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Panteghini M. An improved implementation of metrological traceability concepts is needed to benefit from standardization of laboratory results. Clin Chem Lab Med 2024; 0:cclm-2024-0428. [PMID: 38687497 DOI: 10.1515/cclm-2024-0428] [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: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Non-harmonization of laboratory results represents a concrete risk for patient safety. To avoid harms, it is agreed that measurements by in vitro diagnostic medical devices (IVD-MD) on clinical samples should be traceable to higher-order references and adjusted to give the same result. However, metrological traceability is not a formal claim and has to be correctly implemented, which in practice does not happen for a non-negligible number of measurands. Stakeholders, such as higher-order reference providers, IVD manufacturers, and External Quality Assessment organizers, have major responsibilities and should improve their contribution by unambiguously and rigorously applying what is described in the International Organization for Standardization 17511:2020 standard and other documents provided by the international scientific bodies, such as Joint Committee on Traceability in Laboratory Medicine and IFCC. For their part, laboratory professionals should take responsibility to abandon non-selective methods and move to IVD-MDs displaying proper selectivity, which is one of the indispensable prerequisites for the correct implementation of metrological traceability. The practicality of metrological traceability concepts is not impossible but relevant education and appropriate training of all involved stakeholders are essential to obtain the expected benefits in terms of standardization.
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Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
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2
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Colombo G, Aloisio E, Panteghini M. Laboratory investigation of peritoneal fluids: an updated practical approach based on the available evidence. J Clin Pathol 2024:jcp-2023-209282. [PMID: 38538073 DOI: 10.1136/jcp-2023-209282] [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: 11/09/2023] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
Even though analysis of peritoneal fluids (PF) is often requested to medical laboratories for biochemical and morphological tests, there is still no mutual agreement on what the most appropriate way is to manage PF samples and which tests should be appropriately executed. In this update, we tried to identify the most useful tests for PF analysis to establish best practice indications. We performed a literature review and examined available guidelines to select the most appropriate tests by an evidence-based approach. Accordingly, the basic PF profile should include (1) serum to effusion albumin gradient and (2) automated cell counts with differential analysis. This profile allows to determine the PF nature, differentiating between 'high-albumin gradient' and 'low-albumin gradient' effusions, which helps to identify the pathophysiological process causing the ascites formation. Restricted to specific clinical situations, additional tests can be requested as follows: PF lactate dehydrogenase (LDH) and glucose, to exclude (LDH) or confirm (glucose) secondary bacterial peritonitis; PF total protein, to differentiate ascites of cardiac origin from other causes; PF (pancreatic) amylase, for the identification of pancreatic ascites; PF bilirubin, when a choleperitoneum is suspected; PF triglycerides, in differentiating chylous from pseudochylous ascites and PF creatinine, to detect intraperitoneal urinary leakage.
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Affiliation(s)
- Giulia Colombo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
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Cattaneo D, Panteghini M. Analytical performance specifications for measurement uncertainty in therapeutic monitoring of immunosuppressive drugs. Clin Chem Lab Med 2024; 62:e81-e83. [PMID: 37855255 DOI: 10.1515/cclm-2023-1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Dario Cattaneo
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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Çubukçu HC, Vanstapel F, Thelen M, van Schrojenstein Lantman M, Bernabeu-Andreu FA, Meško Brguljan P, Milinkovic N, Linko S, Panteghini M, Boursier G. APS calculator: a data-driven tool for setting outcome-based analytical performance specifications for measurement uncertainty using specific clinical requirements and population data. Clin Chem Lab Med 2024; 62:597-607. [PMID: 37978287 DOI: 10.1515/cclm-2023-0740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES According to ISO 15189:2022, analytical performance specifications (APS) should relate to intended clinical use and impact on patient care. Therefore, we aimed to develop a web application for laboratory professionals to calculate APS based on a simulation of the impact of measurement uncertainty (MU) on the outcome using the chosen decision limits, agreement thresholds, and data of the population of interest. METHODS We developed the "APS Calculator" allowing users to upload and select data of concern, specify decision limits and agreement thresholds, and conduct simulations to determine APS for MU. The simulation involved categorizing original measurand concentrations, generating measured (simulated) results by introducing different degrees of MU, and recategorizing measured concentrations based on clinical decision limits and acceptable clinical misclassification rates. The agreements between original and simulated result categories were assessed, and values that met or exceeded user-specified agreement thresholds that set goals for the between-category agreement were considered acceptable. The application generates contour plots of agreement rates and corresponding MU values. We tested the application using National Health and Nutrition Examination Survey data, with decision limits from relevant guidelines. RESULTS We determined APS for MU of six measurands (blood total hemoglobin, plasma fasting glucose, serum total and high-density lipoprotein cholesterol, triglycerides, and total folate) to demonstrate the potential of the application to generate APS. CONCLUSIONS The developed data-driven web application offers a flexible tool for laboratory professionals to calculate APS for MU using their chosen decision limits and agreement thresholds, and the data of the population of interest.
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Affiliation(s)
- Hikmet Can Çubukçu
- General Directorate of Health Services, Rare Diseases Department, Turkish Ministry of Health, Ankara, Türkiye
- Hacettepe University Institute of Informatics, Ankara, Türkiye
| | - Florent Vanstapel
- Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
- Department of Public Health, Biomedical Sciences Group, Catholic University Leuven, Leuven, Belgium
| | - Marc Thelen
- SKML, Foundation for Quality Assurance in Laboratory Medicine, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marith van Schrojenstein Lantman
- SKML, Foundation for Quality Assurance in Laboratory Medicine, Nijmegen, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Result Laboratory for Clinical Chemistry, Amphia Hospital Breda, Breda, The Netherlands
| | | | - Pika Meško Brguljan
- Department of Clinical Chemistry, University Clinic for Respiratory and Allergic Deseases, Golnik, Slovenia
| | - Neda Milinkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Guilaine Boursier
- Department of Molecular Genetics and Cytogenomics, Rare Diseases and Autoinflammatory Unit, CHU Montpellier, University of Montpellier, Montpellier, France
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Borrillo F, Capoferri A, Rovegno L, Panteghini M. Closed analyser lids do not reduce the measurement uncertainty of serum total carbon dioxide. Ann Clin Biochem 2024; 61:154-155. [PMID: 37978867 DOI: 10.1177/00045632231216598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
| | | | - Leila Rovegno
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Panteghini M. A Comment about Analytical Performance Specifications for the Combined Measurement Uncertainty Budget in the Implementation of Metrological Traceability of Parathyroid Hormone. Clin Chem 2024; 70:456-457. [PMID: 38029330 DOI: 10.1093/clinchem/hvad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Panteghini M. Analytical performance specifications for combined uncertainty budget in the implementation of metrological traceability. Clin Chem Lab Med 2024; 0:cclm-2023-1325. [PMID: 38311825 DOI: 10.1515/cclm-2023-1325] [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: 11/21/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Abstract
In addition to the correct implementation of calibration traceability, the definition and fulfillment of maximum allowable measurement uncertainty (MAU) are essential in assuring that laboratory measurements are clinically usable. Across the entire calibration hierarchy, three major contributors to the measurement uncertainty (MU) budget are identified, starting with the higher-order reference providers, extending through the in vitro diagnostic (IVD) manufacturers and their processes for assigning calibrator values, and ending with medical laboratories generating the random variability of results reported to clinicians. To understand if it is possible to achieve MAU and, consequently, to fix the possible drawbacks, the definition of combined MU budget limits across the entire calibration hierarchy has a central role. In particular, quality specifications for MU of reference and commercial calibrator materials should be defined according to the MAU on clinical samples. All involved stakeholders (i.e., higher-order reference providers, IVD manufacturers, medical laboratories) should be prepared to improve their performance whenever the clinical application of the test is made questionable by the failure to achieve MAU.
