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Daria Pašalić
Editor-in-Chief
Department of Medical Chemistry, Biochemistry and Clinical Chemistry
Zagreb University School of Medicine
Šalata ul 2.
10 000 Zagreb, Croatia
Phone +385 (1) 4590 205; +385 (1) 4566 940
E-mail: dariapasalic [at] gmail [dot] com

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P04-01
 
Evaluation of new point of care blood gas system Rapidpoint 500
Baršić I, Brkljacic V, Rogic D, Sertic J
University Hospital Center Zagreb, Clinical Institute of Laboratory Diagnostics, Zagreb, Croatia
Corresponding author: ibarsic [at] kbc-zagreb [dot] hr
 
Background: The aim of the study was to evaluate the performance of a new Rapidpoint 500 blood gas system and assess its capability as a point of care analyzer. The results of pH, blood gases, electrolytes, glucose, lactate and total hemoglobin were compared with results obtained on Rapidlab 1265 blood gas analyzer, and neonatal bilirubin results were compared with results obtained on biochemistry analyzer Cobas 6000 series module c501.
Materials and methods: The evaluation was performed at the Department of Anesthesiology and Intensive Care Unit (pH, blood gases, electrolytes, glucose, lactate and total hemoglobin) and at the Department of Pediatrics, Division for Neonatology and Intensive Care (neonatal total bilirubin). We collected arterial blood with balance heparin (N = 52), and capillary and venous samples (N = 40) for neonatal bilirubin. Capillary and venous samples were collected by nurses at the Department of Pediatrics, so we were able to investigate the influence of non-laboratory staff on results obtained from the point-of-care device and in central laboratory. We calculated imprecision, inaccuracy and comparability with Rapidlab 1265 and Cobas 6000 series module c501.
Results: Within-run imprecision CVs were all below 5% and the results showed acceptable inaccuracy for all analytes. The correlation with the comparative methods was satisfactory; correlation coefficients were between 0.9116-0.9938 for all parameters. Passing-Bablok regression analysis of analyte concentrations showed good compatibility.
Conclusion: Rapidpoint 500 showed good imprecision (CV < 5%), acceptable inaccuracy and comparability with central laboratory and it can be used as a point-of-care device in intensive care units and neonatology.
 
P04-02
 
Evaluation of the Enterprise Point of Care meter (EPOC) for the emergency ward
Buurman S (1), Heringhaus C (2), Schenk P (1), Cobbaert C (1)
(1) Leiden University Medical Center, Department of Clinical Chemistry, Leiden, Netherlands
(2) Leiden University Medical Center, Department of Emergency Medicine, Leiden, Netherlands
Corresponding author: c [dot] m [dot] cobbaert [at] lumc [dot] nl
 
Background: Rapid availability of blood gas, metabolite and electrolyte results is crucial for decisions about further medical treatment of reanimation patients at the Emergency Ward. Therefore, we evaluated the Epocal Enterprise Point of Care meter (EPOC) versus the Siemens Rapidlab 865 analyzer intended for central laboratory blood gas measurements.
Materials and methods: Reproducibility of the EPOC parameters was tested using Eurotrol GAS-ISE Metabolites reference material. Method comparison was performed using 30 freshly collected patient samples, which were applied to both devices within 10 seconds. Clinical equivalence was tested for nine parameters by 2-Instrument Comparison (EP Evaluator, Rhoads). An Error Index (the ratio between the (Y-X) difference and allowable total error) was calculated per parameter and per sample. Methods are clinically equivalent if the absolute value of (Y-X) is smaller than allowable error in at least 95% of samples.
Results: Overall reproducibility was < 2% for all parameters except pO2. EPOC pH and lactate measurements were clinically equivalent to those from the Rapidlab 865. However, EPOC and Rapidlab sodium, potassium, ionised calcium, glucose, pO2, pCO2, and haematocrit results were not clinically equivalent, with Error Indices < -1 or > 1 in 10-87% of samples.
Conclusions: The significance of POCT blood gas-electrolyte-metabolite analyses with short turnaround times for critical patients is well known. Whereas the evaluation of the EPOC meter shows excellent reproducibility for all parameters tested, there are clinically relevant differences versus central laboratory equipment for 7 out of 9 parameters. These data clearly illustrate the need for a quality mark for POCT devices.
 
