Kev suav ntawm Kev kwv yees Glomerular filtration Rate Siv 2021 CKD-EPI Creatinine Equation Thiab Tag Nrho Cov Ntshav Creatinine Tus Nqi Ntsuas Nrog Xov Tooj Cua ABL 827 FLEX

Abstract Objectives:Kwv yees glomerular filtration rate(eGFR) tuaj yeem suav nrogntshav ntshav / ntshav creatininentsuas nrog automated chemistry analyzers. Nws tsis paub meej tias eGFR puas tuaj yeem suav nrog cov nqi creatinine ntsuas hauv cov ntshav tag nrho (WB creatinine). Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim qhov sib piv ntawm eGFR suav nrogWB creatininethiabntshav creatinine. 

ORGANIC CISTANCHE EXTRACT nrog 25% ECHINACOSIDE thiab 9% ACTEOSIDE rau lub raum

Cov txheej txheem: Cov ntshav kuaj los ntawm 1,073 tus neeg mob tau nthuav tawm rau lub chaw kho mob xwm txheej ceev (ED), thaj chaw perioperative, chav saib xyuas mob hnyav (ICU) lossis tshuaj nuclear tau siv los txiav txim qhov tseeb ntawm WB creatinine. Rau txhua tus qauv, WB creatinine yog thawj zaug ntsuas nrog Radiometer ABL827 FLEX blood gas analyzer, ces plasma creatinine tau ntsuas nrog Roche Cobas702 chemistry analyzer tom qab kuaj tau centrifuged. Hauv ib qho piv txwv ntawm 247 tus qauv nrog cov ntaub ntawv hnub nyoog thiab poj niam txiv neej, tag nrho cov ntshav eGFR (WB eGFR) thiab ntshav eGFR tau suav nrog siv WB creatinine thiab ntshav creatinine thiab 2021 mob raum kab mob sib kis sib kis (CKD-EPI) creatinine sib npaug, feem.

Cov txiaj ntsig: WB creatinine cuam tshuam nrog plasma creatinine linearly nrog txoj kab nqes ntawm 1.06 thiab cuam tshuam ntawm −0.01. Tus coefficient ntawm kev txiav txim siab (R2) yog 0.99. WB eGFR correlated nrog plasma eGFR linearly nrog txoj kab nqes ntawm 0.95, cuam tshuam ntawm −1.63, thiab R2 ntawm 0.97. Piv rau ntshav eGFR, qhov rhiab heev thiab tshwj xeeb rau WB eGFR los txheeb xyuas cov neeg muaj kev pheej hmoo siab (eGFR<30 mL/min/1.73 m2 ) and low risk (eGFR>45 mL / min / 1.73 m2) rau mob raum yog 100 thiab 92.2%, feem. Tag nrho cov concordance hauv kev faib plaub theem ntawm lub raum puas ntawm WB eGFR thiab ntshav eGFR yog 87.9%.

Cov ntsiab lus: WB creatinine ntsuas nrog Radiometer ABL827 Flex tuaj yeem siv los xam eGFR siv 2021 CKD-EPI creatinine sib npaug. Qhov rhiab heev thiab tshwj xeeb rau WB eGFR txhawm rau txheeb xyuas cov neeg muaj kev pheej hmoo siab thiab tsis tshua muaj kev pheej hmoo rau lub raum raug mob tau txais txiaj ntsig rau cov neeg mob xav tau kev ntsuas sai ntawm lawv lub raum ua haujlwm.

Ntsiab lus:kwv yees glomerular filtration rate(eGFR) suav;point-of-care(POC); Kev soj ntsuam sai ntawm lub raum ua haujlwm; 2021 CKD-EPIcreatinine sib npaug; qhov sib npaug ntawm EKFC; qhov hloov kho lund-malmö equation; tag nrho cov ntshav creatinine.