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Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
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Rovegno L, Civera E, Infusino I, Panteghini M. State of the art of measurement uncertainty of serum ferritin. Clin Chem Lab Med 2024; 62:e6-e8. [PMID: 37466239 DOI: 10.1515/cclm-2023-0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Leila Rovegno
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Elisa Civera
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Ilenia Infusino
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
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Panteghini M. Documenting and validating metrological traceability of serum alanine aminotransferase measurements: a priority for medical laboratory community for providing high quality service in hepatology. Clin Chem Lab Med 2024; 62:249-252. [PMID: 37698363 DOI: 10.1515/cclm-2023-0900] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
Alanine aminotransferase (ALT) represents the first-level test to detect individuals with hepatocellular damage of any etiology. However, it has been highlighted that the lack of assay harmonization may lead to overdiagnosis and unnecessary further testing if guideline-recommended fixed cut-offs are uncritically employed. To solve the issue of ALT (dis)harmonization and improve the interpretation of its values, a series of urgent actions for documenting and validating metrological traceability of serum ALT measurements, as described in this paper, are no longer postponeable. It is time that all medical laboratory stakeholders (in vitro diagnostic manufacturers, laboratorians, external quality assessment scheme organizers) actively co-operate to implement the ALT standardization in a concerted action following well-established theoretical assumptions and applying experimental approaches described in literature.
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Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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Bianchi G, Frusciante E, Colombo G, Infusino I, Aloisio E, Panteghini M. Validation of metrological traceability of the new generation of Abbott Alinity alkaline phosphatase assay. Clin Chem Lab Med 2024; 62:280-287. [PMID: 37614121 DOI: 10.1515/cclm-2023-0553] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Recently, Abbott Diagnostics marketed a new generation of Alinity enzyme assays, introducing a multiparametric calibrator [Consolidated Chemistry Calibrator (ConCC)] in place of or in addition to factor-based calibrations. For alkaline phosphatase (ALP), both calibration options are offered, i.e., with ConCC (ALP2) and with an experimental calibration factor (ALP2F). Both options are declared traceable to the 2011 IFCC reference measurement procedure (RMP). Before to replace the old generation (ALP1) with the new one, we decided to validate the trueness of ALP2/ALP2F. METHODS Three approaches were employed: (a) preliminary comparison on 48 native frozen serum samples with ALP1, of which traceability to RMP was previously successfully verified; (b) examination of three banked serum pools (BSP) with values assigned by RMP; (c) direct comparison with RMP on a set of 24 fresh serum samples. Bias estimation and regression studies were performed, and the standard measurement uncertainty associated with ALP measurements on clinical samples (uresult) was estimated and compared with established analytical performance specifications (APS). ConCC commutability was also assessed. RESULTS A positive proportional bias was found with both ALP2 and ALP2F when compared to ALP1 and RMP. This positive bias was confirmed on BSP: in average, +13.1 % for ALP2 and +10.0 % for ALP2F, respectively. uresult were 13.28 % for ALP2 and 10.04 % for ALP2F, both not fulfilling the minimum APS of 4.0 %. Furthermore, ConCC was not commutable with clinical samples. CONCLUSIONS Our results unearth problems in the correct implementation of traceability of Alinity ALP2/ALP2F, with the risk for the new assay to be unfit for clinical purposes.
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Affiliation(s)
- Giorgia Bianchi
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Erika Frusciante
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Giulia Colombo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ilenia Infusino
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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Panteghini M. What the Milan conference has taught us about analytical performance specification model definition and measurand allocation. Clin Chem Lab Med 2024; 0:cclm-2023-1257. [PMID: 38277658 DOI: 10.1515/cclm-2023-1257] [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: 11/07/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
Analytical performance specifications (APS) represent the criteria that specify the quality required for laboratory test information to satisfy clinical needs. In 2014 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) considered timely to update the topic of APS by organizing a conference in Milan in which some strategic concepts were proposed. Here I summarize the essential points representing the EFLM Strategic Conference heritage and discuss the approaches that will permit us to become more concrete, including roles and main actions expected from each of involved stakeholders for contributing a quantum leap forward in the way of practicality of Milan consensus about APS.
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Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
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12
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Stefanska A, Bergmann K, Suwała S, Mankowska-Cyl A, Kozinski M, Junik R, Krintus M, Panteghini M. Performance Evaluation of a Novel Non-Invasive Test for the Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Fatty Liver Disease. Metabolites 2024; 14:52. [PMID: 38248855 PMCID: PMC10819013 DOI: 10.3390/metabo14010052] [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: 12/15/2023] [Revised: 01/07/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) may progress to advanced liver fibrosis (ALF). We evaluated the diagnostic accuracy of a novel Liver Fibrosis Risk Index (LFRI) in MAFLD subjects using transient elastography (TE) as the reference method for liver fibrosis measurement and then the diagnostic performance of a new two-step non-invasive algorithm for the detection of ALF risk in MAFLD, using Fibrosis-4 (FIB-4) followed by LFRI and comparing it to the reference algorithm based on FIB-4 and TE. We conducted a prospective study on 104 MAFLD European adult subjects. All consenting subjects underwent TE and measurements of FIB-4 and LFRI. For FIB-4 and TE, validated cut-offs were used. An ROC analysis showed that LFRI diagnosed severe fibrosis with moderate accuracy in MAFLD subjects with a negative predictive value above 90%. Using the new algorithm with LFRI thresholds recommended by the manufacturer, the number of subjects classified into ALF risk groups (low, intermediate, or high) differed significantly when compared with the reference algorithm (p = 0.001), with moderate agreement between them (weighted kappa (95% CI) = 0.59 (0.41-0.77)). To improve the performance of the LFRI-based algorithm, we modified cut-off points based on ROC curves obtained by dividing the study population according to the reference algorithm and observed no difference between algorithms (p = 0.054) in categorizing ALF risk, with a slight increase in the total agreement (weighted kappa (95% CI) = 0.63 (0.44-0.82)). Our findings suggest that using the novel LFRI as a second-line test may represent a potential alternative for liver fibrosis risk stratification in MAFLD patients; however, modified cut-offs are needed to optimize its performance.
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Affiliation(s)
- Anna Stefanska
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (K.B.); (A.M.-C.); (M.K.); (M.P.)
| | - Katarzyna Bergmann
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (K.B.); (A.M.-C.); (M.K.); (M.P.)
| | - Szymon Suwała
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (S.S.); (R.J.)
| | - Aneta Mankowska-Cyl
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (K.B.); (A.M.-C.); (M.K.); (M.P.)
| | - Marek Kozinski
- Department of Cardiology and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University in Gdansk, 81-519 Gdynia, Poland;
| | - Roman Junik
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (S.S.); (R.J.)
| | - Magdalena Krintus
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (K.B.); (A.M.-C.); (M.K.); (M.P.)
| | - Mauro Panteghini
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (K.B.); (A.M.-C.); (M.K.); (M.P.)
