• PalmerOctavia M PeckOMP*Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania †Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania ‡The Clinical Research, Inv, Melinda Carter, ChangChung-Chou HCH, Nicole Lucko, Vanessa M Jackson, Qian Sun, Xinyan Xie, Melanie Scott, John A Kellum, Arvind Venkat, and Sachin Yende.
• *Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania †Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania ‡The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania §Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania ||Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania ¶Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania #Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania **Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania ††Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania ‡‡Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
• Shock. 2017 Jun 1; 47 (6): 715-719.

BackgroundA number of studies in critically ill patients are conducted outside the hospital. Specimens should ideally be transported from out-of-hospital setting to a laboratory using dry ice, but this approach is expensive and may not be feasible in some circumstances. We, therefore, examined the impact of temperature during transport of specimens on the precision of biomarker concentrations.ObjectiveTo determine the effects of transport temperature conditions on biomarker concentrations in specimens processed within 1 h of collection.Methods/PatientsWe simulated transport by storing specimens at four temperature conditions: packaged at -80°C (control), on dry ice (-79°C), on cold gel packs (4°C), and at room temperature (RT, 21°C). We examined eight biomarkers spanning four signaling domains- inflammation, hemostasis, endothelial dysfunction, and oxidative stress. We calculated mean, median, and percent difference for each biomarker concentration compared with the control transport temperature at -80°C in 26 subjects (16 hospitalized with severe sepsis and 10 non-hospitalized volunteers).ResultsPatients with severe sepsis had log-fold higher median concentrations of IL-6, hs-CRP, D-dimer, E-selectin, sICAM-1, and sVCAM-1 compared with non-hospitalized volunteers (P <0.05). When specimens were combined, we observed a ≤7% difference in the mean and median IL-6, hs-CRP, D-dimer, PAI-1, E-selectin, s-ICAM, s-VCAM, and nitrite concentrations for dry ice and cold gel packs transport compared with transport at -80°C (P>0.05). Larger differences (up to 12%) were observed when biomarker concentrations for PAI-1 and s-VCAM at room temperature were compared with transport at -80°C (P >0.05).ConclusionsSelect inflammatory, coagulation, endothelial dysfunction, and oxidative stress biomarkers can be transported at 4°C on gel packs for 24 h with minimal effects on precision.

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