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Dirks NF, den Elzen WPJ, Hillebrand JJ, Jansen HI, Boekel ET, Brinkman J, Buijs MM, Demir AY, Dijkstra IM, Endenburg SC, Engbers P, Gootjes J, Janssen MJW, Kniest-de Jong WHA, Kok MB, Kamphuis S, Kruit A, Michielsen E, Wolthuis A, Boelen A, Heijboer AC. Should we depend on reference intervals from manufacturer package inserts? Comparing TSH and FT4 reference intervals from four manufacturers with results from modern indirect methods and the direct method. Clin Chem Lab Med 2024; 0:cclm-2023-1237. [PMID: 38205847 DOI: 10.1515/cclm-2023-1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Correct interpretation of thyroid function tests relies on correct reference intervals (RIs) for thyroid-stimulating hormone (TSH) and free thyroxine (FT4). ISO15189 mandates periodic verification of RIs, but laboratories struggle with cost-effective approaches. We investigated whether indirect methods (utilizing historical laboratory data) could replace the direct approach (utilizing healthy reference individuals) and compared results with manufacturer-provided RIs for TSH and FT4. METHODS We collected historical data (2008-2022) from 13 Dutch laboratories to re-establish RIs by employing indirect methods, TMC (for TSH) and refineR (for FT4). Laboratories used common automated platforms (Roche, Abbott, Beckman or Siemens). Indirect RIs (IRIs) were determined per laboratory per year and clustered per manufacturer (>1.000.000 data points per manufacturer). Direct RIs (DRIs) were established in 125 healthy individuals per platform. RESULTS TSH IRIs remained robust over the years for all manufacturers. FT4 IRIs proved robust for three manufacturers (Roche, Beckman and Siemens), but the IRI upper reference limit (URL) of Abbott showed a decrease of 2 pmol/L from 2015. Comparison of the IRIs and DRIs for TSH and FT4 showed close agreement using adequate age-stratification. Manufacturer-provided RIs, notably Abbott, Roche and Beckman exhibited inappropriate URLs (overall difference of 0.5-1.0 µIU/mL) for TSH. For FT4, the URLs provided by Roche, Abbott and Siemens were overestimated by 1.5-3.5 pmol/L. CONCLUSIONS These results underscore the importance of RI verification as manufacturer-provided RIs are often incorrect and RIs may not be robust. Indirect methods offer cost-effective alternatives for laboratory-specific or platform-specific verification of RIs.
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Affiliation(s)
- Niek F Dirks
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Atalmedial Diagnostic Centers, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Hematology & Immunology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wendy P J den Elzen
- Laboratory Specialized Diagnostics & Research, Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacquelien J Hillebrand
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Heleen I Jansen
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Edwin Ten Boekel
- Department of Clinical Chemistry, Hematology & Immunology, Northwest Clinics, Alkmaar, The Netherlands
| | - Jacoline Brinkman
- Department of Clinical Chemistry, St. Jansdal Hospital, Harderwijk, The Netherlands
| | | | - Ayse Y Demir
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ineke M Dijkstra
- Clinical Chemistry, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Silvia C Endenburg
- Department of Clinical Chemistry and Hematology, Dicoon, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Paula Engbers
- Department of Clinical Chemistry, Treant Care Group, Hoogeveen, The Netherlands
| | | | - Marcel J W Janssen
- Laboratory of Clinical Chemistry and Hematology, VieCuri Medical Center, Venlo, The Netherlands
| | | | - Maarten B Kok
- Saltro Diagnostic Center, Unilabs Netherlands, Utrecht, The Netherlands
| | - Stephan Kamphuis
- Eurofins Clinical Diagnostics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Adrian Kruit
- Medical Laboratory, Nij Smellinghe Hospital, Drachten, The Netherlands
| | | | - Albert Wolthuis
- Stichting Certe Medische Diagnostiek en Advies, Groningen, The Netherlands
| | - Anita Boelen
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Reenen AV, Berger M, Moreau E, Bekx E, Bruinink T, Kemper D, Lippen LV, Weusten J, Mrakovic A, Michielsen E, Vissers J, Theije FD, Nieuwenhuis J, Semjonow V, Mair J. Analytical performance of a single epitope B-type natriuretic peptide sandwich immunoassay on the Minicare platform for point-of-care diagnostics. Pract Lab Med 2019; 15:e00119. [PMID: 30984810 PMCID: PMC6444177 DOI: 10.1016/j.plabm.2019.e00119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/23/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022] Open
Abstract
Point-of-care B-type natriuretic peptide (BNP) testing with adequate analytical performance has the potential to improve patient flow and provide primary care givers with easy-to-use advanced diagnostic tools in the management of heart failure. We present the analytical evaluation of the Minicare BNP immunoassay under development on the Minicare I-20 platform for point-of-care testing. Analytical performance was evaluated using EDTA venous whole blood, EDTA plasma and capillary whole blood. Method comparison with a lab-testing system was performed using samples from 187 patients. Normal values were determined based on 160 healthy adults, aging from 19 to 70 years. Limit of blank (LoB), limit of detection (LoD) were determined to be 3.3 ng/L, 5.8 ng/L. Limit of quantitation (LoQ) in whole blood at 20% and 10% coefficient of variation (CV) was found < 9 ng/L and <30 ng/L respectively without significant differences between EDTA whole blood and EDTA plasma. Total CV was found to be from 6.7% to 9.7% for BNP concentrations between 92.6 and 3984 ng/L. The sample type comparison study demonstrated correlation coefficients between 0.97 and 0.99 with slopes between 1.03 and 1.09 between the different samples. Method comparison between Minicare BNP and Siemens ADVIA Centaur BNP demonstrated a correlation coefficient of 0.92 with a slope of 1.06. The 97.5% URL of a healthy population was calculated to be 72.6 ng/L. The Minicare BNP assay is a robust, easy-to-use and sensitive test for rapid determination of BNP concentrations that can be used in a near-patient setting.