Taw qhia

Hauv chav kho mob xwm txheej ceev (ED), thaj chaw perioperative, chav saib xyuas mob hnyav (ICU), kev tshuaj ntsuam xyuas thiab tshuaj nuclear, kev soj ntsuam sai ntawm cov neeg mob lub raum ua haujlwm siv creatinine thiab / lossis kwv yees glomerular filtration rate (eGFR) ua ntej qee cov tshuaj thiab / lossis cov txheej txheem yog tsim nyog los tiv thaiv cov tshuaj los yog sib piv cov xov xwm-induced mob raum mob [1]. Point-of-care (POC) cov cuab yeej siv tau kom tau txais cov txiaj ntsig creatinine hauv cov ntshav tag nrho (WB) cov qauv tam sim [2]. Thaum kwv yees glomerular filtration rate (eGFR) tuaj yeem suav nrog plasma creatinine qhov tseem ceeb thiab kab mob raum mob sib kis sib kis (CKD-EPI) sib npaug [3, 4], nws tsis paub meej tias WB creatinine qhov tseem ceeb tuaj yeem siv los xam eGFR siv CKD. - EPI sib npaug. Tsis ntev los no, kev sib koom ua haujlwm ntawm National Kidney Foundation thiab American Society of Nephrology (NKF-ASN) tau pom zoo cov chaw sim hauv Tebchaws Meskas kom hloov mus rau 2021 CKD-EPI creatinine sib npaug yam tsis muaj haiv neeg sib txawv los suav eGFR [5]. Hauv txoj kev tshawb no, peb siv 2021 CKD-EPI creatinine sib npaug los xam eGFR siv WB creatinine qhov tseem ceeb ntsuas nrog Radiometer (Radiometer, Brea, CA, USA) ABL 827 FLEX blood gas analyzer (ABL827). Piv rau cov ntshav eGFR, qhov chaw kho mob rhiab heev rau WB eGFR los txheeb xyuas cov neeg muaj kev pheej hmoo siab (eGFR<30 mL/min/ 1.73 m2 ) for kidney injuries and the specificity to identify those with low risk (eGFR>45 mL / min / 1.73 m2) rau kev raug mob raum tau raug txiav txim siab. Peb kuj tau siv qhov kev hloov kho Lund-Malmö equation [6] thiab European Kidney Function Consortium (EKFC) [7] equation los xam WB eGFR thiab plasma eGFR. Qhov kev ua tau zoo ntawm peb qhov sib npaug tau muab piv nrog kev tsis ncaj ncees, qhov sib txawv ntawm qhov sib txawv, thiab 30% kev sib raug zoo ntawm cov txiaj ntsig ntawm WB thiab ntshav eGFR.

Cov ntaub ntawv thiab cov txheej txheem

Cov qauv neeg mob Rau kev txiav txim siab qhov tseeb ntawm WB creatinine ntsuas nrog ABL827, peb siv 1,073 cov ntshav seem uas tau sau rau hauv cov hlab lithium heparin lossis heparinized ntshav cov koob txhaj tshuaj xa los ntawm ED, chav saib xyuas mob hnyav (ICU), cov tshuaj nuclear, thiab thaj chaw perioperative. Hauv ib pawg ntawm 247 cov qauv, peb tau sau cov hnub nyoog thiab poj niam txiv neej ntawm tus neeg mob txhawm rau suav eGFR. Ntawm 247 tus qauv, 131 yog txiv neej thiab 116 yog poj niam. Lub hnub nyoog ntawm cov txiv neej cov neeg mob yog 20-101 xyoo nrog qhov nruab nrab ntawm 58 xyoo. Lub hnub nyoog ntawm cov poj niam cov neeg mob yog 19-101 xyoo nrog qhov nruab nrab ntawm 60 xyoo. Lub koom haum saib xyuas lub koom haum tau zam qhov kev tshuaj xyuas ntawm qhov kev tshawb fawb no vim tias cov qauv no tau raug tshem tawm pov tseg cov ntshav coj mus rau kev saib xyuas neeg mob.