P04-03
 
Performance of Nova StatStrip point of care blood glucose meter in a neonatal intensive care unit
Tendle K
Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
Corresponding author: d [dot] dobson [at] novabiomedical [dot] co [dot] uk
 
Background: Monitoring blood glucose in neonatal intensive care (NICU) patients is important in maintaining normoglycaemia and reducing the risk of hypoglycaemia. POC glucose meters provide short turnaround times (TAT) but it has been reported that the accuracy of many commonly used meters can be affected by hematocrit interference and other biochemical or biological substances present in neonatal whole blood. The aim of this study was to challenge the performance of a POC glucose meter (Nova Biomedical StatStrip) that corrects for interfering substances, to determine its clinical reliability in a challenging pre-term neonatal population.
Methods: StatStrip was tested on 159 heparinised whole blood neonatal samples obtained for blood gas analysis. Patients tested had varying levels of hematocrit, pH and pO2, and received a range of medication. The accuracy of Statstrip Glucose was evaluated by comparing the results of the meter with the results of the blood gas analyser ABL 700 (Radiometer Medical ApS) routinely used for glucose measurements in this NICU setting.
Results: StatStrip results correlated closely to the ABL 700 (r2 = 0.97456) across a wide glucose concentration range including the hypoglycaemic range (min = 13 mg/dL; max = 389 mg/dL). The varying levels of hematocrit pH and pO2 present in the whole blood samples did not affect the accuracy of results. The accuracy of results was also unaffected by the medication used and other factors, e.g. birth weight or patient’s age.
Conclusions: StatStrip showed good clinical accuracy and performance and is a suitable alternative to a blood gas analyser for measuring glucose in NICU patients.
 
P04-04
 
A large-scale randomized clinical trial on the effectiveness of reflective testing in primary care
Verboeket-van de Venne W, Kleinveld H, Oosterhuis W
Atrium Medical Centre, Department of Clinical Chemistry, Heerlen, Netherlands
Corresponding author: wvenne [at] atriummc [dot] nl
 
Background: Reflective testing is a procedure in which the laboratory specialist adds additional tests and/or comments to an original request, after inspection (reflection) of the results. The aim of the present study is to evaluate the effects of reflective testing on patient treatment and outcome.
Materials and methods: We started with laboratory reports from 600 patients that were suitable to be subjected to reflective testing. After randomization, general practitioners (GPs) of 300 patients received the additional tests and comments (intervention). GPs of the other patients only received the results of the originally requested tests (control). After a follow-up period of six months, information was collected about following laboratory reports, treatments or referrals, other additional diagnostic procedures and specific patient data (e.g. medical history, medication).
Results: Informed consent to collect follow-up data was received from 350 patients. In 81 of them additional tests were performed without resulting in added value. Data of 269 patients (intervention: 148, control: 121) were further analyzed. Reflective testing was considered to be useful in 95% of the cases; 74% of the GPs (intervention) compared with 45% (control) had stated the intention of an adequate treatment action. An actual improvement of the care process was observed in 70% of the patients in the intervention group (vs. control: 46%; P < 0.001).
Conclusion: Reflective testing can be seen as a new dimension to the service of the clinical chemistry laboratory to primary health care. In our opinion, these results contribute significantly to the evidence of the effectiveness of reflective testing.
 
P04-05
 
Microdialysis-based biosensors in experimental and clinical research
CibicekN (1), VacekJ (1), HrbacJ (2), ZivnH (3), MandakJ (4), UlrichovaJ (1)
(1) Palacky University Olomouc, Faculty of Medicine and Dentistry, Department of Medical Chemistry and Biochemistry, Olomouc, Czech Republic
(2) Palacky University Olomouc, Faculty of Science, Department of Physical Chemistry, Olomouc, Czech Republic
(3) Charles University in Prague, Faculty of Medicine in Hradec Kralove, Radioisotope Laboratories and Vivarium, Hradec Kralove, Czech Republic
(4) Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Cardiac Surgery, Hradec Kralove, Czech Republic
Corresponding author: norbert [dot] cibicek [at] upol [dot] cz
 