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Rovegno L, Infusino I, Dolci A, Panteghini M. Appropriateness of serum free light chain orders in an academic medical institution. Am J Clin Pathol 2023; 160:540. [PMID: 37449364 DOI: 10.1093/ajcp/aqad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
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Sandberg S, Fauskanger P, Johansen JV, Keller T, Budd J, Greenberg N, Rej R, Panteghini M, Delatour V, Ceriotti F, Deprez L, Camara JE, MacKenzie F, Lyle AN, van der Hagen E, Burns C, Greg Miller W. Recommendations for Setting a Criterion and Assessing Commutability of Sample Materials Used in External Quality Assessment/Proficiency Testing Schemes. Clin Chem 2023; 69:1227-1237. [PMID: 37725906 DOI: 10.1093/clinchem/hvad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
It is important for external quality assessment materials (EQAMs) to be commutable with clinical samples; i.e., they should behave like clinical samples when measured using end-user clinical laboratory in vitro diagnostic medical devices (IVD-MDs). Using commutable EQAMs makes it possible to evaluate metrological traceability and/or equivalence of results between IVD-MDs. The criterion for assessing commutability of an EQAM between 2 IVD-MDs is that its result should be within the prediction interval limits based on the statistical distribution of the clinical sample results from the 2 IVD-MDs being compared. The width of the prediction interval is, among other things, dependent on the analytical performance characteristics of the IVD-MDs. A presupposition for using this criterion is that the differences in nonselectivity between the 2 IVD-MDs being compared are acceptable. An acceptable difference in nonselectivity should be small relative to the analytical performance specifications used in the external quality assessment scheme. The acceptable difference in nonselectivity is used to modify the prediction interval criterion for commutability assessment. The present report provides recommendations on how to establish a criterion for acceptable commutability for EQAMS, establish the difference in nonselectivity that can be accepted between IVD-MDs, and perform a commutability assessment. The report also contains examples for performing a commutability assessment of EQAMs.
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Affiliation(s)
- Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Pernille Fauskanger
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | | | - Jeffrey Budd
- Jeff Budd Consulting, St. Paul, MN, United States
| | - Neil Greenberg
- Neil Greenberg Consulting, LLC, Rochester, NY, United States
| | - Robert Rej
- Department of Biomedical Sciences, School of Public Health, State University of New York at Albany, Albany, NY, United States
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine, University of Milan, Milan, Italy
| | | | | | - Liesbet Deprez
- European Commission, Joint Research Centre, Directorate F, Geel, Belgium
| | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD, United States
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alicia N Lyle
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, United Kingdom
| | - W Greg Miller
- Virginia Commonwealth University, Richmond, VA, United States
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Capoferri A, Infusino I, Panteghini M. A further monoclonal antibody-based immunoturbidimetry option for measuring faecal elastase on the Optilite analyser. Ann Clin Biochem 2023; 60:428-429. [PMID: 37471652 DOI: 10.1177/00045632231190516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
| | - Ilenia Infusino
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
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Thelen MHM, van Schrojenstein Lantman M, Boursier G, Vanstapel F, Panteghini M. In reply to: Limitations in using the EFLM WG-A/ISO approach for assessment of reagent lot variability. Clin Chem Lab Med 2023; 61:e218-e220. [PMID: 37261942 DOI: 10.1515/cclm-2023-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Marc H M Thelen
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Foundation for Quality Assurance in Laboratory Medicine (SKML), Nijmegen, the Netherlands
| | | | - Guilaine Boursier
- Department of Genetics, Rare Diseases and Personalized, Medicine Rare Diseases and Autoinflammatory Unit, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Florent Vanstapel
- Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
- Department of Public Health, Laboratory Medicine, Biomedical Sciences Group, University Hospital Leuven, Leuven, Belgium
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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17
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Miller WG, Keller T, Budd J, Johansen JV, Panteghini M, Greenberg N, Delatour V, Ceriotti F, Deprez L, Rej R, Camara JE, MacKenzie F, Lyle AN, van der Hagen E, Burns C, Fauskanger P, Sandberg S. Recommendations for Setting a Criterion for Assessing Commutability of Secondary Calibrator Certified Reference Materials. Clin Chem 2023; 69:966-975. [PMID: 37566391 DOI: 10.1093/clinchem/hvad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
A secondary higher-order calibrator is required to be commutable with clinical samples to be suitable for use in the calibration hierarchy of an end-user clinical laboratory in vitro diagnostic medical device (IVD-MD). Commutability is a property of a reference material that means results for a reference material and for clinical samples have the same numeric relationship, within specified limits, across the measurement procedures for which the reference material is intended to be used. Procedures for assessing commutability have been described in the literature. This report provides recommendations for establishing a quantitative criterion to assess the commutability of a certified reference material (CRM). The criterion is the maximum allowable noncommutability bias (MANCB) that allows a CRM to be used as a calibrator in a calibration hierarchy for an IVD-MD without exceeding the maximum allowable combined standard uncertainty for a clinical sample result (umaxCS). Consequently, the MANCB is derived as a fraction of the umaxCS for the measurand. The suitability of an MANCB for practical use in a commutability assessment is determined by estimating the number of measurements of clinical samples and CRMs required based on the precision performance and nonselectivity for the measurand of the measurement procedures in the assessment. Guidance is also provided for evaluating indeterminate commutability conclusions and how to report results of a commutability assessment.
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Affiliation(s)
- W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Jeffrey Budd
- Jeff Budd Consulting, St. Paul, MN, United States
| | | | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine, University of Milan, Milan, Italy
| | - Neil Greenberg
- Neil Greenberg Consulting, LLC, Rochester, NY, United States
| | | | | | - Liesbet Deprez
- European Commission, Joint Research Centre, Directorate F, Geel, Belgium
| | - Robert Rej
- Department of Biomedical Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Johanna E Camara
- National Institute of Standards and Technology, Gaithersburg, MD, United States
| | - Finlay MacKenzie
- Birmingham Quality/UK NEQAS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alicia N Lyle
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Chris Burns
- National Institute for Biological Standards and Control, A Centre of the MHRA, Hertfordshire, United Kingdom
| | - Pernille Fauskanger
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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18
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Miller WG, Panteghini M, Wielgosz R. Implementing metrological traceability of C-reactive protein measurements: consensus summary from the Joint Committee for Traceability in Laboratory Medicine Workshop. Clin Chem Lab Med 2023; 61:1558-1560. [PMID: 37253275 DOI: 10.1515/cclm-2023-0498] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
The Joint Committee for Traceability in Laboratory Medicine (JCTLM) currently lists the secondary commutable certified reference material (CRM) ERM DA-474/IFCC (DA-474) "C-Reactive Protein in Human Serum" and two generic immunoassay-based method principles as the basis for implementing the metrological traceability of C-reactive protein (CRP) measurements by end-user measurement procedures used by medical laboratories. The current metrological traceability has produced well harmonized results for clinical samples among different end-user measurement procedures. New higher-order pure substance and secondary commutable CRMs have been nominated for listing by the JCTLM. However, the data supporting performance of these new candidate CRMs, including use of new mass spectrometry based candidate reference measurement procedures (RMPs), was not clear regarding the influence that introducing these new CRMs would have on the current well harmonized results achieved with the existing metrological traceability to DA-474. The clinically relevant CRP measurand in blood serum or plasma is a pentamer of identical subunits, which adds complexity to the application of higher-order CRMs and RMPs. The JCTLM convened a workshop in December 2022 to review the appropriate implementation of metrological traceability of CRP measurements. The workshop consensus was that the extent-of-equivalence data must include considerations about the impact of a new CRM when used for its intended purpose in the calibration hierarchies of existing end-user measuring systems; and that a new RMP must compare results with another existing well validated candidate RMP or with a globally available end-user measurement system.