Kev ntsuas ntawm creatinineWB creatinine tau ntsuas nrog ABL827. Peb muaj plaub ABL827 analyzers nrog ib tug nyob rau hauv lub ED Laboratory, ob tug nyob rau hauv lub anesthesia Laboratory rau cov neeg mob nyob rau hauv radiology los yog perioperative cheeb tsam, thiab ib tug nyob rau hauv lub ceev teb cheeb tsam ntawm lub hauv paus chaw kuaj mob rau cov neeg mob ICU. Raws li ib feem ntawm peb qhov kev lees paub zoo los txheeb xyuas qhov tseeb ntawm WB creatinine, peb siv cov qauv neeg mob uas tau xaiv los sib piv los sib piv WB creatinine qhov tseem ceeb nrog cov txiaj ntsig plasma creatinine rau txhua qhov ntsuas ABL827 peb zaug hauv ib hnub (hnub, yav tsaus ntuj, thiab hmo ntuj ua haujlwm, raws li) txhua hnub. Rau txhua tus qauv xaiv, WB creatinine tau ntsuas nrog ABL827 ua ntej, tom qab ntawd cov qauv raug centrifuged rau 3 min ntawm 4,440g kom cais cov ntshav los ntawm cov hlwb thiab cov ntshav creatinine tau ntsuas nrog Roche (Roche Diagnostics, Indianapolis, Indiana, USA) Cobas 702 chemistry analyzer (Cobas702) tsis pub dhau 1 teev ntawm WB creatinine ntsuas. Hauv peb lub hlis, peb tau sau 1,073 hnub sib piv los ntawm plaub ABL827 analyzers.

Lub Cobas702 siv lub cascade ntawm enzymatic cov tshuaj tiv thaiv los hloov creatinine rau creatine los ntawm creatininase, creatine rau sarcosine los ntawm creatinase, thiab sarcosine rau glycine los ntawm sarcosine oxidase (SOD). Cov khoom kawg ntawm cov tshuaj tiv thaiv yog hydrogen peroxide, uas tuaj yeem ntsuas los ntawm spectrophotometry thaum nws tshwm sim nrog 4-aminophenazone los tsim cov xim hloov [8]. Vim tias qhov sib npaug ntawm creatine thiab creatinine hauv cov tshuaj aqueous, lub teeb liab ntawm creatine yuav tsum raug txiav tawm ntawm qhov ntsuas rau creatinine. Txoj kev Cobas702 enzymatic creatinine txoj kev siv creatinase, SOD, thiab catalase los rhuav tshem cov creatine endogenous thaum incubation hauv R1 [8]. Cov tshuaj tiv thaiv enzymatic rau creatinine yog pib tom qab noj creatine, thiab qhov concentration ntawm creatinine yog txiav txim siab siv cov qauv uas muaj cov calibration traceability rau NIST SRM 967 siv isotope-dilution mass spectrometry (IDMS). Cov coefficient ntawm kev hloov pauv (CV) yog 2.1, 1.4, thiab 0.8%, raws li hauv cov qauv ntshav nrog creatinine concentrations ntawm {{30}}.55, 0.97, thiab 2.04 mg / dL . ABL827 creatinine txoj kev siv ob lub electrodes nrog ib qho (electrode B uas muaj creatinine amidohydrolase, creatine amidohydrolase, thiab SOD) kuaj cov khoom kawg (Hydrogen peroxide) ntawm ob qho tib si creatinine thiab creatine thiab lwm yam (electrode A uas tsuas muaj creatine amidohydrolase thiab OD). kuaj pom qhov kawg-cov khoom ntawm cov tshuaj tiv thaiv rau creatine nkaus xwb. Hydrogen peroxide yog ntsuas nrog txoj kev amperometric. Tom qab lub teeb liab los ntawm electrode A raug txiav tawm los ntawm electrode B, qhov concentration ntawm creatinine yog txiav txim siab siv cov qauv calibration uas yog traceable rau NIST SRM 914 [9, 10]. CV yog 1.6, 1.3, thiab 0.9%, feem, nyob rau hauv tag nrho cov ntshav kuaj uas muaj 0.69, 2.81, thiab 5.14 mg / dL ntawm creatinine.