Background: Microdialysis, a sampling method originally developed for in situ experimental tissue metabolism monitoring, has also been utilized in (clinical) pharmacological / toxicological studies, for barrier function assessment and estimation of local blood perfusion.
Materials and methods: A contemporary literature review (years 2007-2012) was performed using Medline, Scopus and WOS databases with search terms “microdialysis” and “biosensor”. Relevant studies were subgrouped into experimental and clinical research categories. The major methodological and application advances were summarized for both areas and compared with our own experimental and clinical experience.
Results: Concerning the experimental papers, neuroscience dominates the wide array of applications in various organs. In the area of clinical research, implantable microdialysis sensors are (still) focused on the brain, subcutaneous and intravenous measurements of glucose and its metabolites on one hand, and on the monitoring of neurotransmitters and pharmaceuticals on the other. In keeping with our practice, the major drawbacks of microdialysis biosensors remain in the realm of biointerface conditions, which affect their function and longevity. The technological evolution concentrates on increased sensitivity and lag-time reduction (employment of enzymes and on-line electrochemical detection mechanisms), continuous calibration techniques (e.g. with fluorescent probes), wireless setups and miniaturization (lab-on-a-chip).
Conclusions: In the experimental brain and diabetes research, microdialysis has become a well-established technique that may be used as a reference for the development of other (e.g. optical) biosensors. Clinical research attempts to identify the situations, where microdialysis could replace the standard methods. Acknowledgements This work was supported by grant project MPO FR-TI4/457.
 
P04-06
 
Pitfalls in measurement of lysosomal enzymes using dried blood spots on filter paper
Brzak M (1), Bilić K (2) Fumić K (2)
(1) Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
(2) Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
Corresponding author: kbilic [at] kbc-zagreb [dot] hr
 
Background: Increasing interest in dried blood spot (DBS) measurement of lysosomal enzymes is due to small sample volume and easy transport and storage. However, most pre-analytic procedures are not under laboratory control. The objective of this study was to analyze the effect of leukocytosis and the time period from blood drawing to spotting on filter paper for activity of α-galactosidase A and α-glucosidase.
Materials and methods: a) DBS samples from 130 individuals with and without leukocytosis who did not have the diagnosis of Pompe and Fabry disease; b) Aliquotes of 60 µl EDTA-blood from 65 healthy individuals were spotted on filter papers immediately after blood was drawn and then one hour after blood drawing without inverting the sample gently in the meantime. α-galactosidase A and α-glucosidase activities were measured using in house fluorometric methods.
Results: The activities of α-galactosidase A (mean ± SD) and α-glucosidase (mean ± SD) were respectively (nmol/21h/mL): a) DBS samples with leukocytosis: 25.4 ± 17.09 and 28.7 ± 22.30; DBS samples without leukocytosis: 13.0 ± 11.00 and 20.0 ± 19.51; b) DBS prepared immediately after blood was drawn: 12.8 ± 10.89 and 19.9 ± 20.27; DBS prepared one hour after blood drawing without inverting the sample: 7.6 ± 7.42 and 7.2 ± 6.19.
Conclusions: DBS samples prepared during the period in which patients suffered from leukocytosis can lead to false negative results in juvenile or adult forms of Fabry or Pompe disease in patients with moderately lowered enzyme activity. Adequate use of DBS measurement requires continuous education of all participants in the diagnostic process.
 
P04-07
 
Clinical evaluation and etiologies of prolonged jaundice in IVF born neonates
Mehrotra V (1), Saini P (2)
(1) Himalayan Institute of Medical Sciences, Jollygrant, Clinical Biochemistry, Dehradun, India
(2) Saini Infertility Centre, Rajpur Road, Saini Infertility Centre, Dehradun, India
Corresponding author: mehrotravinit [at] rediffmail [dot] com
 
Background: When jaundice persists beyond 14 days it is called prolonged or protracted neonatal icterus or jaundice. Etiology of this cause needs a pivotal step for management because a delay in the diagnosis and treatment may lead to serious complication or even death. The most common causes include hyperbilirubinemia (physiologic or hemolytic), breast feeding or breast milk jaundice. Considering all the possible etiologies as an essential a clinical evaluating is most crucial.
Material and methods: Hospitalized or outpatients of known IVF born neonates with prolonged jaundice were studied. General data of mother and neonates containing age, sex, weight, type of delivery, type of feeding, jaundice history and therapy was collected and clinical investigations: serum bilirubin (total and conjugate), liver functions tests, blood group, complete hemograme, thyroid function tests, glucose-6-phosphate dehydrogenase and urine culture were performed.
Results: One hundred IVF born neonates with prolonged jaundice were enrolled (male: 67 and female: 33) with the mean age of 21 days, weight 2.5 kg and jaundice onset was 5 days. 75% were breastfeeding and 7% shows urinary tract infection and 45% G6PD deficiency. 4% shows higher values of TSH or T4. Septicemia, Down syndrome and ABO incompatibility were present in only 1%. The neonate also shows good evidence of liver dysfunction or hypothyroidism. The etiological cause was unknown in 4% of the cases.
Conclusions: It was concluded that the most common clinical and etiologic causes of IVF born neonates with prolonged jaundice were breast feeding, G6PD deficiency, UTI and hypothyroidism correspondingly.
 
