Biochemia medica最新文献

Considering the concept of quality as a degree of excellence, the term quality of laboratory work tells us how excellent our results are in all areas of laboratory work. Therefore, quality indicators have been introduced with the aim of monitoring and measuring quality. Quality indicators describe the efficiency of the laboratory process in the form of a numerical value, providing objective evidence of the conformity of the specified laboratory process with respect to predefined criteria. The Working Group for Postanalytics of the Croatian Society of Medical Biochemistry and Laboratory Medicine has decided to describe the necessary steps in designing and monitoring quality indicators, with an emphasis on the quality of the postanalytical and post-postanalytical phase. The main purpose of these recommendations is to facilitate the incorporation of quality indicators into laboratories' daily routines. Laboratories in the Republic of Croatia are recommended to monitor three quality indicators in the postanalytical phase of laboratory work: turnaround time, withdrawn or retracted laboratory test reports, and notification of critical results. Additionally, two indicators are recommended in the post-postanalytical phase: monitoring issuance of laboratory test reports and monitoring user satisfaction. Harmonising acceptable performance limits and monitoring of the most commonly used quality indicators opens up the possibility of comparisons between laboratories and a uniform quality of laboratory services throughout the healthcare system.

Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. The accurate measurement of triglyceride concentration is essential for diagnosis and therapeutic monitoring. This article presents a case of acute hypertriglyceridemia pancreatitis in which the patient's triglyceride concentration appeared to drop rapidly from 128.04 mmol/L to 1.53 mmol/L within 12 hours of admission. Subsequent retesting revealed an actual triglyceride value of 88.92 mmol/L. This case underscores a critical and underreported preanalytical challenge: the failure of the analyzer to trigger "> Kin" warnings despite clear abnormalities in the reaction kinetics curve, leading to clinically significant underestimation. To mitigate such errors, we propose a novel strategy that integrates automated lipemic index-based predilution protocols with enhanced alarm configurations, including the introduction of a ">Abs" alert, adjustment of prozone detection parameters, and the implementation of correlation checks between lipemic indices and triglyceride values within the laboratory information system. These practical interventions, which can be adopted in clinical laboratories, represent a proactive approach to prevent erroneous reporting and enhance diagnostic reliability. This report highlights the necessity for increased vigilance among laboratory professionals when discordance occurs between high lipemic indices and unexpectedly low triglyceride results, suggesting possible kinetic anomalies.

Introduction: The hormonal interplay between the mother and the fetal-placental unit may influence the mode of delivery. This study aimed to investigate the association between maternal peripartal serum concentrations of sex hormone-binding globulin (SHBG) and 10 steroid hormones with delivery outcomes.

Materials and methods: This observational study included 171 healthy pregnant women with spontaneous onset of labor: 117 had vaginal delivery and 54 underwent urgent cesarean section (C-section). Serum concentrations of aldosterone, androstenedione, cortisol, cortisone, corticosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, progesterone, and total testosterone were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS), while free testosterone was calculated. Sex hormone-binding globulin was measured by chemiluminescent microparticle immunoassay. Group differences were tested with the Mann-Whitney U test, and associations with delivery mode were assessed by logistic regression and receiver operating characteristic (ROC) analysis.

Results: Compared with the vaginal delivery group, women who underwent urgent C-section had significantly lower serum concentrations of SHBG, corticosterone, cortisol, aldosterone, progesterone, 17-hydroxyprogesterone, DHEA, DHEAS, and free testosterone (all P < 0.001). In multivariate logistic regression, aldosterone (odds ratio, OR 0.11, 95% CI 0.04 to 0.27, P < 0.001) and DHEAS (OR 0.74, 95% CI 0.58 to 0.94, P = 0.011) were independently associated with delivery mode. ROC analysis showed that aldosterone > 0.9 nmol/L predicted vaginal delivery with AUC 0.874, sensitivity 88%, and specificity 77%.

Conclusions: Low maternal aldosterone concentrations showed the strongest association with urgent C-section, suggesting that aldosterone may play a protective role in successful vaginal delivery.

Introduction: Differentiating between malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE) remains challenging in clinical practice. The cancer ratio plus (CR+), a potential diagnostic tool calculated as serum lactate dehydrogenase/(pleural adenosine deaminase x pleural lymphocyte percentage) has emerged to address this diagnostic challenge. This scoping review maps the available evidence on its diagnostic performance.

