Journal of Mass Spectrometry and Advances in the Clinical Lab最新文献

{"title":"A simple, rapid and cost-effective UHPLC–MS/MS method for simultaneous quantitation of seven antiepileptic drugs/metabolites in human serum","authors":"Xiaowei Fu,&nbsp;Xiangtang Li,&nbsp;Hui He","doi":"10.1016/j.jmsacl.2025.09.001","DOIUrl":"10.1016/j.jmsacl.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy affects approximately 50 million people worldwide. Antiepileptic drugs (AEDs) are the mainstream treatment. Therapeutic drug monitoring (TDM) of AEDs is necessary to maximize efficacy and minimize toxicity. We report a simple, rapid, and cost-effective ultra-performance liquid chromatography-mass spectrometry method that can simultaneously measure seven AEDs/metabolites, including levetiracetam (LEV), lacosamide (LCM), zonisamide (ZON), lamotrigine (LMT), 10-hydroxycarbazepine (OXC-M1), clobazam (CLO), and N-desmethyl clobazam (N-CLB) in serum.</div></div><div><h3>Method</h3><div>Only 20 µl of serum was used with simple protein precipitation and dilution. Analysis was performed on a SCIEX 6500 UHPLC–MS/MS in positive ion mode. Separation was performed on a C18 reversed-phase column using a gradient. The seven AEDs/metabolites were eluted in 4.5 min.</div></div><div><h3>Results</h3><div>The assay was linear over the concentration ranges 0.4–100 µg/mL for LEV, 0.12–30 µg/mL for LMT, 0.12–30 µg/mL for LCM, 0.32–80 µg/mL for ZON, 0.28–70 µg/mL for OXC-M1, and 7.82–2000 ng/mL for CLO, 78.2–20000 ng/mL for N-CLB, respectively, with correlation coefficient greater than 0.99. Recovery was from 88 to 108 %. Intra and inter assay precision for three levels of quality controls were from 2.1 to 6.8 % and 4.2 to 10.9 %, respectively. The accuracy was evaluated by comparing with the College of American Pathologists survey results, and a correlation coefficient greater than 0.96 was observed. The absence of matrix effects was also confirmed.</div></div><div><h3>Conclusion</h3><div>We have developed and validated a simple, rapid, and cost-effective UHPLC–MS/MS method for the simultaneous quantitation of seven AEDs/metabolites in serum within a 4.5-min analysis time. It has been implemented in our children’s hospital with same-day turnaround time.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"38 ","pages":"Pages 2-9"},"PeriodicalIF":3.4,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “A rapid method for determination of rosuvastatin in blood plasma with supported liquid extraction” [J. Mass Spectromet. Adv. Clin. Lab 36 (2025) 29–36]","authors":"Tjaša Dermota ,&nbsp;Mojca Božič Mijovski ,&nbsp;Jurij Trontelj","doi":"10.1016/j.jmsacl.2025.08.001","DOIUrl":"10.1016/j.jmsacl.2025.08.001","url":null,"abstract":"","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"38 ","pages":"Page 1"},"PeriodicalIF":3.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the detuning ratio as a tool to detect potential interference in LC-MSMS analysis","authors":"Arber Rexhaj ,&nbsp;Michael Vogeser ,&nbsp;Katharina Habler","doi":"10.1016/j.jmsacl.2025.07.002","DOIUrl":"10.1016/j.jmsacl.2025.07.002","url":null,"abstract":"<div><h3>Objective</h3><div>Tandem mass spectrometry (MS/MS) is highly specific in principle, but there is always the possibility of interference due to unexpected substances in the samples that have the identical mass transitions as the target analytes (isomeric/isobaric interferences). By recording the ion ratio (IR), clinical laboratories already widely attempt to identify such interferences in individual cases. To supplement this procedure, differential tuning effects can be assessed. We aimed to evaluate this approach experimentally.