Cov nyhuv ntawm hematocrit ntawm WB creatinine

Peb cov qauv ntxiv nrog creatinine qib ntawm 1.06, 1.16, thiab 1.18 mg / dL, feem, tau siv hauv qhov kev sim no. Tom qab ntsuas WB nrog ABL827 thiab hematocrit (Hct) nrog Sysmex XN9000, txhua tus qauv raug centrifuged ntawm 500g rau 5 feeb kom maj mam cais cov hlwb ntawm cov ntshav. Cov qauv nrog Hct sib txawv tau ua ntej ua ntej los ntawm kev rov ua cov ntshav thiab cov hlwb ntawm tib tus neeg mob tus qauv hauv qhov sib txawv. Cov qauv 1A, 2A, thiab 3A tau npaj los ntawm kev sib xyaw peb feem ntawm cov hlwb nrog ib feem ntawm cov ntshav los ntawm Cov Qauv 1, 2, thiab 3, raws li. Tom qab ntawd WB creatinine thiab ntshav creatinine tau ntsuas hauv cov qauv no tib yam li tau piav qhia ua ntej.

Kev cuam tshuam ntawm bilirubin ntawm plasma creatinine

Tag nrho cov ntshav kuaj uas muaj 20, 40, thiab 100 mg / dL ntawm bilirubin tau ua los ntawm spiking aliquots ntawm tag nrho cov ntshav kuaj nrog ntau npaum li cas ntawm cov tshuaj bilirubin. Qhov kev cia siab ntawm creatinine nyob rau hauv txhua tus qauv yog xam los kho qhov ntim hloov. WB creatinine tau ntsuas nrog ABL827 hauv duplicate thiab plasma creatinine tau ntsuas nrog Cobas702 hauv duplicate. Qhov sib txawv ntawm WB thiab plasma creatinine yog xam rau txhua tus qauv uas muaj qib sib txawv ntawm bilirubin los qhia cov nyhuv ntawm bilirubin ntawm qhov sib txawv.

Kev suav ntawm eGFR

2021 CKD-EPI creatinine sib npaug tsis muaj haiv neeg sib txawv [5] tau programmed hauv Microsoft Excel (Microsoft, Redmond, WA). WB thiab plasma eGFR tau suav nrog WB thiab plasma creatinine tus nqi, raws li:

eGFRcr {{0}} × min(creatinine/κ, 1) ×max(creatinine/κ, 1) −1.200 ×0.9938Age × 1 .012 [yog poj niam] Qhov twg creatinine concentration nyob rau hauv mg/dL; min (creatinine / κ, 1) qhia qhov tsawg kawg ntawm creatinine / κ thiab 1, thiab max (creatinine / κ, 1) qhia qhov siab tshaj plaws ntawm creatinine / κ thiab 1. κ yog 0.7 rau cov poj niam thiab { {38}}.9 rau txiv neej; yog −0.241 rau poj niam thiab −0.302 rau txiv neej. Raws li kev sib piv, WB thiab ntshav eGFR kuj tau suav nrog kev hloov kho Lund-Malmö [6] equation, thiab EKFC equation, ntsig txog. Cov kev hloov kho Lund-Malmö [6] qhov sib npaug yog raws li nram no: eGFR=e(X−0.0158 × age+0.438 × ln age ( )) Rau poj niam thiab Cr < 150 μmol / L, X=2. Rau cov txiv neej thiab Cr < 180 μmol / L, X=2 56 + 0. .56 − 0.926 × ln Cr/180 ( ) Qhov twg Cr sawv cev rau creatinine concentration hauv μmol/L. Qhov kev hloov kho Lund-Malmö sib npaug tau programmed hauv Excel. Cov txiaj ntsig creatinine tau hloov los ntawm mg / dL rau μmol / L ua ntej. Tom qab ntawd X factor yog xam rau txhua plasma thiab WB creatinine tus nqi. Tom qab ntawd lub WB lossis ntshav eGFR tau suav nrog siv X yam thiab qhov hloov kho Lund-Malmö equation. EKFC [7] equations yog raws li nram no: Rau hnub nyoog 2 - 40 xyoo, yog Cr/Q< 1, eGFR=107.3× SCr/Q ( )−0.322 For age 2 − 40 years old, if Cr/Q ≥ 1, eGFR=107.3× SCr/Q ( )−1.132 For age >40 xyoo, yog Cr/Q< 1, eGFR=107.3× SCr/Q ( )−0.322×0.990 Age −40 ( ) For age > 40 years old, if Cr/Q ≥ 1, eGFR=107.3× SCr/Q ( )−1.132×0.990 Age −40 ( ) Where Q values are: For male 2−25 years old, ln(Q)=3.200+0.259×Age −0.543×ln(Age)−0.00763×Age2 +0.0000790×Age3 For female 2−25 years old, ln(Q)=3.080+0.177×Age −0.223×ln(Age)−0.00596×Age2 +0.0000686×Age3 For male > 25 years old, Q=80 μmol/L For female >25 xyoo, Q=62 μmol/L Qhov kev sib npaug EKFC [7] tau program hauv Excel. Chav tsev ntawm creatinine tau hloov los ntawm mg / dL rau μmol / L. Q tus nqi raug xam raws hnub nyoog thiab poj niam txiv neej ntawm txhua tus neeg mob. Tom qab ntawd WB thiab plasma eGFR tau suav nrog siv qhov sib npaug tshwj xeeb rau hnub nyoog thiab creatinine qhov tseem ceeb, raws li. Qhov nruab nrab, kev tsis ncaj ncees, qhov sib txawv ntawm qhov sib txawv ntawm WB thiab ntshav eGFR, thiab P10 thiab P30 qhov tseeb tau txais los ntawm eGFR suav nrog txhua qhov peb qhov sib npaug (2021 CKD-EPI creatinine equation, kho dua Lund-Malmö kab zauv , thiab EKFC equation).

Kev txheeb cais

Linear regression analysis of Microsoft Excel thiab Bland–Altman Difference Plant (programmed in Excel) tau siv los sib piv WB creatinine nrog plasma creatinine thiab WB eGFR nrog plasma eGFR, feem. Thaum twg siv tau, qhov nruab nrab thiab tus qauv sib txawv (SD), thiab coefficient ntawm kev hloov pauv (CV) tau muab los ntawm Excel. Qhov kev tsis ncaj ncees tau txhais tias yog qhov nruab nrab ntawm qhov sib txawv ntawm tus kheej ntawm WB thiab ntshav creatinine lossis eGFR. P10 thiab P30 raug rauWB eGFRtxhais tau tias yog qhov feem pua ​​​​ntawm WB eGFR uas nyob hauv ± 10% thiab ± 30% ntawm cov ntshav ntshav eGFR, feem. Qhov sib txawv ntawm qhov sib txawv ntawm WB thiab ntshav eGFR tau txhais raws li qhov sib txawv ntawm Q3 (tus nqi sib txawv ntawm 75 feem pua) thiab Q1 (tus nqi sib txawv ntawm 25 feem pua) thaum qhov sib txawv ntawm WB eGFR thiab plasma eGFR ( WB eGFR - plasma eGFR) tau txheeb xyuas thiab muab faib ua plaub ntu.

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