Materials and methods: We conducted a systematic search of PubMed, Scopus, and Web of Science databases from inception to April 2025. Eligible studies assessed the accuracy of CR+ in distinguishing MPE from TPE. Data on study design, cut-off values, sensitivity, specificity, area under the curve (AUC), and likelihood ratios were extracted and synthesized narratively.

Results: Six studies comprising 881 patients were included. Reported cut-off values varied widely (5.7 - 41.0), as did sensitivity (74.3 - 97.6%) and specificity (36.6 - 94.1%). Most studies, however, reported good discriminatory power with AUC values generally above 0.80. The highest diagnostic accuracy was observed in one study, which reported a sensitivity of 97.6%, a specificity of 94.1%, and an AUC of 0.86. Differences in cut-off thresholds, study populations, local tuberculosis epidemiology, and laboratory methodology (particularly lymphocyte quantification) likely contributed to this heterogeneity.

Conclusions: The CR+ appears promising as a non-invasive tool using routine parameters for differentiating MPE from TPE, but diagnostic performance varies across settings. The heterogeneity in optimal cut-off values highlights the need for local validation before clinical adoption. Future research should standardize methodology and assess its impact on decision-making and patient outcomes.

Introduction: Cardiac biomarkers may help diagnose and monitor different neonatal conditions, but their concentrations are still underexplored in common pathologies diagnosed within the first day. This study compared N-terminal pro b-type natriuretic peptide (NT-proBNP), high sensitivity troponin I (hs-TnI), creatine kinase (CK), and its isoenzyme creatine kinase-myocardial band (CK-MB) concentrations and activities, measured within the first 24 hours (h) postpartum, between the healthy term neonates and those with jaundice, perinatal infection, transient neurological abnormalities (TNA), and heart ultrasound abnormalities.

Materials and methods: The study included 100 term newborns, whose cardiac biomarkers' concentrations were determined from the serum within 24 h postpartum on the Alinity ci analyzer (Abbott, Chicago, USA). The Mann-Whitney and Kruskal-Wallis tests, performed in SPSS Statistics v. 25.0 (IBM Corp., Armonk, USA), were used to test the significance of differences between the study groups, with P < 0.05 indicating significance.

Results: Within first 24 h postpartum healthy newborns had significantly higher CK activities compared to those with jaundice (P = 0.047), perinatal infection (P = 0.012), or combination of both (P = 0.017). Lower CK activities were demonstrated in perinatal infection compared to TNA (P = 0.041). Other biomarkers' concentrations did not differ between the study groups. No significant differences were found in cardiac biomarkers' concentrations regarding gender or heart ultrasound findings.

Conclusions: During the first 24 h postpartum, only CK activities differed between healthy newborns and those with the common pathologic conditions, being lower in the newborns with jaundice and/or infection. Analogous differences were present between newborns with infection and those with TNA.

This case report describes a patient with uric acid kidney stones. Alkalization therapy using mainly potassium citrate is the first-choice treatment. When hyperuricosuria > 4 mmol/24 hours is present, xanthine oxidase inhibitors are added. It implies that accurate urine uric acid measurement is of high importance. Uric acid was measured in a 24-hour collection and a second-morning sample. Urine uric acid was measured after sample alkalization to pH > 6.5 and heating to 56 °C for 10 minutes, and for educational reasons without sample treatment. The uric acid excretion in the sample without alkalization in the 24-hour collection was 2.436 mmol, after alkalization, the excretion was 4.650 mmol/24 hours. Sample alkalization led to a prescription for xanthine oxidase inhibitor medication that is indicated as the second-line therapy when hyperuricosuria > 4 mmol/24 hours is present. This case study shows how the correct preanalytical phase is essential for medical decision-making.

Acute abdominal pain accounts for 7-10% of all emergency department visits. Appendicitis, being one of the leading causes of acute abdominal surgery, poses significant diagnostic challenges. Negative appendectomy rates can be as high as 40%, while complications occur in more than 90% if the diagnosis is missed during the initial examination. Therefore, more effective preoperative screening is required for patients with suspected appendicitis. Recent studies suggest that novel biomarkers, particularly leucine-rich alpha 2-glycoprotein and calprotectin, may improve the early and accurate diagnosis of acute appendicitis by demonstrating high specificity and sensitivity, respectively. Unlike C-reactive protein, the production of leucine-rich alpha 2-glycoprotein 1 and calprotectin takes place at the site of inflammation. As a result, their raised concentrations might be evident early in a disease, possibly before other common markers of inflammation start to rise. This literature review aims to assess the potential role of leucine-rich alpha 2-glycoprotein 1 and calprotectin as diagnostic biomarkers in patients with suspected acute appendicitis, acknowledging the need for additional data to fully assess their diagnostic accuracy.