</div></div><div><h3>Methods</h3><div>The detuning ratio (DR) is based on the differential influences of MS instrument settings on the ion yield of a respective target analyte; isomeric or isobaric interferences can lead to a shift of the DR for an affected sample. By determining the DR in samples in which known isomeric interference substances have been spiked to the target analyte, the applicability of DR detection was quantitatively investigated.</div></div><div><h3>Results</h3><div>It was observed in two independent exemplary test systems (Cortisone / Prednisolone and O-Desmethylvenlafaxine / <em>cis</em>-Tramadol HCl) that a DR can indicate the presence of isomeric interferences.</div></div><div><h3>Conclusion</h3><div>It was confirmed that a DR can be used as a method to obtain indications of the presence of isomeric or isobaric interferences in individual samples in an analytical LC-MS/MS system; the technique can be used in addition to the established method of IR detection to increase the analytical reliability of clinical MS analyses.</div><div>Abbreviations: CE, collision energy; CID, collision induced dissociation; CXP, cell exit potential; CLSI, Clinical and Laboratory Standards Institute; DR, detuning ratio; ESI+, positive electrospray ionization; IR, ion ratio; IS, internal standard; LC, liquid chromatographic; LC-MS/MS, liquid chromatography tandem mass spectrometry; ME, matrix effects; MRM, multiple reaction monitoring; MS, mass spectrometry; <em>m</em>/<em>z</em>, mass-to-charge ratio; TIC, Total ion current.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 56-64"},"PeriodicalIF":3.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urine methamphetamine-to-amphetamine ratio by LC-MS/MS to differentiate methamphetamine use from pharmaceutical impurity in patients prescribed amphetamine","authors":"Lindsey Contella ,&nbsp;Phillip Kang ,&nbsp;Clara E. Wolf ,&nbsp;Victoria L. Thomas ,&nbsp;Melissa Gildenberg ,&nbsp;Marion L. Snyder ,&nbsp;Stacy E.F. Melanson ,&nbsp;Nicole V. Tolan","doi":"10.1016/j.jmsacl.2025.07.001","DOIUrl":"10.1016/j.jmsacl.2025.07.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients compliant with prescribed amphetamine (AMPH) should not have detectable methamphetamine (METH) in their urine; detectable METH typically indicates illicit use. However, we have identified patients with results suggestive of METH as an impurity in prescribed AMPH.</div></div><div><h3>Objectives</h3><div>Derive a METH:AMPH ratio cut-off from a training set of patients compliant with AMPH prescriptions to differentiate METH as an impurity from illicit use.</div></div><div><h3>Methods</h3><div>Retrospective review of AMPH and METH-positive cases by liquid chromatography-tandem mass spectrometry (LC-MS/MS) at Brigham and Women’s Hospital (BWH) and Luxor Scientific. Correlated results with clinical and medication history and compliance with prescribed medications.</div></div><div><h3>Results</h3><div>The median ± interquartile range (IQR) METH:AMPH ratio for the Adderall training sets was 0.43 ± 0.31 % and 0.05 ± 0.040 %, with a maximum ratio of 1.125 % and 0.125 % at BWH and Luxor, respectively. The median ± IQR METH:AMPH ratio for the Luxor d-AMPH training set was 0.039 ± 0.028 %, with a maximum ratio of 0.09 %; not statistically different from the Adderall training set. Assessment of the BWH test set where METH &lt; AMPH (n = 22) revealed that METH was likely due to an impurity (n = 10), distant METH mis/use (n = 11), or requiring further analysis (n = 1). METH was also detected by LC-MS/MS in a commercial AMPH calibrator and in Adderall XR.</div></div><div><h3>Discussion</h3><div>METH may represent an impurity in the AMPH formulation. Laboratories are encouraged to define a METH:AMPH ratio below which an impurity is the likely explanation for METH and/or to increase the METH positivity cut-off to 50 or 100 ng/mL to reduce potential false-accusations of illicit METH use.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 49-55"},"PeriodicalIF":3.