Scandinavian Journal of Clinical & Laboratory Investigation最新文献

Platelet indices at admission offer the most opportune time for clinical decision-making, as they provide earliest insights, unlike later assessments during the intensive care unit (ICU) stay. There is emerging evidence suggesting the utility of platelet indices in predicting mortality. The objective of this study was, for the first time as far as the literature indicates, to elucidate the utility of seven platelet indices at admission in a large ICU cohort using Sysmex XN-series analysers. This cross-sectional study enrolled 592 ICU patients. The association of platelet indices at admission with the in-ICU and 90-day mortality was evaluated using logistic regression and receiver operating characteristic curve analysis. Of the platelet indices studied, absolute-immature platelet fraction (A-IPF), and mean platelet volume (MPV) and percentage-immature platelet fraction (%-IPF) were shown to be independently associated with predicting the in-ICU and 90-day mortality, respectively. The A-IPF cut-off value for predicting the in-ICU mortality was >6.4 × 10⁹/L (adjusted area under the curve (aAUC) 0.736, and adjusted Odds Ratio (aOR) 1.04), and the MPV and %-IPF cut-off values for predicting the 90-day mortality were >9.5 fL (aAUC 0.759, and aOR 1.26) and >6.3% (aAUC 0.762, and aOD 1.06), respectively (all p < 0.05). Admission A-IPF was the best predictor of in-ICU mortality, while admission MPV and %-IPF were the best predictors of 90-day mortality. These indices, all measured at admission, provide the earliest possible data relevant to mortality prediction. These are routinely available indices which deserve to be considered for new future ICU scoring systems.

This study evaluates the utility of leftover EDTA whole blood from a diagnostic biobank for determining concentrations of ferritin, cobalamin, homocysteine, hCG, and thyroid-related hormones and antibodies (TSH, fT4, fT3, TRAb, and anti-TPO). Twenty participants were included. Pre-analytical bias in their blood samples was assessed as per European Federation of Clinical Chemistry and Laboratory Medicine Milano performance specifications. We evaluated the stability of EDTA whole blood stored at various intervals (days 0, 1, 6, and 13), and compared plasma derived from these samples with serum samples. Bland Altman plots and Paired t-test were used to identify statistically significant differences. We found good quantitative agreement, with biases within set performance specifications for cobalamin (14%), fT4 (3.5%), fT3 (3.6%), TSH (15%), and ferritin (7.4%). The calculated biases for serum vs. EDTA plasma day 6 were as follows: cobalamin 1.9%, fT4 2.6%, fT3 0.4%, TSH -2.1%, and ferritin -4.5%. The biases for homocysteine exceeded limits in all comparisons, except serum vs. EDTA plasma on day 0 and between EDTA plasma from day 0 and day 1. The calculated bias of 41% exceeded the set limit of 13% when comparing serum with EDTA plasma day 6. For hCG, anti-TPO, and TRAb, limited measurable levels restricted bias calculations. As per the diagnostic biobank protocols, EDTA blood stored for up to 6 days provides plasma suitable for analyzing cobalamin, fT4, fT3, TSH, and ferritin. Our study confirms previous findings that homocysteine has poor stability in whole blood.

Diagnosing using laboratory results is commonly based on whether the concentration of a biomarker is outside of the reference limits following the currently dominating statistical decision theoretical approach. Such dichotomization disregards several crucial factors, including the uncertainty of the measurement result, how extreme the concentration of the biomarker is, the prevalence of the condition in the tested population, and the costs of false positives and false negatives. The history, properties, pros, and cons of reference intervals are discussed, including promising alternatives such as standard scores, percentiles, and likelihood ratios.

