Biochemia medica最新文献

Introduction: Higher concentrations of the small-cell lung cancer (SCLC) serum marker, pro-gastrin-releasing peptide (proGRP), in lung inflammations has been indicated in literature. The objective of this study was to compare serum proGRP concentration in pneumonia, chronic obstructive pulmonary disease (COPD) and early-stage primary lung cancers.

Materials and methods: An observational study was performed to assess serum proGRP against other lung cancer markers in pneumonia, COPD and in stage 1/2 carcinomas. A total of 91 cases of pneumonia or chronic obstructive pulmonary disease (COPD), with 107 cases of early-stage lung adenocarcinoma (ADC), squamous cell carcinoma (SQCC) and 14 cases of neuroendocrine tumors (NET), including SCLC, were analyzed. Serum proGRP (Roche Diagnostics, Basel, Switzerland), cytokeratin 19 fragment 21-1, carcinoembryonic antigen, neuron-specific enolase and C-reactive protein were measured and compared. For the statistical analysis, Mann-Whitney U test, Kruskal-Wallis ANOVA, multiple linear and multinomial logistic regression modeling were used.

Results: Compared to the early-stage ADC and SQCC, proGRP in pneumonia, COPD and in NET was higher (P ≤ 0.011 in all comparisons). In 11 cases of pneumonia and COPD, proGRP reached cut-off for SCLC of 100 ng/L. No clinically relevant differences between pneumonia or COPD and early-stage cancer were observed for other markers. Concentration of proGRP was associated with CRP (model coefficient was 0.20; P < 0.019) and both parameters contributed to classification of cases to pneumonia/COPD, ADC/SQCC, and NET categories (P < 0.004, in all cases).

Conclusions: Concentrations of proGRP in pneumonia and COPD patients were higher than in patients in the ADC and SQCC early stages and could exceed the SCLC cut-off.

Ceftriaxone, a widely used antibiotic, is one of the most common drugs to cause drug-induced immune hemolytic anemia. In this report, we describe the effect of ceftriaxone on red blood cell parameters (low red blood cell count, low hematocrit, and high erythrocyte index values) in two pediatric patients without clinical symptoms of hemolytic anemia. Although automated hematology analyzers have helped to detect incorrect results, a peripheral blood smear examination was necessary for recognizing the erythrocyte agglutinins caused by ceftriaxone. Serological testing was not possible, but the resulting drug-induced antibodies mimicked cold agglutinins in the first patient and warm agglutinins in the second patient. Timely reactions and corresponding laboratory procedures prevented potential complications due to drug administration. This report aims to present laboratory findings and preanalytical challenges in these cases and share our experiences in solving them.

The application of advanced artificial intelligence (AI) models and algorithms in clinical laboratories is a new inevitable stage of development of laboratory medicine, since in the future, diagnostic and prognostic panels specific to certain diseases will be created from a large amount of laboratory data. Thanks to machine learning (ML), it is possible to analyze a large amount of structured numerical data as well as unstructured digitized images in the field of hematology, cytology and histopathology. Numerous researches refer to the testing of ML models for the purpose of screening various diseases, detecting damage to organ systems, diagnosing malignant diseases, longitudinal monitoring of various biomarkers that would enable predicting the outcome of each patient's treatment. The main advantages of advanced AI in the clinical laboratory are: faster diagnosis using diagnostic and prognostic algorithms, individualization of treatment plans, personalized medicine, better patient treatment outcomes, easier and more precise longitudinal monitoring of biomarkers, etc. Disadvantages relate to the lack of standardization, questionable quality of the entered data and their interpretability, potential over-reliance on technology, new financial investments, privacy concerns, ethical and legal aspects. Further integration of advanced AI will gradually take place on the basis of the knowledge of specialists in laboratory and clinical medicine, experts in information technology and biostatistics, as well as on the basis of evidence-based laboratory medicine. Clinical laboratories will be ready for the full and successful integration of advanced AI once a balance has been established between its potential and the resolution of existing obstacles.

[This corrects the article DOI: 10.11613/BM.2025.010702.].

Adrenocorticotropic hormone (ACTH) has historically been considered an unstable hormone after venous sampling, necessitating stringent conditions for the transport of blood samples to the laboratory to ensure accurate measurement. However, recent investigations suggest that ACTH may be more stable than previously assumed, raising the possibility of more flexible handling conditions. This prompted us to conduct a systematic review using the MEDLINE database to ascertain the stability of ACTH in blood samples. We included 9 studies in our final analysis from 405 reports. Our findings reveal that all studies reported a mean percentage difference (PD%) in ACTH concentrations relative to baseline below the 10% threshold when uncentrifuged tubes were stored under refrigerated conditions for 2, 4, 6, and 8 hours. In contrast, the mean PD% exceed the 10% threshold in 5 out of 7 studies investigating a storage duration of 24 hours under refrigerated conditions. Nearly all studies reported a mean PD% in ACTH concentrations relative to baseline below 10% when uncentrifuged tubes were stored at room temperature for 2, 4, and 6 hours. However, for storage durations of 8, 12, and 24 hours at room temperature, most studies observed a mean PD% exceeding 10%. In summary, our findings suggest that ACTH remains stable in uncentrifuged tubes containing EDTA for 6 h at room temperature and at least 8 h under refrigerated conditions. Our findings can assist clinical laboratories in reviewing their acceptance criteria for sample transport regarding time and temperature.

Introduction: Sphingolipids, essential to trophoblast and endothelial function, may impact inflammation in preeclampsia. However, their specific role in late-onset preeclampsia remains unclear. To address this research gap, we analyzed sphingolipid profiles in pregnancies at high risk for preeclampsia development to identify potential biomarkers and clarify their role in disease pathogenesis.