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Affiliation(s)
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Robert Wielgosz
- Bureau International des Poids et Mesures (BIPM), Sevres, France
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19
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Borrillo F, Panteghini M. Current performance of C-reactive protein determination and derivation of quality specifications for its measurement uncertainty. Clin Chem Lab Med 2023; 61:1552-1557. [PMID: 36773318 DOI: 10.1515/cclm-2023-0069] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023]
Abstract
From External Quality Assessment data, current harmonization of CRP measuring systems appears to be satisfactory, the inter-assay CV being well below 10%. The inter-method variability is even better (close to 3%) when the widely used measuring systems are compared at CRP concentrations employed as cut-off for detecting sub-clinical infection (i.e., 10.0 mg/L) and measurement variability estimated, according to ISO 20914:2019 Technical Specification, from the intermediate within-lab reproducibility of 6-month consecutive measurement data. According to the state-of-the-art model (which is better suited for CRP), the maximum allowable measurement uncertainty (MAU) for CRP measurement on clinical samples with 10.0 mg/L concentrations is 3.76% (desirable quality). As measurement uncertainty (MU) of the only available reference material (ERM-DA474/IFCC) is ∼3%, to fulfil desirable MAU on clinical samples, IVD manufacturers should work to keep the contribution of remaining MU sources (commercial calibrator and intermediate within-lab reproducibility) lower than 2.3%.
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Affiliation(s)
- Francesca Borrillo
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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20
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Aloisio E, Colombo G, Dolci A, Panteghini M. C-reactive protein and clinical outcome in COVID-19 patients: the importance of harmonized measurements. Clin Chem Lab Med 2023; 61:1546-1551. [PMID: 37036741 DOI: 10.1515/cclm-2023-0276] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
C-reactive protein (CRP) is a cytokine-mediated acute phase reactant with a recognized role in inflammatory conditions and infectious disease. In coronavirus disease 2019 (COVID-19), elevated CRP concentrations in serum were frequently detected and significantly associated with poor outcome in terms of disease severity, need for intensive care, and in-hospital death. For these reasons, the marker was proposed as a powerful test for prognostic classification of COVID-19 patients. In most of available publications, there was however confounding information about how interpretative criteria for CRP in COVID-19 should be derived, including quality of employed assays and optimal cut-off definition. Assuring result harmonization and controlling measurement uncertainty in terms of performance specifications are fundamental to allow worldwide application of clinical information according to specific CRP thresholds and to avoid risk of patient misclassification.
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21
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Panteghini M. Developments in reference measurement systems for C-reactive protein and the importance of maintaining currently used clinical decision-making criteria. Clin Chem Lab Med 2023; 61:1537-1539. [PMID: 37267501 DOI: 10.1515/cclm-2023-0558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
- Joint Committee for Traceability in Laboratory Medicine (JCTLM) Task Force on Reference Measurement System Implementation, Milan, Italy
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22
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Panteghini M. Evaluating and monitoring analytical quality by internal quality control. Clin Biochem 2023; 118:110594. [PMID: 37271492 DOI: 10.1016/j.clinbiochem.2023.110594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Mauro Panteghini
- Research Center for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy.
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23
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Birindelli S, Tarkowski MS, Gallucci M, Schiuma M, Covizzi A, Lewkowicz P, Aloisio E, Falvella FS, Dolci A, Riva A, Galli M, Panteghini M. Corrigendum: Definition of the immune parameters related to COVID-19 severity. Front Immunol 2023; 14:1219179. [PMID: 37292212 PMCID: PMC10246498 DOI: 10.3389/fimmu.2023.1219179] [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: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2022.850846.].
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Affiliation(s)
- Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Maciej S. Tarkowski
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Marcello Gallucci
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | - Marco Schiuma
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alice Covizzi
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
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24
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Chibireva M, Szoke D, Borille S, Rovegno L, Panteghini M. Association of maternal folate and B12 vitamin status with gestational diabetes mellitus: still an open issue. Clin Chim Acta 2023; 544:117307. [PMID: 37019326 DOI: 10.1016/j.cca.2023.117307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/27/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES There is conflicting evidence about the role of folate and B12in gestational diabetes mellitus (GDM) onset. The association of vitamin status with GDM was therefore revalued, also measuring the B12active form holotranscobalamin. METHODS 677 women were evaluated at 24-28 weeks of gestation when OGTT was carried out. The 'one-step' strategy was employed for GDM diagnosis. Odds ratio (OR) of having GDM was estimated to quantify the association with vitamin levels. RESULTS 180 women (26.6%) had GDM. They were older (median, 34.6 vs. 33.3 years, p=0.019) and had higher body mass index (BMI) (25.8 vs. 24.1 kg/m2, p<0.001). Multiparous women had lower levels of all evaluated micronutrients, while overweight lowered both folate and total B12, but not holotranscobalamin. Lower total B12(270 vs. 290 ng/L, p=0.005), but not holotranscobalamin, was observed in GDM, being weakly negatively correlated with fasting glycemia (r=-0.11, p=0.005) and 1-h OGTT serum insulin (r=-0.09, p=0.014). At multivariate analysis, age, BMI and multiparity remained the strongest GDM predictors, while total B12(but not holotranscobalamin and folate) showed a slight protective effect (OR=0.996, p=0.038). CONCLUSIONS A weak association between total B12 levels and GDM risk was shown, but it was not confirmed when holotranscobalamin was measured.
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Affiliation(s)
| | | | | | | | - Mauro Panteghini
- Luigi Sacco University Hospital, Milan, Italy; Luigi Sacco Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
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25
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Birindelli S, Aiello GB, Panteghini M. Optimizing order entry presentation: a simple tool to help decrease redundancy in coagulation testing. Am J Clin Pathol 2023; 159:517-518. [PMID: 36897263 DOI: 10.1093/ajcp/aqad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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26
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Borrillo F, Pasqualetti S, Panteghini M. Measurement Uncertainty of Thyroid Function Tests on a Chemiluminescent Microparticle Immunoassay System Needs to Be Improved. J Appl Lab Med 2023; 8:420-422. [PMID: 36645382 DOI: 10.1093/jalm/jfac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Francesca Borrillo
- Research Center for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Sara Pasqualetti
- Research Center for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Research Center for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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27
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Arrigo C, Aloisio E, Rovegno L, Dolci A, Panteghini M. The laboratory investigation of pleural fluids: An update based on the available evidence. Ann Clin Biochem 2023:45632231157547. [PMID: 36860132 DOI: 10.1177/00045632231157547] [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] [Indexed: 03/03/2023]
Abstract
Selecting appropriate laboratory tests based on available evidence is central to improve clinical effectiveness and impacting on patient outcome. Although long studied, there is no mutual agreement upon pleural fluid (PF) management in the laboratory context. Given the experienced confusion about the real contribution of laboratory investigations to guide clinical interpretation, in this update, we tried to identify useful tests for the PF analysis, aiming to unravel critical points and to define a common line in requesting modalities and practical management. We performed a careful literature review and a deepened study on available guidelines to finalize an evidence-based test selection, intended for clinicians' use to streamline PF management. The following tests depicted the basic PF profile routinely needed: (1) abbreviated Light's criteria (PF/serum total protein ratio and PF/serum lactate dehydrogenase ratio) and (2) cell count with differential analysis of haematological cells. This profile fulfils the primary goal to determine the PF nature and discriminate between exudative and transudative effusions. In specific circumstances, clinicians may consider additional tests as follows: the albumin serum to PF gradient, which reduces exudate misclassification rate by Light's criteria in patients with cardiac failure assuming diuretics; PF triglycerides, in differentiating chylothorax from pseudochylothorax; PF glucose, for identification of parapneumonic effusions and other causes of effusion, such as rheumatoid arthritis and malignancy; PF pH, in suspected infectious pleuritis and to give indications for pleural drainage; and PF adenosine deaminase, for a rapid detection of tuberculous effusion.