Proenkephalin (PENK) is assumed to be freely filtered by the glomerulus, thus potentially useful for estimating glomerular filtration rate (eGFR). Recently developed eGFR-equation based on PENK and creatinine has not been validated against existing cystatin C-based equations. This study aimed to test the hypothesis of free filtration of PENK. Also, the PENK-creatinine based eGFR-equation was validated against cystatin C. Plasma concentrations of PENK, creatinine and cystatin C were determined in arterial and renal venous blood samples collected from 70 patients undergoing transcatheter aortic valve implantation (TAVI). The renal elimination ratio (RER) of PENK (RER_PENK) was calculated and compared to the RER of creatinine (RER_crea). RER constitutes the single-pass renal elimination of a molecule, calculated as the arteriovenous concentration difference divided by the arterial concentration. For eGFR validations, the CAPA (cystatin C) and LMR (creatinine) equations were used. RER_PENK (23.7 ± 9.6%) was approximately 10% higher than RER_crea (21.4 ± 5.8%). The PENK-creatinine equation overestimated GFR by 26,1% on average, compared to the mean of the LMR and CAPA equations. The relationship between RER_PENK and RER_crea suggests free filtration and a slight degree of non-glomerular elimination of PENK. There was poor agreement between PENK and cystatin C derived eGFR-equations. PENK needs further evaluation as a predictor of GFR.

Liver fibrosis is a common condition that potentially leads to cirrhosis, liver dysfunction, and hepatocellular carcinoma. The Enhanced Liver Fibrosis (ELF™) test is a validated tool for assessing fibrosis. The influence of preanalytical factors on ELF™ test has not been described in previous literature. Thus, this study aims to investigate preanalytical factors affecting the ELF™ score. We evaluated the effects of hemolysis, icterus, and lipemia on the ELF™ score by measuring hyaluronic acid (HA), aminoterminal propeptide of type III procollagen (PIIINP), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) concentrations and calculating the ELF™ scores in samples with interfering substances. The ELF™ scores and parameters were also compared between serum and lithium heparin plasma samples. Measurements were performed using a Siemens Healthineers Atellica IM 1600 analyzer. Hemolysis decreased PIIINP concentration by -21.3% and -40.5% in samples containing 1 and 2 g/L hemoglobin, respectively. Correspondingly, ELF™ scores decreased by 2.0% and 4.4%. By contrast, bilirubin and lipemia did not affect the ELF™ score. No difference in ELF™ scores was found between serum and plasma, but PIIINP concentration was 23.1% higher and TIMP-1 concentration was -38.3% lower in plasma compared with serum. Moderate hemolysis affects ELF™ scores, which might lead to a misinterpretation of patient results. Thus, we recommend automated hemolysis index testing for the ELF™ test. Significant differences in PIIINP and TIMP-1 concentrations between plasma and serum could affect individual patient results.

The biochemical diagnosis of porphyria is based on the analysis of porphyrins in urine, feces, and blood using fluorometry and spectrometry. High-performance liquid chromatography (HPLC) with fluorescence detection has been used since the 1980s as standard procedure for separation of porphyrin isomers and classification of the different types of porphyria since each type of porphyria presents a characteristic HPLC isomer distribution either in urine, plasma or feces. We present a unified collection of chromatograms as an aid for porphyria classification in laboratories using HPLC equipment. Biological samples were collected according to approved hospital protocols, and analyzed by reverse-phase HPLC with fluorescence detection, using an unused dedicated chromatographic column BDS-Hypersil^™ C18 and reproducing, with minor variations, the conditions originally reported by Lim and Peters in 1984. With the chromatograms, we include a concise explanation of the changes observed. When inter-individual variation is frequent, we include for clarification chromatograms of two different individual samples. Additionally, we present chromatograms showing abnormalities of porphyrin metabolism in patients without porphyria. We add our collection to the literature, as a visual guide to facilitate porphyria diagnosis and classification though understanding of the key metabolic changes. Our aim is to support education of new experts in the porphyria field increasing diagnostic accuracy and ultimately leading to improved patient outcomes and management.

