in post-PTT period [7 (0-112) vs. 6 (0-82), p<0.001]. Results reported as 'Hemolysis' in P increased from 6.6% in pre-PTT to 9.4% in post-PTT (p<0.001). Investigated tests gave the following rejection rates (pre-PTT vs. post-PTT): LDH, 13.4% vs. 18.8%, p<0.001; cBIL, 9.4% vs. 27.0%, p<0.05; K, 3.7% vs. 5.6%, p<0.001; ALT, 2.9% vs. 4.4%, p<0.01. The slightly higher susceptibility to H of S compared to paired P found in the pre-PTT [9 (1-64) vs. 6 (0-85)] was not confirmed in the post-PTT period [7 (0-90) vs. 8 (1-72)], in which median HI in S was significantly lower (p<0.001) than in pre-PTT.

Conclusions: In our setting PTT promotes H in P, increasing the rate of rejected tests. The use of S appears to protect against the hemolysing effect of PTT.
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http://dx.doi.org/10.1515/cclm-2015-0751DOI Listing
May 2016
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