P04-08
 
Influence of the assay for measuring serum albumin on level of corrected calcium (CaC) concentration
Garcia Moreira V, Martinez Gago M, Fernandez Leivas A, Bachiller Sister M, Llorente Torres A, Fernandez Rodriguez E
Hospital de Cabueñes, Servicio de Analisis Clinicos, Gijon, Spain
Corresponding author: eloyfr [at] gmail [dot] com
 
Background: The use of albumin-corrected calcium (CaC) is recommended as calcium measurement. Usually, albumin is measured by dyebinding assays: bromcresol green (AlbBCG) and bromcresol purple (AlbBCP) and systematic differences between them have been described. Our objective was to evaluate the impact of the albumin method on CaC concentrations.
Materials and methods: We measured calcium and albumin concentrations by BCG and BCP methods in 100 sera. CaC was calculated according to: CaC (mg/dL) = total Ca (mg/dL) +0.8 x [4-albumin (g/dL)]. Comparisons were performed using the Student t-test for paired data and the Bland-Altman plot, using the program MedCalc. Significance was set at P < 0.05.
Results: Total calcium mean was 8.81 mg/dL and standard deviation of 0.91. Mean concentration of AlbBCG was 36.81 ± 7.53 g/L and 30.96 ± 9.61 g/L for the AlbBCP. So, there were significant differences between methods, being 5.85 ± 3.28 g/L higher in AlbBCG is employed (P < 0.01). Mean CaC based on AlbBCG and AlbBCP was 9.36 ± 0.58 mg/dL and 9.82 ± 0.64 mg/dL, respectively (P < 0.01), with a mean difference BCG-BCP of -0.46. Using the AlbBCG to estimate CaC there was 1 "hypocalcaemic" (< 8.5 mg/dL), 12 "hypercalcaemic" (> 10 mg/dL) and 87 "normocalcemic" cases. Measuring AlbBCP theses cases were 1, 32 and 67, respectively. Thus, we have obtained a 20% discrepancy by using one or other method: 32 patients were classified as hypercalcemic when the AlbBCP was used, of which 20 would considered normal and 12 hypercalcemic using AlbBCG.
Conclusion: On average, AlbBCP are > 5g/L lower than AlbBCG. The choice of albumin method has a great impact on CaC calculation and therefore in the patients classification according to their phophocalcic status.
 
P04-09
 
Performance of the StatStrip POCT analyzer in detecting hypoglycaemic episodes in diabetic patients
Vučić Lovrenčić M (1), Radišić BiljakV (1), Božičević S (1), CarN (2)
(1) Merkur Teaching Hospital, Institute of Clinical Chemistry and Laboratory Medicine, Zagreb, Croatia
(2) Merkur Teaching Hospital, Vuk Vrhovac University Clinic, Zagreb, Croatia
Corresponding author: vucic [at] idb [dot] hr
 
Background: Improving glycaemic control, whilst minimizing risk of hypoglycaemia is the ultimate goal of diabetes management. Intensified insulin treatment is the most common source of iatrogenic hypoglycaemia. Due to the hypoglycaemia unawareness, common in diabetes, many of the hypoglycaemic episodes remain undiagnosed and untreated, leading to a variety of adverse outcomes, ranging from mild autonomic symptoms to death. Accurate and readily available plasma glucose monitoring is of utmost importance in diagnosis and subsequent treatment of hypoglycaemia. The aim of this study was to evaluate the performance of a new type glucose sensor for the POCT glucose analyzer (StatStrip, Nova Biomedical, USA) in detecting hypoglycaemic episodes in diabetic patients upon institution of intensified insulin treatment.
Materials and methods: Capillary plasma glucose was measured by the StatStrip POCT glucose analyzer in hospitalized diabetic patients (N = 49) upon institution of intensified insulin treatment (glycaemic profile: 8 times per 24 hours) and results were compared to the reference hexokinase procedure (Olympus AU400, Beckman Coulter, USA).
Results: A total of 41 hypoglycaemic episodes (plasma glucose ≤ 3.9 mmol/L) were detected in the study period. There was no statistically significant bias between plasma glucose, as measured by the StatStrip and reference procedure (3.0 ± 0.83 vs. 3.1 ± 0.69 mmol/L, P = 0.071). Diagnostic test revealed a 95.1% sensitivity of the StatStrip in detecting hypoglycaemia, when tested against reference procedure.
Conclusions: The StatStrip POCT glucose analyzer showed excellent performance and clinical accuracy for detecting hypoglycaemic episodes in diabetic patients treated with intensified insulin therapy.
 