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Affiliation(s)
- Claudia Arrigo
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Leila Rovegno
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, 472674ASST Fatebenefratelli-Sacco, Milan, Italy
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28
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Miller WG, Greenberg N, Panteghini M, Budd JR, Johansen JV. Guidance on Which Calibrators in a Metrologically Traceable Calibration Hierarchy Must Be Commutable with Clinical Samples. Clin Chem 2023; 69:228-238. [PMID: 36660772 DOI: 10.1093/clinchem/hvac226] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023]
Abstract
Equivalent results for the same measurand in clinical samples (CSs), measured using different end-user in-vitro diagnostic medical devices (IVD-MDs), are essential for the application of clinical practice guidelines for diagnosis, treatment, monitoring, or risk assessment. The International Organization for Standardization (ISO) document 17511:2020 specifies how to establish metrological traceability to the highest available reference system component to enable equivalent results among IVD-MDs. Commutability with CSs is an essential property of a reference material used as a calibrator in a calibration hierarchy. However, not all calibrators in a calibration hierarchy are required to be commutable; different calibration hierarchies have different requirements for which calibrators must be commutable with CSs. Because assessment of commutability is a substantial effort, it is therefore important to determine which calibrators need to be commutable when implementing a calibration hierarchy. We provide guidance on which calibrators must be commutable with CSs, when a correction for any noncommutability bias is appropriate, and when commutability of a calibrator with CSs is not required for various types of calibration hierarchies described in ISO 17511:2020.
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Affiliation(s)
- W Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | | | - Jesper V Johansen
- Department of Research and Development, Radiometer Medical ApS, Copenhagen, Denmark
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29
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Krintus M, Panteghini M. Judging the clinical suitability of analytical performance of cardiac troponin assays. Clin Chem Lab Med 2023; 61:801-810. [PMID: 36798043 DOI: 10.1515/cclm-2023-0027] [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: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
New millennium diagnostic criteria for acute myocardial infarction precipitated a revolutionary shift from an approach based primarily on electrocardiography and clinical symptoms to a strategy based on biomarkers, and preferably cardiac troponins (cTn) I and T. In the last 20 years, clinical recommendations have strengthened the role of cTn and led to the development of highly sensitive (hs-cTn) assays, which are now leading players in all current clinical practice guidelines. To optimize the clinical use of these hs-cTn assays, focus on their analytical aspects has become increasingly important, emphasizing the need for the establishment of suitable analytical performance by the definition and implementation of appropriate specifications. An accurate estimate of measurement uncertainty, together with the acquisition of the highest analytical quality when very low concentrations of hs-cTn are measured, are essential requirements and should represent a practical laboratory standard in assuring optimal clinical use. Additional goals for further improving the quality of laboratory information should be the establishment of robust data concerning biological variation of cTn and the resolution of practical challenges opposed to the harmonization of cTn I results obtained by differing commercial measuring systems.
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Affiliation(s)
- Magdalena Krintus
- Department of Laboratory Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Torun, Poland
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
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30
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Braga F, Pasqualetti S, Borrillo F, Capoferri A, Chibireva M, Rovegno L, Panteghini M. Definition and application of performance specifications for measurement uncertainty of 23 common laboratory tests: linking theory to daily practice. Clin Chem Lab Med 2023; 61:213-223. [PMID: 36282875 DOI: 10.1515/cclm-2022-0806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022]
Abstract
Laboratories should estimate and validate [using analytical performance specifications (APS)] the measurement uncertainty (MU) of performed tests. It is therefore essential to appropriately define APS for MU, but also to provide a perspective on suitability of the practical application of these APS. In this study, 23 commonly ordered measurands were allocated to the models defined during the 2014 EFLM Strategic Conference to derive APS for MU. Then, we checked if the performance of commercial measuring systems used in our laboratory may achieve them. Most measurands (serum alkaline phosphatase, aspartate aminotransferase, creatine kinase, γ-glutamyltransferase, lactate dehydrogenase, pancreatic amylase, total proteins, immunoglobulin G, A, M, magnesium, urate, and prostate-specific antigen, plasma homocysteine, and blood red and white cells) were allocated to the biological variation (BV) model and desirable APS were defined accordingly (2.65%, 4.75%, 7.25%, 4.45%, 2.60%, 3.15%, 1.30%, 2.20%, 2.50%, 2.95%, 1.44%, 4.16%, 3.40%, 3.52%, 1.55%, and 5.65%, respectively). Desirable APS for serum total cholesterol (3.00%) and urine albumin (9.00%) were derived using outcome-based model. Lacking outcome-based information, serum albumin, high-density lipoprotein cholesterol, triglycerides, and blood platelets were temporarily reallocated to BV model, the corresponding desirable APS being 1.25%, 2.84%, 9.90%, and 4.85%, respectively. A mix between the two previous models was employed for serum digoxin, with a 6.00% desirable APS. In daily practice by using our laboratory systems, 16 tests fulfilled desirable and five minimum APS, while two (serum albumin and plasma homocysteine) exceeded goals, needing improvements.
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Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Sara Pasqualetti
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | | | - Alessia Capoferri
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mariia Chibireva
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Leila Rovegno
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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31
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Bergmann K, Stefanska A, Krintus M, Szternel L, Panteghini M, Sypniewska G. Association between Fasting and Postprandial Levels of Liver Enzymes with Metabolic Syndrome and Suspected Prediabetes in Prepubertal Children. Int J Mol Sci 2023; 24:ijms24021090. [PMID: 36674606 PMCID: PMC9861425 DOI: 10.3390/ijms24021090] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Elevated liver enzyme activity may be associated with metabolic syndrome (MetS); however, it is not included in the MetS definition for children. Postprandial changes in the levels of biochemistry tests are related to manifestations of metabolic abnormalities. We assessed the association between fasting and postprandial liver enzymes levels with MetS and elevated hemoglobin A1c (HbA1c) in children aged 9-11. The study included 51 girls and 48 boys, all presumably healthy. In all participants' anthropometric indices, fasting glucose, insulin, lipid profile and HbA1c were measured. Enzymes, including alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT), were assayed in fasting and postprandial states. Individuals were divided into subgroups: with (MetS(+): n = 26); without MetS (MetS(-): n = 73); with HbA1c levels ≤ 5.3% (n = 39); and ≥5.7% (n = 11). Elevated fasting GGT levels were found in 23% of MetS(+) children and rarely in MetS(-) children; increased postprandial GGT was noted in 35% of MetS(+) individuals. Postprandial GGT changes tend to predict MetS (OR = 1.16; p = 0.092). Increased fasting ALT was found rarely in MetS(+) children, but did not occur in MetS(-) children. HbA1c ≥ 5.7% occurred rarely and neither fasting ALT nor GGT were related to elevated HbA1c. However, postprandial change of ALT was a good positive predictor of increased HbA1c (OR = 1.33; p = 0.021). Postprandial GGT performs better as an indicator of metabolic syndrome occurrence, and instead postprandial ALT may predict prediabetes in prepubertal children.
