Clin Chem Lab Med
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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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Splanchnic ischemia plays a major role in the development of organ failure during septic shock. Plasma D-lactate has been proposed as a better marker of splanchnic hypoperfusion than L-lactate. We studied the prognostic ability of plasma D- and L-lactate levels. ⋯ A rapid decrease in plasma D-lactate during the course of septic shock could indicate reduced 28-day mortality.
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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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In this study the analytical performance of eight glucose point-of-care testing (POCT) devices was evaluated. For this purpose, POCT measurement of glucose in heparinized blood collected from patients was paralleled by determination of the glucose concentration in the respective plasma by an analyzer (Hitachi 917) in the central laboratory, providing traceable results. ⋯ In conclusion, this study shows an insufficient trueness of glucose measurements by POCT devices in the normo- and hypoglycemic range. To improve quality assessment, sample splitting and simultaneous measurement of blood glucose concentration every 4 weeks by POCT devices and of plasma glucose concentration by a reliable TMP is recommended.
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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.