P04-10
 
Implementation of blood gas analysis POCT network in an Italian Health Organization with 3 hospitals
Bianchi V, Camurati C, Casalecchi M, Perticone V, Arfini C
SS Antonio e Biagio Hospital, Clinical Laboratory, Alessandria, Italy
Corresponding author: vbianchi [at] ospedale [dot] al [dot] it
 
Background: The debate on point of care testing (POCT) is an important aspect of Laboratory Medicine. Purpose of this work is to show a POCT network for blood gas analysis realized in Alessandria (Italy).
Materials and methods: Three hospitals far each other, one of these paediatric, with 11 critical wards. Project and implementation steps. First step: setting, needs analysis, study of connectivity. Second step: writing requirements, inviting tenders, carrying out task, appointing winner. Third step: instrument installation linked with a middleware server for data management. Fourth step: staff training, writing standard operation procedures, monitoring errors, managing warehouse, accounting tests.
Results: POCT network involves 11 analyzers and 11 wards. Both nurses and medical doctor can correctly instrumentations. A middleware server located in the Laboratory Unit collects all data and put them in electronic records. A total quality control is performed, when results are out the limit, POCT Technician switch off single electrodes or all instrumentation. Unique warehouse and stock control allow considerable savings. Every test is quantified as Euros. Management is carried out according to UNI EN ISO 9001:2008.
Conclusions: POCT network for blood gas analysis in the Health Organization of Alessandria is a proper system for decentralized tests where Central Laboratory Unit controls and monitors all activities according national and local laws. It is also a good example where a lab Technician can perform specific functions as well as management of activities, cooperation in savings resources and improving quality of patient care.
 
P04-11
 
Method validation for quantifying cobalt in serum by electrothermal atomic absorption spectrometry
López-Lozano L (1), Palazón-Bru I (1), Morales-Bayle C (1), Palazón-Bru A (2), González-Estecha M (1), Arroyo-Fernández M (1)
(1) Hospital Clínico San Carlos, Laboratory Medicine, Madrid, Spain
(2) Universidad Miguel Hernández de Elche, Departamento de Medicina Clínica, Alicante, Spain
Corresponding author: lore_l_l [at] hotmail [dot] com
 
Background: Metal-on-metal bearings may release a variety of metal ions into local tissue and into general circulation, with Cr and Co being the most widely reported of the released metals. The aim of this study is to validate a method for cobalt determination in serum by electrothermal atomic absorption spectrometry, as it is an emerging area of interest in Laboratory Medicine.
Materials and methods: A Perkin Elmer AAnalyst 800 atomic absorption spectrometer with Zeeman correction system was used.
Instrumental conditions:
Wavelength: 242.5 nm
Slit width: 0.2 nm
Measurement: peak area
Furnace program
Drying [temperature (°C)/time (s) ramp-hold]: 80/10-30; 130/10-30
Pyrolysis [temperature (°C)/time (s) ramp-hold]: 800/20-20; 1200/10-20
Atomization [temperature (°C)/time (s) ramp-hold]:1900/0-3
Cleaning [temperature (°C)/time (s) ramp-hold]: 2400/1-4; 20/1-5
The flow gas used in all stages, except for atomization, was 250 mL/min
Reagents:
Standard cobalt of 1000 mcg/mL and a matrix modifier of palladium and magnesium nitrates were used.
Sample treatment:
Blank, standards and samples were diluted 1 to 2 with the matrix modifier.
The calibration curve was performed with five standards: 10, 20, 30, 40 and 50 mcg/L.
Results and conclusions:
Characteristic mass (pg): 21 pg
Detection limit: 0.31 mcg/L
Quantification limit: 1.04 mcg/L
Linearity: until 50 mcg/L
Uncertainty: ± (7.4% + 0.4 mcg/L)
Imprecision: 2.4% + 0.2 mcg/L
Bias: < 15%
The proposed method proves to be sensitive, robust, accurate and precise for biomonitoring the concentration of cobalt in serum samples as an indicator of health risk.
 