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an LC-MS/MS method for quantification of colistin and colistin methanesulfonate in human plasma and its application to stability studies and therapeutic drug monitoring","authors":"Tinghui Zhao ,&nbsp;Lu Liu ,&nbsp;Guangjie Yang ,&nbsp;Hengyi Yu ,&nbsp;Lihui Qiu ,&nbsp;Xiping Li ,&nbsp;Dong Xiang ,&nbsp;Xuepeng Gong","doi":"10.1016/j.jmsacl.2025.05.001","DOIUrl":"10.1016/j.jmsacl.2025.05.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Colistin serves as the last line of defense against multidrug-resistant Gram-negative bacterial infections and is commonly administered in clinical practice as its prodrug, colistin methanesulfonate (CMS). However, due to its notable nephrotoxicity and narrow therapeutic window, therapeutic drug monitoring (TDM) is essential.</div></div><div><h3>Objectives</h3><div>To develop an optimal LC-MS/MS method for the quantification of colistin and CMS in human plasma and to apply it to stability studies and TDM.</div></div><div><h3>Methods</h3><div>Colistin A, colistin B, and internal standard (IS, polymyxin B2) were extracted from plasma using solid phase extraction columns. Sample separation was performed using a Welch Ultimate LP-C18 column with a 5-minute gradient elution consisting of water and acetonitrile, both supplied with 1.0% formic acid. The CMS concentration was obtained by comparing the total amount of colistin in acid-hydrolyzed and non-acid-hydrolyzed plasma.</div></div><div><h3>Results</h3><div>Colistin A and colistin B showed excellent linearity in the concentration range of 0.1–10.0 μg/mL (R² &gt; 0.995) with acceptable specificity, accuracy (90.97 %–114.65 %), precision (RSD &lt; 15 %), matrix effect (RSD &lt; 15 %), and recovery (91.93 %–100.93 %). CMS in five commonly used clinical infusion solutions was stable when stored at room temperature for 8 h or at 4 °C for 24 h. The whole blood and plasma samples of CMS are susceptible to degradation at room temperature but are stable on ice. Plasma concentrations of colistin and CMS were accurately determined in three critically ill patients.</div></div><div><h3>Conclusion</h3><div>The method we have developed is robust and streamlined, and has successfully demonstrated the potential feasibility for future TDM applications of colistin and CMS in critically ill patients.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 39-48"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “A liquid chromatography-high-resolution mass spectrometry method for separation and identification of hemoglobin variant subunits with mass shifts less than 1 Da” [J. Mass Spectromet. Adv. Clin. Lab 35 (2025) 1–7]","authors":"Ainslie Chen ,&nbsp;Ryan M. Aquino ,&nbsp;Hector A. Vidal ,&nbsp;Carolyn V. Wong ,&nbsp;Ruben Y. Luo","doi":"10.1016/j.jmsacl.2025.04.009","DOIUrl":"10.1016/j.jmsacl.2025.04.009","url":null,"abstract":"","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 14-15"},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced identification of Morganella spp. using MALDI-TOF mass spectrometry","authors":"Mathilde Duque ,&nbsp;Cécile Emeraud ,&nbsp;Rémy A. Bonnin ,&nbsp;Quentin Giai-Gianetto ,&nbsp;Laurent Dortet ,&nbsp;Alexandre Godmer","doi":"10.1016/j.jmsacl.2025.04.011","DOIUrl":"10.1016/j.jmsacl.2025.04.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The genus <em>Morganella,</em> including clinically isolated species <em>M. sibonii</em> and <em>M. morganii</em>, has a still underexplored role in clinical microbiology. Despite the clinical relevance of <em>Morganella</em> spp., current MALDI-TOF commercial systems fail to differentiate these species. Whole genome sequencing (WGS) remains the most effective method to distinguish species. However, this method is not adapted for routine lab workflow. Enhancing MALDI-TOF’s accuracy could make it a rapid and effective approach for distinguishing <em>Morganella</em> species in routine laboratory diagnostics.