Thyroid function tests (TFTs) - thyroid stimulating hormone (TSH), total triiodothyronine (T3), total thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibodies (anti-TPO), thyroglobulin antibodies (anti-Tg), TSH receptors antibodies (anti-TSHR), and thyroglobulin (Tg) - are used to diagnose thyroid disorders and are crucial biomarkers for monitoring and managing thyroid cancer. The 2022 national survey results revealed that thyroid function testing is not standardized among Croatian medical-biochemistry laboratories. Laboratories follow individual protocols at each testing stage, from patient preparation to result reporting. To address this, the Working group for laboratory endocrinology of the Croatian society of medical biochemistry and laboratory medicine has developed recommendations based on the latest national and international guidelines, research and the authors' expert opinion. The document aims to standardize all phases of thyroid function testing, with 7 preanalytical, 12 analytical, and 8 postanalytical recommendations, each supported by expert explanations. While primarily directed at Croatian laboratory professionals, this document is also relevant to other healthcare professionals managing thyroid-related health issues.

Introduction: Hepcidin (Hep), a key regulatory hormone of iron (Fe) homeostasis, governs its absorption and storage, and is influenced by inflammation and Fe status. This study investigated serum Hep concentrations and their associations with Fe markers and inflammation in patients with sporadic colorectal cancer (CRC).

Materials and methods: We compared serum concentrations of Hep, Fe, unsaturated and total iron binding capacity, transferrin, transferrin saturation, ferritin, C-reactive protein (CRP), interleukin-6 (IL-6) and tumor markers in 82 CRC patients and 58 controls. Statistically significant differences were tested using the Mann-Whitney U test and Student's t test. Additionally, Hep were analyzed according to tumor stage. Colorectal cancer was confirmed histopathologically after colonoscopy with biopsy (TNM staging).

Results: Colorectal cancer patients exhibited significantly lower Hep concentrations than controls (8.1 vs. 19.7 ng/mL, P = 0.020). Ferritin was also lower in CRC (109 vs. 250 µg/L, P = 0.002). Hepcidin showed the strongest positive correlation with ferritin in CRC. Inflammatory markers (CRP and IL-6) correlated moderately to weakly with hepcidin in both groups (controls: rho = 0.52 (P < 0.001); CRC: rho = 0.26 (P = 0.022) for CRP and CRC: rho = 0.30 (P = 0.033) for IL-6). Notably, Hep concentrations were lower in patients with advanced tumor stage (T0 vs. T3, P = 0.043).

Conclusion: These findings suggest that CRC is associated with lower hepcidin and ferritin concentrations, potentially reflecting complex and cancer-specific dysregulation in Fe metabolism beyond inflammation alone.

Atherosclerosis is an active interaction between lipoproteins and inflammatory cells. Monocytes and macrophages are the most important immune cells involved in the process of atherosclerosis. They interact with atherogenic lipoproteins, in particular low density lipoprotein (LDL) cholesterol and lipoprotein(a) (Lp(a)). The increased concentration of the LDL cholesterol and Lp(a) accelerates the polarization of monocytes and macrophages toward proinflammatory phenotype and the formation of the foam cells. These cells then release large quantities of inflammatory cytokines that stimulate the oxidation of atherogenic lipoproteins that are even more atherogenic and contribute to the formation of foam cells and the secretion of the pro-inflammatory cytokines, thus creating a vicious circle. Surface marker C-C chemokine receptor type 2, expressed on monocytes/macrophages, enables their adhesion and migration into the subendothelial layer. The rupture of the atherosclerotic plaque on one hand, and the ability of the oxidized LDL cholesterol and Lp(a) to trigger arterial thrombosis by different mechanisms on the other hand, result in acute cardiovascular event. Here, we summarize the role of the monocytes and macrophages in atherosclerosis and explore the influence of LDL cholesterol and Lp(a) on monocytes and macrophages during the entire process of atherosclerosis, from its initiation to progression.