Background: Inappropriate or unnecessary test requests are one of the reasons for the increase in laboratory utilization. We aimed to investigate the frequency of simultaneous antinuclear antibody (ANA) and extractable nuclear antigens (ENA) test orders and to investigate whether ENA test ordering is necessary in the presence of negative ANA in terms of criteria for rational test selection.

Methods: We examined 2 years of data from a Turkish tertiary hospital in this retrospective cohort analysis. ANA and other autoimmune test data and clinical information of all patients with a negative ANA but positive ENA were obtained from the hospital record system.

Results: 32,800 patients had 37,584 ANA tests between January 2019 and January 2021. 4136 patients were tested for ANA simultaneously. Out of 2279 negative ANA tests, 371 (16.2%) were positive for ENA. Out of 307 individuals with negative ANA but positive ENA and clinical information, 23 were newly diagnosed with ANA-associated rheumatic disease (AARD), a 7.4% positive predictive value. The most common autoantibody causing ANA/ENA discordant results was anti-Ro52 (61 [19.9%]), followed by anti-DFS70 (53 [17.3%] and anti Jo-1 (48 [15.6%]).

Conclusions: The results of our study support proposals to reduce ENA testing after a negative ANA test and gradually increase it after a positive test or clinical indication. It will eliminate inaccurate test requests, expenditures, and unnecessary patient assessments.

Prolonged activated partial thromboplastin time (APTT) and thrombin time (TT), normal prothrombin time (PT) and elevated D-dimer level are typical manifestation of routine coagulation parameters in patients infected with Dabie bandavirus (DBV), infection-induced coagulation activation and consumption, and a heparin-like effect due to endogenous heparan are the common explanations. To understand the exact implication of abnormal coagulation parameters in patients infected with DBV and their correlation with bleeding tendency and prognosis. One hundred and twenty-one consecutive DBV-infected patients were enrolled in this prospective, single-center, observational study. Routine coagulation parameters, levels of heparan sulfate (HS) and thrombin-antithrombin (TAT) complex, and thrombin generation (TG) test of these patients on admission were detected, and their hemorrhagic events during hospitalization were recorded. In the enrolled patients, both of APTT and TT were significantly positively correlated with HS, while significantly negatively correlated with endogenous thrombin potential (ETP) of TG test (p < .05). In addition, there was a strong correlation between D-dimer and TAT (r = 0.841). The patients with hemorrhagic events during hospitalization had significantly higher APTT and D-dimer and lower platelet count and ETP on admission than those without, and only ETP was the independent predictor (p < .05). The prolongation of APTT and TT of DBV-infected patients reflected decreased TG potential, and increased D-dimer level reflected an increase in thrombin activity. An accurate understanding of the implication of these coagulation parameters is helpful for the rational management of DBV infection.

Since haematopoiesis changes dramatically after birth and during childhood, specific paediatric reference intervals are critical for meaningful interpretation of haematological blood analyses. Paediatric reference intervals for reticulocyte count are not available for Abbott platforms. In this study, we used an indirect, data-mining approach with data from Abbott's Alinity hq platform to establish reticulocyte count reference intervals for children aged up to 18 years. Data were extracted from the 1^st of July 2021 to the 6^th of November 2024 and in order to find the 'healthiest patients', we included only reticulocyte counts from samples with normal haemoglobin and only samples from patients with a single reticulocyte count in the extraction period (n = 1633). We found relatively high reticulocyte counts in the first week of life (reference intervals for age 0-<7 days: 74-442 *10^9/L) and similar reticulocyte counts after this period and throughout childhood (reference interval for age 7 days-<18 years: 32-115 *10^9/L). In conclusion, this is the first study to report reference intervals for reticulocyte count in children using an Abbott platform. Compared to the literature, our reference intervals are higher than the reference intervals on other platforms, which is in line with reference intervals for adults, where Abbott also reports higher values compared to other platforms. The established reference interval for reticulocytes offers valuable insights for other laboratories using the Alinity hq platform and enhances the laboratory's ability to support clinical decision-making.