Concordance between point-of-care blood gas analysis and laboratory autoanalyzer in measurement of hemoglobin and electrolytes in critically ill patients

Authors

Shivesh Prakash
Shailesh Bihari
Zhan Y. Lim
Santosh Verghese
Hemant Kulkarni, The University of Texas Rio Grande Valley
Andrew D. Bersten

Document Type

Article

Publication Date

7-2018

Abstract

Background

We tested the hypothesis that the results of the same test performed on point‐of‐care blood gas analysis (BGA) machine and automatic analyzer (AA) machine in central laboratory have high degree of concordance in critical care patients and that the two test methods could be used interchangeably.

Methods

We analyzed 9398 matched pairs of BGA and AA results, obtained from 1765 patients. Concentration pairs of the following analytes were assessed: hemoglobin, glucose, sodium, potassium, chloride, and bicarbonate. We determined the agreement using concordance correlation coefficient (CCC) and Bland‐Altman analysis. The difference in results was also assessed against the United States Clinical Laboratory Improvement Amendments (US‐CLIA) 88 rules. The test results were considered to be interchangeable if they were within the US‐CLIA variability criteria and would not alter the clinical management when compared to each other.

Results

The median time interval between sampling for BGA and AA in each result pair was 5 minutes. The CCC values ranged from 0.89(95% CI 0.89‐0.90) for chloride to 0.98(95% CI 0.98‐0.99) for hemoglobin. The largest bias was for hemoglobin. The limits of agreement relative to bias were largest for sodium, with 3.4% of readings outside the US‐CLIA variation rule. The number of readings outside the US‐CLIA acceptable variation was highest for glucose (7.1%) followed by hemoglobin (5.9%) and chloride (5.2%).

Conclusion

We conclude that there is moderate to substantial concordance between AA and BGA machines on tests performed in critically ill patients. However, the two tests methods cannot be used interchangeably, except for potassium.

Comments

Copyright © 2018 Wiley Periodicals, Inc.

Recommended Citation

Prakash, S., Bihari, S., Lim, Z. Y., Verghese, S., Kulkarni, H., & Bersten, A. D. (2018). Concordance between point-of-care blood gas analysis and laboratory autoanalyzer in measurement of hemoglobin and electrolytes in critically ill patients. Journal of clinical laboratory analysis, 32(6), e22425. https://doi.org/10.1002/jcla.22425

Publication Title

Journal of clinical laboratory analysis

DOI

10.1002/jcla.22425

Academic Level

faculty

Mentor/PI Department

Office of Human Genetics