P04-12
 
Method validation for quantifying chromium in serum by electrothermal atomic absorption spectrometry
Palazón-BruI (1), López-LozanoL (1), Palazón-BruA (2), González-EstechaM (1), Arroyo-FernándezM (1)
(1) Hospital Clínico San Carlos, Laboratory Medicine, Madrid, Spain
(2) Universidad Miguel Hernández de Elche, Departamento de Medicina Clínica, Alicante, Spain
Corresponding author: irene_pb [at] hotmail [dot] es
 
Background: Metal-on-metal bearings may release a variety of metal ions into local tissue and into general circulation, with Cr and Co being the most widely reported of the released metals. The aim of this study is to validate a method for chromium determination in serum by electrothermal atomic absorption spectrometry, as it is an emerging area of interest in Laboratory Medicine.
Materials and methods: A Perkin Elmer AAnalyst 800 atomic absorption spectrometer with Zeeman background correction system was used.
Instrumental conditions:
Wavelength: 357.9 nm
Slit width: 0.7 nm
Measurement: peak area
Furnace program:
Drying [temperature (°C)/time (s) ramp-hold]: 80/10-30; 130/10-30
Pyrolysis [temperature (°C)/time (s) ramp-hold]: 800/20-15; 1300/20-20
Atomization [temperature (°C)/time (s) ramp-hold]:2200/0-3
Cleaning [temperature (°C)/time (s) ramp-hold]: 2600/1-4; 20/1-5
The flow gas used in all stages, except for atomization, was 250 mL/min
Reagents:
Standard chromium of 1000 mcg/ mL and a matrix modifier of palladium and magnesium nitrates were used.
Sample treatment:
Blank, standards and samples were diluted 1 to 2 with the matrix modifier.
The calibration curve was performed with five standards: 2,4,6,8 and 10 mcg/L.
Results and conclusions:
Characteristic mass (pg): 7.1 pg
Detection limit: 0.074mg/L
Quantification limit: 0.24 mcg/L
Linearity: until 10 mcg/L
Uncertainty: ± (10.99% - 0.04 mcg/L)
Imprecision: 4.59% - 0.02 mcg/L
Bias: < 15%
The proposed method proves to be sensitive, robust, accurate and precise for biomonitoring the concentration of chromium in serum samples as an indicator of health risk.
 
P04-13
 
Palladium as a universal matrix modifier for ETAAS technique in biological samples
Palazón-BruI, López-LozanoL, Trasobares-IglesiasE, González-EstechaM, Arroyo-FernándezM
Hospital Clínico San Carlos, Laboratory Medicine, Madrid, Spain
Corresponding author: irene_pb [at] hotmail [dot] es
 
Background: Choosing the best matrix modifier is one of the key points in measurements by electrothermal atomic absorption spectrometry (ETAAS). It is an advantage to have a single matrix modifier for clinical laboratories that perform multi-element analyses. A mixture of palladium and magnesium nitrates was evaluated. This matrix modifier has two main mechanisms of action: it thermally stabilizes thermally and removes chlorinated interfering ions during the pyrolysis step. The aim of this study is to find a matrix modifier which can be used for measuring a variety of elements in biological samples, using aqueous standard calibrations.
Materials and methods: A Perkin Elmer AAnalyst 800 atomic absorption spectrometer was used.
Matrix modifier:
500 µL 10 g/L palladium nitrate
500 µL 10 g/L magnesium nitrate hexahydrate
100 µL Triton X-100
49 mL bidistilled water
Standard solutions (1.000 µg/mL) of:
Chromium
Cobalt
Selenium
Lead
Cadmium
Results and conclusions:
Chromium:
Expected mass characteristic (pg): 7
Obtained mass characteristic (pg): 7.1
Cobalt:
Expected mass characteristic (pg): 17
Obtained mass characteristic (pg): 21
Selenium:
Expected mass characteristic (pg): 45
Obtained mass characteristic (pg): 48
Lead:
Expected mass characteristic (pg): 50
Obtained mass characteristic (pg): 45
Cadmium:
Expected mass characteristic (pg): 1.3
Obtained mass characteristic (pg): 1.3
The results show that the Pd+Mg modifier removes the interferences of matrix and allows the use of aqueous standards and the performance of a simple sample treatment. It enables the use of only one modifier for the five elements.
 