Materials and methods: We monitored 90 pregnant women at high risk for preeclampsia development across four gestational points. These women were later categorized into the group of women with high risk who did not develop preeclampsia (HRG) (70 women) or the preeclampsia group (PG) (20 women). Sphingolipids (sphingosine, sphinganine, sphingosine-1-phosphate (S1P), ceramides C16:0/C24:0, and sphingomyelin C16:0) were quantified via liquid chromatography-tandem mass spectrometry.

Results: Sphingolipid profiles revealed distinct patterns between groups. Concentrations of S1P in the HRG increased from the 1st trimester to delivery (P < 0.001). We did not notice significant changes in S1P during pregnancy in the PG but compared with the HRG we found significantly lower concentrations at each test point from the 2nd trimester until delivery (P = 0.020, P = 0.013, P = 0.011, respectively). Ceramides C16:0 and C24:0 demonstrated significant increases over time in HRG (P < 0.001, both). Sphingomyelin C16:0 increased significantly across pregnancy in both groups (P < 0.001 in HRG and P = 0.006 in PG), with no significant differences between groups.

Conclusions: We identified S1P as a potential biomarker for late-onset preeclampsia, with lower concentrations observed in PG compared to HRG. Rising sphingomyelin concentrations in both cohorts might serve as a relevant cardiovascular risk indicator in pregnancies at high risk for preeclampsia.

Diagnostic tests are important means in clinical practice. To assess the performance of a diagnostic test, we commonly need to compare its results to those obtained from a gold standard test. The test sensitivity is the probability of having a positive test in a diseased-patient; the specificity, a negative test result in a disease-free person. However, none of these indices are useful for clinicians who are looking for the inverse probabilities, i.e., the probabilities of the presence and absence of the disease in a person with a positive and negative test result, respectively, the so-called positive and negative predictive values. Likelihood ratios are other performance indices, which are not readily comprehensible to clinicians. There is another index proposed that looks more comprehensible to practicing physicians - the number needed to misdiagnose. It is the number of people who need to be tested in order to find one misdiagnosed (a false positive or a false negative result). For tests with continuous results, it is necessary to set a cut-off point, the choice of which affects the test performance. To arrive at a correct estimation of test performance indices, it is important to use a properly designed study and to consider various aspects that could potentially compromise the validity of the study, including the choice of the gold standard and the population study, among other things. Finally, it may be possible to derive the performance indices of a test solely based on the shape of the distribution of its results in a given group of people.

Introduction: Reliable and accurate measurement of blood glucose concentration is of crucial importance for making clinical decisions in diagnosis diabetes, gestational diabetes and impaired fasting glucose tolerance.

Materials and methods: Survey was performed in form of questionnaire. Questionnaire was sent to all Croatian laboratories (N = 204) in electronic form using SurveyMonkey cloud-based software (SurveyMonkey, Inc., San Mateo, USA) as an extra-analytical module of the Croatian EQA (External Quality Assessment) provider Croatian center for external quality assessment (CROQALM) in June 2023.

Results: In total 148 (73%) of laboratories responded to the survey. Large proportion of laboratories never use glucose inhibitor tubes for random glucose measurement (more than half) or for glucose function tests (one quarter). Only three laboratories use recommended glycolysis inhibitor citrate. Many other inhibitors are also used, even if some of them are not recommended for plasma glucose measurement. Glucose is almost never (93%) sampled on ice when glucose inhibitor tube is not available.

Conclusions: Laboratories in Croatia do not follow the recommended procedures regarding glycolysis inhibitors for glucose determination.

Introduction: Ferroportin (Fpn) is the only known iron exporter and plays an essential role in iron homeostasis. Serum concentrations of Fpn in health and/or diseased states are still mostly unknown. Therefore, the aim of this study was to determine the concentration of Fpn in the serum of women of reproductive age (WRA) for the first time, and to establish whether there is a difference in the concentration of Fpn according to ferritin status.

Materials and methods: This research included 100 WRA (18-45 years, C-reactive protein (CRP) < 5 mg/L, hemoglobin > 120 g/L). Serum Fpn was measured using Enzyme Linked Immunosorbent Assay (ELISA) method on the analyzer EZ Read 800 Plus (Biochrom, Cambridge, UK). Reference interval was calculated using the robust method.

Results: The median concentration of Fpn in the whole study group was 9.74 (5.84-15.69) µg/L. The subgroup with ferritin concentration > 15 µg/L had a median Fpn concentration 15.21 (10.34-21.93) µg/L, which significantly differed from Fpn concentration in the subgroup with ferritin concentration ≤ 15 µg/L (5.93 (4.84-8.36) µg/L, P < 0.001). The reference limits for the Fpn were 2.26-29.81 µg/L with 90% confidence intervals (CI) of 1.78 to 2.83 and 25.37 to 34.33, respectively.

Conclusions: The proposed reference interval could help in the future research on iron homeostasis both in physiological conditions and in various disorders, because this is the first study that measured Fpn concentration in a certain gender and age group of a healthy population.

This case report describes interference from heterophilic antibodies in D-dimer assay. The interference was suspected due to discrepancies between D-dimer concentrations in the original sample and diluted samples, as well as inconsistent clinical findings. The patient's medical history, laboratory results, and imaging studies were considered in the investigation. Heterophilic antibodies, likely developed during the SARS-CoV-2 infection, were identified as the probable cause of interference. The interference was confirmed through various methods, including dilution studies, blocking heterophilic antibodies, and comparing results with an alternative D-dimer method. This case highlights the importance of recognizing and addressing interference in D-dimer testing, emphasizing the need for collaboration between clinicians and laboratory specialists.