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Affiliation(s)
- Katarzyna Bergmann
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
- Correspondence:
| | - Anna Stefanska
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Magdalena Krintus
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Lukasz Szternel
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland
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32
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Panteghini M. Redesigning the surveillance of in vitro diagnostic medical devices and of medical laboratory performance by quality control in the traceability era. Clin Chem Lab Med 2022; 61:759-768. [PMID: 36542481 DOI: 10.1515/cclm-2022-1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Abstract
IVD manufacturers have total responsibility in terms of the traceability of marketed in vitro diagnostic medical devices (IVD-MD). This includes the provision of a quality control (QC) material as a part of the measuring system, suitable for traceability verification and alignment surveillance by end-users in daily practice. This material [to be used for the internal QC (IQC) component I as described in this paper] should have unbiased target values and an acceptability range corresponding to analytical performance specifications (APS) for suitable (expanded) measurement uncertainty (MU) on clinical samples. On the other hand, medical laboratories (by the IQC component II as described in this paper) should improve the IQC process and its judging criteria to establish a direct link between their performance, estimated as MU of provided results, and APS defined according to recommended models to apply corrective actions if the performance is worsening with the risk to jeopardize the clinical validity of test results. The participation to external quality assessment (EQA) programs that meet specific metrological criteria is also central to the evaluation of performance of IVD-MDs and of medical laboratories in terms of harmonization and clinical suitability of their measurements. In addition to the use of commutable materials, in this type of EQA it is necessary to assign values to them with selected reference procedures and to define and apply maximum allowable APS to substantiate the suitability of laboratory measurements in the clinical setting.
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Affiliation(s)
- Mauro Panteghini
- Centre for Metrological Traceability in Laboratory Medicine (CIRME) , University of Milan , Milano , Italy
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33
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Braga F, Pasqualetti S, Frusciante E, Borrillo F, Chibireva M, Panteghini M. Harmonization Status of Serum Ferritin Measurements and Implications for Use as Marker of Iron-Related Disorders. Clin Chem 2022; 68:1202-1210. [PMID: 35794075 DOI: 10.1093/clinchem/hvac099] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Serum ferritin is considered a suitable biomarker of iron-related disorders. However, data about the comparability of results among commercial measuring systems (MSs) are contradictory. We performed an intercomparison study aimed at verifying the current interassay variability and its impact on clinical application of the test. Obtaining this information is vital because manufacturers continue to claim calibration alignment to different WHO preparations, which are not related to each other in terms of traceability. METHODS Four widely used MSs were evaluated. The interassay agreement was verified using 39 human serum pools. The recovery of WHO International Standard (IS) 94/572 (the only reference material available at the time of the study) was evaluated, after assessing the material commutability. Finally, an approach for harmonizing ferritin results was proposed. RESULTS Highly significant differences (P < 0.00001) among ferritin concentrations assayed by different MSs were detected and the interassay CV (median 22.9%; interquartile range 21.8-25.5) overlapped the desirable intermethod bias (24.6%). IS 94/572 was commutable for use only with Access and Centaur, with Access being the only MS correctly recovering its assigned value. Accordingly, we used regression data against Access to recalibrate MSs, indirectly aligning them to IS 94/572, with a substantial improvement in degree of harmonization and traceability to higher-order reference. CONCLUSIONS The harmonization among evaluated ferritin MSs is far from optimal, with the implementation of traceability to different WHO ISs being a factor of confusion. A recalibration approach, however, would permit measurement harmonization, allowing the use of common decision thresholds.
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Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Sara Pasqualetti
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Erika Frusciante
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Francesca Borrillo
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Mariia Chibireva
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
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34
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Szoke D, Robbiano C, Dolcini R, Montefusco L, Aiello GB, Caruso S, Ottolenghi A, Birindelli S, Panteghini M. Incidence and status of insulin secretion in pregnant women with flat plasma glucose profiles during oral glucose tolerance test. Clin Biochem 2022; 109-110:23-27. [PMID: 36041500 DOI: 10.1016/j.clinbiochem.2022.08.010] [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: 02/14/2022] [Revised: 06/30/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Flat shaped glucose curves (FC) during oral glucose tolerance test (OGTT) in pregnant women (PW) are a not uncommon finding. We aimed to define the FC incidence in a large PW cohort and to describe the status of insulin and C-peptide secretion in women with FC when compared with a well-matched control group. METHODS 1050 PW performing OGTT for gestational diabetes screening were enrolled. An increase <6% in plasma glucose (PG) during OGTT defined a FC. Serum samples for measuring insulin and C-peptide were also obtained. RESULTS 61 (5.8%) women showed a FC. 60 of them, paired to a group of 60 no-FC women matched for age, body mass index and gestational age, were further investigated. C-peptide and insulin concentrations were significantly lower (P<0.001) in FC in both 1-h and 2-h OGTT samples. When incremental area under the curves (AUC) normalized to PG were estimated, only AUCinsulin remained however significantly lower. The insulin sensitivity index was higher in FC. CONCLUSIONS PW with FC showed a hypersensitivity to insulin with normal β-cell function. Moreover, a delayed glucose absorption could be hypothesised because of the slight but continuously increasing shape of insulin curve found in FC group. Both phenomena could occur in parallel and contribute to FC.
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Affiliation(s)
- Dominika Szoke
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy.
| | | | - Roberta Dolcini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Laura Montefusco
- UOC Endocrinologia e Diabetologia, ASST Fatebenefratelli-Sacco, Milano, Italy
| | | | - Simone Caruso
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Anna Ottolenghi
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Sarah Birindelli
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy; Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", Università degli Studi, Milano, Italy
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35
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Panteghini M, Dolci A, Birindelli S, Szoke D, Aloisio E, Caruso S. Pursuing appropriateness of laboratory tests: a 15-year experience in an academic medical institution. Clin Chem Lab Med 2022; 60:1706-1718. [PMID: 35998662 DOI: 10.1515/cclm-2022-0683] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
Appropriateness in Laboratory Medicine has been the object of various types of interventions. From published experiences, it is now clear that to effectively manage the laboratory test demand it is recommended to activate evidence-based preventative strategies stopping inappropriate requests before they can reach the laboratory. To guarantee appropriate laboratory test utilization, healthcare institutions should implement and optimize a computerized provider order entry (CPOE), exploiting the potential of electronic requesting as "enabling factor" for reinforcing appropriateness and sustaining its effects over time. In our academic institution, over the last 15 years, our medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use. The following types of intervention were implemented: (1) applying specific recommendations supported by monitoring by CPOE as well as a continuous consultation with clinicians (tumour markers); (2) removing outdated tests and avoiding redundant duplications (cardiac markers, pancreatic enzymes); (3) order restraints to selected wards and gating policy (procalcitonin, B-type natriuretic peptide, homocysteine); (4) reflex testing (bilirubin fractions, free prostate-specific antigen, aminotransferases, magnesium in hypocalcemia); and (5) minimum retesting interval (D-Dimer, vitamin B12, C-reactive protein, γ-glutamyltranspeptidase). In this paper, we reviewed these interventions and summarized their outcomes primarily related to the changes in total test volumes and cost savings, without neglecting patient safety. Our experience confirmed that laboratory professionals have an irreplaceable role as "stewards" in designing, implementing, evaluating, and maintaining interventions focused to improving test appropriateness.
