Clin Chem Lab Med
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Comparative Study
Comparability of point-of-care whole-blood electrolyte and substrate testing using a Stat Profile Critical Care Xpress analyzer and standard laboratory methods.
Rapid technological progress in point-of-care testing allows the measurement of multiple analytes in whole-blood samples. The present study evaluated biosensor-based methods for the measurement of electrolytes and substrates in whole blood using a Stat Profile Critical Care Xpress (Nova Biomedical, Waltham, MA, USA) multiprofile analyzer and their comparability with standard laboratory methods. Because of the increased utilization of arterial blood samples in hospitalized patients and limited information on differences between arterial and venous blood for most routine laboratory tests, analytical differences caused by different sample types were evaluated. ⋯ The Stat Profile Critical Care Xpress multiprofile point-of-care analyzer provides rapid and accurate direct whole-blood measurement with acceptable performance compared to standard laboratory methods. The results obtained for electrolytes and substrates in whole blood were comparable to those for standard laboratory methods using arterial plasma or venous serum samples.
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Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery. ⋯ The significant increase observed in NT-proBNP suggests that patients undergoing major uncomplicated orthopedic surgery may develop subclinical cardiac stress, presumably attributable to the considerable infusion of liquids. The clinical significance of this finding deserves further investigation, especially in patients at higher risk of heart failure.
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Severe traumatic brain injury (TBI) is associated with a 30%-70% mortality rate. S100B has been proposed as a biomarker for indicating outcome after TBI. Nevertheless, controversy has arisen concerning the predictive value of S100B for severe TBI in the context of multitrauma. Therefore, our aim was to determine whether S100B serum levels correlate with primary outcome following isolated severe TBI or multitrauma in males. ⋯ Increased serum S100B levels constitute a valid predictor of unfavourable outcome in severe TBI, regardless of the presence of associated multitrauma.
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The glycemia decision limits recommended by WHO/ADA for type 2 diabetes detection are derived from clinical signs in advanced stages of the disease. Since insulin secretion patterns and sensitivitity are impaired at the beginning of type 2 diabetes, this stage may be better suited to identify decision limits with higher diagnostic efficiency than those currently applied. ⋯ The efficiency of type 2 diabetes diagnosis can be improved by optimizing cutoff values according to disease prevalence. Unexpectedly, the optimized 2-h post-load cutoff was lower for capillary blood than for venous plasma. It is proposed to identify a risk group e.g., by characteristics of the metabolic syndrome in which the 2-h post-challenge concentration is determined using lower cut-off values than presently recommended.
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Comparative Study
Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing.
Despite remarkable advances in technology and laboratory automation, results of laboratory testing still suffer from a high degree of preanalytical variability. Although there is no definitive evidence, the use of small-gauge needles for venipuncture is usually discouraged to reduce the chance of producing unsuitable specimens. ⋯ The results of our investigation indicate that 23 G needles, if handled correctly, will not introduce any statistically or clinically significant error to the measurement results compared to a 21 G needle. For the 25 G needle, we observed increased variability for potassium compared to a 23 G needle. Small-bore needles of 25 G or less cannot be universally recommended when collecting venous blood for clinical chemistry testing and should be reserved for selected circumstances, such as in patients with problematical venous accesses and newborns. In such cases, however, the bias introduced by the use of smaller needles should always be taken into consideration when interpreting test results.