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Key Words
- Analytical performance
- B-type natriuretic peptide
- BNP, B-type Natriuretic Peptide
- CI, confidence interval
- CLSI, clinical laboratory standards institute
- CV, coefficient of variation
- Capillary blood
- Diagnosis
- EDTA, ethylene-diamine-tetraacetic acid
- HAMA, human anti-mouse antibody
- HF, heart failure
- Heart failure
- K2-EDTA, dipotassium ethylene-diamine-tetraacetic acid
- Li-heparin, lithium heparin
- LoB, limit of blank
- LoD, limit of detection
- LoQ, limit of quantitation
- NP, Natriuretic Peptide
- NYHA, New York Heart Association
- POC, point-of-care
- Point-of-care
- RF, rheumatoid factor
- RFID, radiofrequency identification
- RT, room temperature
- SD, standard deviation
- URL, upper reference limit
- fTIR, frustrated total internal reflection
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Affiliation(s)
- Alexander van Reenen
- Minicare BV, Eindhoven, the Netherlands.,Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | - Mario Berger
- Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | | | - Edwin Bekx
- Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | - Tom Bruinink
- Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | | | | | - Jos Weusten
- Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | - Anita Mrakovic
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Joost Vissers
- Future Diagnostics Solutions, Wijchen, the Netherlands
| | - Femke de Theije
- Minicare BV, Eindhoven, the Netherlands.,Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | - Jeroen Nieuwenhuis
- Minicare BV, Eindhoven, the Netherlands.,Philips BG Emerging Businesses, Eindhoven, the Netherlands
| | | | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
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Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M. Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem 2008; 55:101-8. [PMID: 18988757 DOI: 10.1373/clinchem.2008.106427] [Citation(s) in RCA: 230] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endurance exercise can increase cardiac troponin (cTn) concentrations as high as those seen in cases of minor myocardial infarction. The inability of most cTn assays to reliably quantify cTn at very low concentrations complicates a thorough data analysis, and the clinical implications of such increases remain unclear. The application of recently developed highly sensitive cTn immunoassays may help resolve these problems. METHODS We evaluated the precommercial highly sensitive cardiac troponin T (hs-cTnT) assay from Roche Diagnostics and the Architect cardiac troponin I (cTnI-Architect) assay from Abbott Diagnostics by testing samples from a reference population of 546 individuals and a cohort of 85 marathon runners. We also measured the samples with the current commercial cTnT assay for comparison. RESULTS Although the hs-cTnT and cTnI-Architect assays were capable of measuring cTn concentrations at low concentrations (<0.01 microg/L), only the hs-cTnT assay demonstrated a CV of <10% at the 99th percentile of the reference population and a near-gaussian distribution of the measurements. After a marathon, 86% of the runners had cTnT concentrations greater than the 99th percentile with the hs-cTnT assay, whereas only 45% of the runners showed increased concentrations with the current cTnT assay. cTn concentrations remained significantly increased the day after the marathon. A multiple regression analysis demonstrated marathon experience and age to be significant predictors of postmarathon cTn concentrations (P < 0.05). CONCLUSIONS The hs-cTnT assay was the only assay tested with a performance capability sufficient to detect cTn concentrations in healthy individuals. The number of runners with increased cTn concentrations after a marathon depends highly on an assay's limit of detection (LOD). The assay with the lowest LOD, the hs-cTnT assay, showed that almost all runners had increased cTn concentrations. The clinical implications of these findings require further investigation.
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Affiliation(s)
- Alma Mingels
- Department of Clinical Chemistry, University Hospital Maastricht, Maastricht, the Netherlands
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