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Affiliation(s)
- Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi, Milan, Italy
| | - Alberto Dolci
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi, Milan, Italy
| | - Sarah Birindelli
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dominika Szoke
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Aloisio
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Simone Caruso
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milan, Italy
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36
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Badrick T, Jones G, Miller WG, Panteghini M, Quintenz A, Sandberg S, Spannagl M. Differences between Educational and Regulatory External Quality Assurance/Proficiency Testing Schemes. Clin Chem 2022; 68:1238-1244. [PMID: 35957512 DOI: 10.1093/clinchem/hvac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Tony Badrick
- Chief Executive Officer, Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards, Sydney, Australia
| | - Graham Jones
- Senior Staff Specialist in Chemical Pathology at SydPath, St Vincent's Hospital, Sydney, Australia.,Conjoint Associate Professor, University of New South Wales, Sydney, Australia
| | - W Greg Miller
- Professor of Pathology, Co-Director of Clinical Chemistry, Director of Pathology Information Systems, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Mauro Panteghini
- Full Professor and Director of Clinical Biochemistry and Clinical Molecular Biology, University of Milan Medical School, Italy.,Director of the Department of Laboratory Medicine, Clinical Pathology Unit of the ASST Fatebenefratelli-Sacco in Milan, Italy.,Scientific Coordinator of the Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Italy
| | - Andrew Quintenz
- Director of Global Scientific and Professional Affairs, Bio-Rad Laboratories, Irvine, CA, USA
| | - Sverre Sandberg
- Director of NOKLUS, The Norwegian Organisation for Quality Improvement of Laboratory Examinations, Bergen, Norway.,Chair of SKUP, Scandinavian Evaluation of Laboratory Equipment for Primary Health Care, Bergen, Norway.,Director of the Norwegian Diabetes Registry, Bergen, Norway.,Consultant of the Norwegian Porphyria Centre (NAPOS), Bergen, Norway.,Professor at the Institute of Global Health and Primary Health Care at the University of Bergen, Bergen, Norway
| | - Michael Spannagl
- Chairman INSTAND e.V., Ubierstraße 20, 40223 Düsseldorf, Germany.,Professor LMU Klinikum Munich, Dept. Transfusion Medicine and Haemostasis, Ziemssenstr 1, 802336 Munich, Germany
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37
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Bianchi G, Colombo G, Pasqualetti S, Panteghini M. Alignment of the new generation of Abbott Alinity γ-glutamyltransferase assay to the IFCC reference measurement system should be improved. Clin Chem Lab Med 2022; 60:e228-e231. [PMID: 35938935 DOI: 10.1515/cclm-2022-0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Giorgia Bianchi
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Giulia Colombo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
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38
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Panteghini M. The simple reproducibility of a measurement result does not equal its overall measurement uncertainty. Clin Chem Lab Med 2022; 60:e221-e222. [PMID: 35802464 DOI: 10.1515/cclm-2022-0618] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
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39
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Panteghini M. Reply to Westgard et al.: 'Keep your eyes wide … as the present now will later be past'. Clin Chem Lab Med 2022; 60:e202-e203. [PMID: 35786491 DOI: 10.1515/cclm-2022-0557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milan, Italy
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40
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Caruso S, Szoke D, Panteghini M. 'Penelope test': a practical instrument for checking appropriateness of laboratory tests. Clin Chem Lab Med 2022; 60:1342-1349. [PMID: 35785546 DOI: 10.1515/cclm-2022-0368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/15/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022]
Abstract
In medical laboratories, the appropriateness challenge directly revolves around the laboratory test and its proper selection, data analysis, and result reporting. However, laboratories have also a role in the appropriate management of those phases of total testing process (TTP) that traditionally are not under their direct control. So that, the laboratory obligation to act along the entire TTP is now widely accepted in order to achieve better care management. Because of the large number of variables involved in the overall TTP structure, it is difficult to monitor appropriateness in real time. However, it is possible to retrospectively reconstruct the body of the clinical process involved in the management of a specific laboratory test to track key passages that may be defective or incomplete in terms of appropriateness. Here we proposed an appropriateness check-list scheme along the TTP chain to be potentially applied to any laboratory test. This scheme consists of a series of questions that healthcare professionals should answer to achieve laboratory test appropriateness. In the system, even a single lacking answer may compromise the integrity of all appropriateness evaluation process as the inability to answer may involve a significant deviation from the optimal trajectory, which compromise the test appropriateness and the quality of subsequent steps. Using two examples of the check-list application, we showed that the proposed instrument may offer an objective help to avoid inappropriate use of laboratory tests in an integrated way involving both laboratory professionals and user clinicians.
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Affiliation(s)
- Simone Caruso
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dominika Szoke
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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41
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Altilia M, Braga F, Capoferri A, Panteghini M. Biological variation of serum cholinesterase catalytic concentrations. Clin Chem Lab Med 2022; 60:e177-e180. [PMID: 35561807 DOI: 10.1515/cclm-2022-0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Mariangela Altilia
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università Degli Studi di Milano, Milan, Italy
| | - Federica Braga
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Via GB Grassi 74, 20157, Milan, Italy
| | - Alessia Capoferri
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università Degli Studi di Milano, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università Degli Studi di Milano, Milan, Italy
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42
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Caruso S, Szoke D, Birindelli S, Falvella FS, Dolci A, Panteghini M. Improving D-dimer testing appropriateness by controlling periodicity of retesting: prevention is better than cure. Clin Chem Lab Med 2022; 60:e175-e176. [PMID: 35510643 DOI: 10.1515/cclm-2022-0389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Simone Caruso
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Dominika Szoke
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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43
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Van Schrojenstein Lantman M, Can Çubukçu H, Boursier G, Panteghini M, Bernabeu-Andreu F, Milinkovic N, Mesko Brguljan P, Linko S, Brugnon D, O'Kelly R, Kroupis C, Lohmander M, Šprongl L, Vanstapel F, Thelen M. M133 An approach for determining allowable between reagent lot variation. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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van Schrojenstein Lantman M, Çubukçu HC, Boursier G, Panteghini M, Bernabeu-Andreu FA, Milinkovic N, Mesko Brguljan P, Linko S, Brugnoni D, O'Kelly R, Kroupis C, Lohmander M, Šprongl L, Vanstapel F, Thelen M. An approach for determining allowable between reagent lot variation. Clin Chem Lab Med 2022; 60:681-688. [PMID: 35172415 DOI: 10.1515/cclm-2022-0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/15/2022]
Abstract
Clinicians trust medical laboratories to provide reliable results on which they rely for clinical decisions. Laboratories fulfil their responsibility for accurate and consistent results by utilizing an arsenal of approaches, ranging from validation and verification experiments to daily quality control procedures. All these procedures verify, on different moments, that the results of a certain examination procedure have analytical performance characteristics (APC) that meet analytical performance specifications (APS) set for a particular intended use. The APC can in part be determined by estimating the measurement uncertainty component under conditions of within-laboratory precision (uRw), which comprises all components influencing the measurement uncertainty of random sources. To maintain the adequacy of their measurement procedures, laboratories need to distinguish aspects that are manageable vs. those that are not. One of the aspects that may influence uRw is the momentary significant bias caused by shifts in reagent and/or calibrator lots, which, when accepted or unnoticed, become a factor of the APC. In this paper, we postulate a model for allocating a part of allowable uRw to between-reagent lot variation, based on the need for long-term consistency of the measurement variability for that specific measurand. The allocation manages the ratio between short-term and long-term variation and indicates laboratories when to reject or correct certain variations due to reagent lots.