P04-14
 
Diagnostic odds ratio as a single indicator of PCT performance in different clinical settings
Fernandez Rodriguez E (1), Barros Garcia C (1), Garcia Alonso S (1), Fernandez Garcia E (2)
(1) Cabuenes Hospital, Biochemistry, Gijon, Spain
(2) Central Hospital, Intensive Care Unit, Oviedo, Spain
Corresponding author: eloyfr [at] gmail [dot] com
 
Background: Procalcitonin (PCT) has been most widely evaluated as biomarker to distinguish sepsis from other inflammatory conditions. However, different indicators of test performance have been used to assess the diagnostic accuracy of PCT. The aim of this study was to establish a homogeneous comparison by means of a Diagnostic Odds Ratio (DOR) as a single indicator of PCT’s accuracy.
Materials and methods: Nine studies corresponding to 1 systematic review and 8 meta-analyses of sepsis in adults, sepsis in children and neonatal sepsis, were included. DOR (ratio of the of positivity in disease relative to the odds of positivity in nondiseased) was calculated as: DOR = Likelihood ratio (+)/ Likelihood ratio (- ) = [Sens/(1-Spec)] / (1-Sens)/Spec] from the Sensitivities and Specificities of 59 reports. Statistical analysis was performed with the program Meta-Disc.
Results and conclusion: Tests potentially useful tend to have DOR well above 20. LH (+) greater than 10 or LH (-) less than 0.1 have the potential to alter clinical decisions. LR (+) between 5 and 10, and LH (-) between 0.1 and 0.2 often provide useful additional information. Tests with LH ranging from 0.33 to 3 rarely alter clinical decisions. The results of DOR in our study were between 6.77 (ED, adults) and 14.8 (ICU, neonates) showing that the diagnostic performance of the PCT in different settings is moderate (low to intermediate, median DOR under 20) thus not lending support to its widespread use.
 
P04-15
 
Serum copper, ceruloplasmine and zinc concentrations in a hospital working population
Castillo Perez C, González-Estecha M, Diaz Diaz A, Trasobares E, Morales C, Arroyo M
Hospital Clínico San Carlos, Laboratory Medicine, Madrid, Spain
Corresponding author: avellaneda [dot] diaz [dot] diaz [at] gmail [dot] com
 
Background: Copper and zinc are essential micronutrients for humans, even though they are not included in routine analyses. The objective of this study is to measure copper and zinc in a hospital working population and to evaluate the need of measure copper and ceruloplasmine together.
Material and methods: We recruited 395 employees (64 men and 331 women). Serum copper (µg/dL) and zinc (µg/dL) concentrations were measured using flame atomic absorption spectrometry. In addition we measured ceruloplasmine (mg/dL) by immunonephelometry in the 100 non menopausal women (14 under oral contraceptive treatment).
Results: The mean of serum copper was 118.2 µg/dL (SD: 26.4). Copper percentiles (5, 25, 50, 75, 95) were: 84, 102, 114, 127, 178 µg/dL. Among the non menopausal women (100), the mean of ceruloplasmine was 36.8 mg/dL (SD: 14.4). Women under oral contraceptive treatment had serum ceruloplasmine (66.3, SD: 13.6) and copper (204.9, SD: 19.2) higher (P < 0.01) than those who did not take contraceptives (32.1, SD: 8.4; 108.9, SD: 20.5). However, no significant differences were found in the calculated free copper concentrations between both groups of women. The serum zinc mean was 88.3 µg/dL (SD: 10.6). Zinc percentiles (5, 25, 50, 75, 95) were: 71, 82, 88, 95, 105 µg/dL.
Conclusion: We found an appropriate copper and zinc status in this population. Since ceruloplasmine concentrations influence copper concentrations, it is necessary to measure both of them in order to correctly interpret serum copper in clinical practice. It would be desirable to establish reference values for zinc, copper and ceruloplasmine in Spanish population.