A comparison of sodium concentration measured in laboratory autoanalyser versus point-of-care blood gas machine: A retrospective, multicentre, analytical study in a large adult intensive care unit population

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2025-12-01 Epub Date: 2025-12-05 DOI:10.1016/j.ccrj.2025.100149

Keegan Hunter BMedSc MD , Chris Anstey MBBS BSc MSc FANZCA FCICM PhD , Alexander Nesbitt BSc MBBS FCICM AFHEA , Karthik Venkatesh BMed MD FCICM , Dinesh Parmar MD FRCA FCICM , Amanda Corley RN PhD , Marissa Daniels MBBS , Jatinder Grewal FCICM, FANZCA, GchPOM , Kevin B. Laupland MD, PhD , Mahesh Ramanan BSc(Med) MBBS(Hons) MMed(Clin Epi) FCICM , Alexis Tabah MD FCICM , James McCullough MMed FCICM , Aashish Kumar MBBS FCICM , Antony G. Attokaran MBBS FCICM FRACP , Stephen Luke MBBS BSc(Hons) FCICM , Peter Garrett MBBS, BSc(Hons) FCICM FACEM FCEM , Stephen Whebell MBBS FCICM , Sebastiaan Blank FCICM , Philippa McIlroy BPhty (Hons) MBBS FCICM , Kyle C. White BSc MBBS MPH FCICM FRACP

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引用次数: 0

Abstract

Objective

Discrepancies between laboratory sodium and point-of-care arterial blood gas sodium values may lead to delayed interpretation of, and intervention on, the results. We studied the mean difference between these two techniques and assessed the degree of agreement.

Design

A multicentre, retrospective, observational study was conducted.

Setting

Twelve intensive care units in Queensland, Australia, with tertiary-level hospitals accounting for 81% of admissions were included in the study.

Participants

Adult patients with at least one paired laboratory sodium and arterial blood gas measurement during their intensive care unit admission were a part of this study.

Main outcome measures

Main outcome measures included mean difference between laboratory sodium and point-of-care sodium measurement, with a positive difference demonstrating laboratory sodium values higher than arterial blood gas sodium values.

Results

A total of 65,042 patients with 224,383 paired samples were included in the analysis. The Bland–Altman mean difference of laboratory sodium and arterial blood gas sodium was 0.72 mmol/L (95% limit of agreement [LoA]: 4.35) with a Deming regression slope of 0.93 (95% confidence interval: 0.92, 0.94) and intercept +10.07 (p < 0.001). On subgroup analysis of hyponatraemia, eunatraemia and hypernatraemia a mean difference (95% LoA) of 1.53 mmol/L (4.21), 0.15 mmol/L (4.39), and −1.02 mmol/L (5.37), was calculated, respectively. Patients with severe hyperglycaemia and normal albumin had a mean difference (95% LoA) of −1.85 mmol/L (4.78). Analysis of mild, moderate, and severe subgroups within both hyponatraemic and hypernatraemic samples showed increasing mean differences, with severe hyponatraemia showing a mean difference of 2.01 mmol/L (95% LoA: 8.08) and severe hypernatraemia showing a mean difference of −4.7 mmol/L (95% LoA: 15.46).

Conclusions

Point-of-care arterial blood gas sodium measurements show small mean differences in eunatraemia and good agreement with paired laboratory samples in adult intensive care unit patients. Caution should be applied when interchanging results between laboratory and point-of-care sodium values in patients with moderate to severe dysnatraemia, as serial measurements using different methods during treatment are unlikely to be within a clinically acceptable range. This is important when caring for patient groups with severe hyponatraemia and induced hypernatraemia, and serial measurement may be better achieved with point-of-care testing due to a combination of ease of access, repeatability, and lower cost.

查看原文本刊更多论文

实验室自动分析仪与现场血气机测量钠浓度的比较：一项针对大型成人重症监护病房人群的回顾性、多中心分析研究

目的实验室钠值与现场动脉血气钠值的差异可能导致对结果的延迟解释和干预。我们研究了这两种技术之间的平均差异，并评估了一致程度。设计进行一项多中心、回顾性、观察性研究。研究对象为澳大利亚昆士兰州的12个重症监护病房，其中三级医院占入院人数的81%。在重症监护病房入院期间，至少有一次配对实验室钠和动脉血气测量的成年患者是本研究的一部分。主要结果测量包括实验室钠和护理点钠测量的平均差异，阳性差异表明实验室钠值高于动脉血气钠值。结果共纳入65,042例患者和224,383例配对样本。实验室钠和动脉血气钠的Bland-Altman平均差值为0.72 mmol/L(95%一致限[LoA]: 4.35)， Deming回归斜率为0.93(95%可信区间：0.92,0.94)，截断量为+10.07 （p < 0.001）。对低钠血症、低钠血症和高钠血症进行亚组分析，分别计算出1.53 mmol/L（4.21）、0.15 mmol/L（4.39）和- 1.02 mmol/L（5.37）的平均LoA差异（95% LoA）。严重高血糖患者与白蛋白正常患者的平均差异（95% LoA）为- 1.85 mmol/L（4.78）。对低钠血症和高钠血症样本中轻度、中度和重度亚组的分析显示，平均差异越来越大，重度低钠血症的平均差异为2.01 mmol/L (95% LoA: 8.08)，重度高钠血症的平均差异为- 4.7 mmol/L （95% LoA: 15.46）。结论监护点动脉血气钠测量结果显示成人重症监护病房患者血钠含量差异较小，且与配对实验室样本吻合较好。在中度至重度钠血症患者的实验室和护理点钠值互换结果时应谨慎，因为在治疗期间使用不同方法的连续测量不太可能在临床可接受的范围内。这在治疗患有严重低钠血症和诱发性高钠血症的患者群体时很重要，并且由于易于获取、可重复性和成本较低，通过即时检测可以更好地实现系列测量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.