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Affiliation(s)
- Marith van Schrojenstein Lantman
- Result Laboratory for Clinical Chemistry, Amphia Hospital, Breda, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hikmet Can Çubukçu
- Interdisciplinary Stem Cells and Regenerative Medicine, Ankara University Stem Cell Institute, Ankara, Turkey
| | - Guilaine Boursier
- Dept of Genetics, Rare Diseases and Personalized Medicine Rare Diseases and Autoinflammatory Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", and Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy
| | | | - Neda Milinkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Pika Mesko Brguljan
- Department of Clinical Chemistry, University Clinic for Respiratory and Allergic Diseases, Golnik, Slovenia
| | | | - Duilio Brugnoni
- Clinical Chemistry Laboratory, Spedali Civili, Brescia, Italy
| | - Ruth O'Kelly
- Association of Clinical Biochemists in Ireland, Dublin, Ireland
| | - Christos Kroupis
- Department of Clinical Biochemistry, Medical School, Attikon University General Hospital, National and Kapodistrian University of Athens, Haidari, Greece
| | - Maria Lohmander
- Regional Laboratoriemedicin, Sahlgrenska Universitetssjukhuset, Trollhättan, Sweden
| | - Luděk Šprongl
- Clinical Laboratory, Hospital Kladno, Kladno, Czech Republic
| | - Florent Vanstapel
- Belgium and Department of Public Health, Laboratory Medicine, University Hospital Leuven, Biomedical Sciences Group, Leuven, Belgium
| | - Marc Thelen
- Result Laboratory for Clinical Chemistry, Amphia Hospital, Breda, The Netherlands
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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45
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Capoferri A, Aloisio E, Pasqualetti S, Panteghini M. More about the random uncertainty of photometric determination of hemolysis index on the Abbott Alinity c platform. Clin Biochem 2022; 105-106:94-95. [PMID: 35460611 DOI: 10.1016/j.clinbiochem.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Alessia Capoferri
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy.
| | - Elena Aloisio
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
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46
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Birindelli S, Tarkowski MS, Gallucci M, Schiuma M, Covizzi A, Lewkowicz P, Aloisio E, Falvella FS, Dolci A, Riva A, Galli M, Panteghini M. Definition of the Immune Parameters Related to COVID-19 Severity. Front Immunol 2022; 13:850846. [PMID: 35371011 PMCID: PMC8971756 DOI: 10.3389/fimmu.2022.850846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/23/2022] [Indexed: 01/08/2023] Open
Abstract
A relevant portion of patients with disease caused by the severe acute respiratory syndrome coronavirus 2 (COVID-19) experience negative outcome, and several laboratory tests have been proposed to predict disease severity. Among others, dramatic changes in peripheral blood cells have been described. We developed and validated a laboratory score solely based on blood cell parameters to predict survival in hospitalized COVID-19 patients. We retrospectively analyzed 1,619 blood cell count from 226 consecutively hospitalized COVID-19 patients to select parameters for inclusion in a laboratory score predicting severity of disease and survival. The score was derived from lymphocyte- and granulocyte-associated parameters and validated on a separate cohort of 140 consecutive COVID-19 patients. Using ROC curve analysis, a best cutoff for score of 30.6 was derived, which was associated to an overall 82.0% sensitivity (95% CI: 78–84) and 82.5% specificity (95% CI: 80–84) for detecting outcome. The scoring trend effectively separated survivor and non-survivor groups, starting 2 weeks before the end of the hospitalization period. Patients’ score time points were also classified into mild, moderate, severe, and critical according to the symptomatic oxygen therapy administered. Fluctuations of the score should be recorded to highlight a favorable or unfortunate trend of the disease. The predictive score was found to reflect and anticipate the disease gravity, defined by the type of the oxygen support used, giving a proof of its clinical relevance. It offers a fast and reliable tool for supporting clinical decisions and, most important, triage in terms of not only prioritization but also allocation of limited medical resources, especially in the period when therapies are still symptomatic and many are under development. In fact, a prolonged and progressive increase of the score can suggest impaired chances of survival and/or an urgent need for intensive care unit admission.
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Affiliation(s)
- Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- *Correspondence: Sarah Birindelli,
| | - Maciej S. Tarkowski
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Marcello Gallucci
- Department of Psychology, University of Milano Bicocca, Milan, Italy
| | - Marco Schiuma
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alice Covizzi
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
- Department of Infectious Diseases, Division III, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
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Affiliation(s)
- Mauro Panteghini
- Department of Biomedical and Clinical Sciences and Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy.,Department of Laboratory Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
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Caruso S, Aloisio E, Dolci A, Panteghini M. Lipase elevation in serum of COVID-19 patients: frequency, extent of increase and clinical value. Clin Chem Lab Med 2022; 60:135-142. [PMID: 34687597 DOI: 10.1515/cclm-2021-0824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/22/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Previous studies reported lipase elevations in serum of COVID-19 patients trying to establish a causal link between SARS-CoV-2 infection and pancreatic damage. However, the degree and prevalence of hyperlipasemia was not uniform across studies. METHODS We retrospectively evaluated 1,092 hospitalized patients with COVID-19 and at least one available lipase result. The number and frequency of patients with lipase above the upper reference limit (URL), >3 URL, and >6 URL were estimated. Correlations between lipase values and other biomarkers of organ or tissue damage were performed to identify possible extra-pancreatic sources of lipase release. The potential prognostic role of lipase to predict death and intensive care unit (ICU) admission during hospitalization was also evaluated. RESULTS Lipase was >URL in 344 (31.5%) of COVID-19 patients. Among them, 65 (5.9%) and 25 (2.3%) had a peak lipase >3 URL and >6 URL, respectively. In the latter group, three patients had acute pancreatitis of gallstone or drug-induced etiology. In others, the etiology of lipase elevations appeared multifactorial and could not be directly related to SARS-CoV-2 infection. No correlation was found between lipase and other tested biomarkers of organ and tissue damage. Lipase concentrations were not different between survivors and non-survivors; however, lipase was significantly increased (p<0.001) in patients admitted to the ICU, even if the odds ratio for lipase as predictor of ICU admission was not significant. CONCLUSIONS Lipase was elevated in ∼1/3 of COVID-19 patients, but the clinical significance of this finding is unclear and irrelevant to patient prognosis during hospitalization.
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Affiliation(s)
- Simone Caruso
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Pasqualetti S, Carnevale A, Dolci A, Panteghini M. A step towards optimal efficiency of HbA 1c measurement as a first-line laboratory test: the TOP-HOLE (Towards OPtimal glycoHemOgLobin tEsting) project. Clin Chem Lab Med 2022; 60:441-450. [PMID: 35041303 DOI: 10.1515/cclm-2021-1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The TOP-HOLE (Towards OPtimal glycoHemOgLobin tEsting) project aimed to validate the HbA1c enzymatic method on the Abbott Alinity c platform and to implement the HbA1c testing process on the total laboratory automation (TLA) system of our institution. METHODS Three different measuring systems were employed: Architect c4000 stand-alone (s-a), Alinity c s-a, and Alinity c TLA. Eight frozen whole blood samples, IFCC value-assigned, were used for checking trueness. A comparison study testing transferability of HbA1c results from Architect to Alinity was also performed. The alignment of Alinity TLA vs. s-a was verified and the measurement uncertainty (MU) estimated according to ISO 20914:2019. Turnaround time (TAT) and full time equivalent (FTE) were used as efficiency indicators. RESULTS For HbA1c concentrations covering cut-offs adopted in clinical setting, the bias for both Architect and Alinity s-a was negligible. When compared with Architect, Alinity showed a mean positive bias of 0.54 mmol/mol, corresponding to a mean difference of 0.87%. A perfect alignment of Alinity TLA to the Alinity s-a was shown, and a MU of 1.58% was obtained, widely fulfilling the desirable 3.0% goal. After the full automation of HbA1c testing, 90% of results were released with a maximum TAT of 1 h, 0.30 FTE resource was also saved. CONCLUSIONS The traceability of Alinity HbA1c enzymatic assay to the IFCC reference system was correctly implemented. We successfully completed the integration of the HbA1c testing on our TLA system, without worsening the optimal analytical performance. The shift of HbA1c testing from s-a mode to TLA significantly decreased TAT.
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Affiliation(s)
- Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | | | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Falvella FS, Panteghini M. Reply to La Gioia: effects of cold agglutinins on the automated complete blood count accuracy. Scand J Clin Lab Invest 2021; 82:68. [PMID: 34851218 DOI: 10.1080/00365513.2021.2004615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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