The effect of extremely high glucose concentrations on 21 routine chemistry and thyroid Abbott assays: interference study

Introduction

Extremely high glucose concentrations have been shown to interfere with creatinine assays especially with Jaffe method in peritoneal dialysate. Because diabetes is the fastest growing chronic disease in the world, laboratories study with varying glucose concentrations. We investigated whether different levels of glucose spiked in serum interfere with 21 routine chemistry and thyroid assays at glucose concentrations between 17-51 mmol/L.

Materials and methods

Baseline (group I) serum pool with glucose concentration of 5.55 (5.44-5.61) mmol/L was prepared from patient sera. Spiking with 20% dextrose solution, sample groups were obtained with glucose concentrations: 17.09, 34.52, and 50.95 mmol/L (group II, III, IV, respectively). Total of 21 biochemistry analytes and thyroid tests were studied on Abbott c8000 and i2000sr with commercial reagents. Bias from baseline value was checked statistically and clinically.

Results

Creatinine increased significantly by 8.74%, 31.66%, 55.31% at groups II, III, IV, respectively with P values of < 0.001. At the median glucose concentration of 50.95 mmol/L, calcium, albumin, chloride and FT4 biased significantly clinically (-0.85%, 1.63%, 0.65%, 7.4% with P values 0.138, 0.214, 0.004, < 0.001, respectively). Remaining assays were free of interference.

Conclusion

Among the numerous biochemical parameters studied, only a few parameters are affected by dramatically increased glucose concentration. The creatinine measurements obtained in human sera with the Jaffe alkaline method at high glucose concentrations should be interpreted with caution. Other tests that were affected with extremely high glucose concentrations were calcium, albumin, chloride and FT4, hence results should be taken into consideration in patients with poor diabetic control.Key words: assay interference, glucose interference, preanalytical phase, creatinine, Jaffe kinetic assay, thyroid function tests     

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Prostate Specific Antigen (PSA) has emerged as the most applicable and important tumor marker for carcinoma prostate. In the present study PSA was determined in serum of healthy subjects, patients of benign prostate hypertrophy (BPH) and Carcinoma Prostate (Ca−P) to evaluate its diagnostic efficiency in day to day management of prostate cancer patients and in differentiating patients of early prostate cancer from those with BPH. Receiver operating characteristic curve (ROC) revealed 2 ng/ml and 10 ng/ml cut off serum PSA level for BPH and untreated carcinoma prostate patients (Ca−P). An extremely significant increase (P<0.0001) was observed in mean PSA concentration in BPH patients and adenocarcinoma prostate patients when compared to healthy males. Clinical relevance of PSA was highlighted by a case study of cancer patient prior to any therapy till death.     

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Hyperactive Grey Objects

Previous papers on grey literature by the authors have described (1) the need for formal metadata to allow machine understanding and therefore scalable operations; (2) the enhancement of repositories of grey (and other) e-publications by linking with CRIS (Current Research Information Systems); (3) the use of the research process to collect metadata incrementally reducing the threshold barrier for end-users and improving quality in an ambient GRIDs environment. This paper takes the development one step further and proposes “intelligent” grey objects. The hypothesis is in 2 parts: (1) that the use of passive catalogs of metadata does not scale (a) in a highly distributed environment with millions of nodes and (b) with vastly increased volumes of R&D output grey publications with associated metadata; (2) that a new paradigm is required that (a) integrates grey with white literature and other R&D outputs such as software, data, products and patents (b) in a self-managing, self-optimizing way and that this paradigm manages automatically curation, provenance digital rights, trust, security and privacy. Concerning (1) existing repositories provide catalogs; harvesting takes increasing time ensuring non-currency. The end-user expends much manual effort/intelligence to utilize the results. The elapsed time of (1) the network (2) the centralized (or centrally controlled distributed) catalog server searches (3) end-user intervention becomes unacceptable. Concerning (2) there is no paradigm currently known to the authors that satisfies the requirement. Our proposal is outlined below. Hyperactive combines both hyperlinking and active properties of a (grey) object. Hyperlinking implies multimedia components linked to form the object and also external links to other resources. The term active implies that objects do not lie passively in a repository to be retrieved by end-users. They “get a life” and the object moves through the network knowing where it is going. A hyperactive grey object is wrapped by its (incrementally recorded) formal metadata and an associated (software) agent. It moves through process steps such as initial concept, authoring, reviewing and depositing in a repository. The workflow is based on the rules and information in the corporate data repository with which the agent interacts. Once the object is deposited, the agent associated with it actively pushes the object to the end-users (or systems) whose metadata indicate interest or an obligation in a workflowed process. The agents check the object and user (or system) metadata for rights, privacy, security parameters, and for any charges and assure compatibility. Alternatively the object can be found passively by end-user or system agents. The object can also associate itself with other objects forming relationships utilising metadata or content. Declared relationships include references and citations; workflowed relationships include versions and also links to corporate information and research datasets and software; inferenced relationships are discovered relationships such as between documents by different authors developed from an earlier idea of a third author. Components of this paradigm have been implemented to some extent. The challenge is implementing—respecting part two of the hypothesis—the integration architecture. This surely is harnessing the power of grey.

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