</div></div><div><h3>Objectives</h3><div>This study aims to improve the performance of MALDI-TOF for identifying <em>Morganella</em> spp. using WGS as the gold-standard reference method.</div></div><div><h3>Methods</h3><div>We applied Machine Learning (ML) algorithms to a collection of 235 clinicial <em>Morganella</em> <!-->spp. strains to develop an optimized identification model. Whole genome sequencing was used to characterize these strains and perform phylogenetic analysis, categorizing 209 strains as <em>M. morganii</em> and 26 as <em>M. sibonii</em>.</div></div><div><h3>Results</h3><div>The ML-based classifiers showed improved identification accuracy (44 of the 160 designed with accuracy at<!--> <!-->1). Also, MS analysis identified 11 peaks able to discriminate between <em>M. morganii</em> and <em>M. sibonii</em>.</div></div><div><h3>Conclusion</h3><div>Through development of a publicly-available online ML-based classifier, this study has improved the capacity of MALDI-TOF for distinguishing <em>Morganella</em> spp<em>.</em>, providing a reliable, user-friendly solution suited to routine clinical diagnostics and supporting a better understanding of the roles of <em>M. morganii</em> and <em>M. sibonii</em> in human pathology.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 9-13"},"PeriodicalIF":3.1,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum peptides as candidate biomarkers for relapsing polychondritis","authors":"Toshiyuki Sato ,&nbsp;Masaaki Sato ,&nbsp;Kouhei Nagai ,&nbsp;Masahiko Fukasawa ,&nbsp;Yoshiaki Nagashima ,&nbsp;Teisuke Uchida ,&nbsp;Atsuhiro Tsutiya ,&nbsp;Kazuki Omoteyama ,&nbsp;Mitsumi Arito ,&nbsp;Yukiko Takakuwa ,&nbsp;Seido Ooka ,&nbsp;Naoya Suematsu ,&nbsp;Kimito Kawahata ,&nbsp;Yoshihisa Yamano ,&nbsp;Tomohiro Kato ,&nbsp;Manae S. Kurokawa","doi":"10.1016/j.jmsacl.2025.04.001","DOIUrl":"10.1016/j.jmsacl.2025.04.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Relapsing polychondritis (RP) is an intractable disease characterized by recurrent inflammation of cartilaginous tissue throughout the body. It is difficult to accurately diagnose RP, and no useful biomarkers have yet been identified.</div></div><div><h3>Objectives</h3><div>We analyzed serum peptide profiles to identify novel candidate biomarkers for RP.</div></div><div><h3>Methods</h3><div>Thirty-seven patients with RP, 42 patients with rheumatoid arthritis (RA), and 35 healthy control (HC) subjects were divided into training and testing sets. Seven patients demonstrating granulomatosis with polyangiitis (GPA) were used for validation. The ion intensity of serum peptides was comprehensively measured by matrix-assisted laser desorption/ionization time-of-flight/time-of-flight mass spectrometry and applied to a supervised multivariate analysis. Peptides of interest were analyzed by liquid chromatography-tandem mass spectrometry.</div></div><div><h3>Results</h3><div>In the training set, models developed based on 11 (RP/HC-11P model), 9 (RP/RA-9P model), and 14 (RP/nonRP-14P model) peptides, out of 160 peptides detected were able to completely discriminate the RP group from the HC, RA, and nonRP (HC + RA) groups. Almost all of the 15 identified discriminatory peptides comprising these models were fragments of proteins associated with coagulation. Four models, each consisting of 4 out of 10 identified peptides of the RP/nonRP-14P model (models RP/nonRP-4P-2, -10, -11, and -38), provided ≥ 70.0 % sensitivity and specificity when applied to the validation set (the testing set and the GPA group) (AUROC, 0.779–0.815). Notably, the RP/nonRP-4P-2 model provided 83.3 % sensitivity and 71.7 % specificity in the validation set (AUROC, 0.802).</div></div><div><h3>Conclusions</h3><div>Serum peptides are useful as candidate biomarkers for discriminating RP and may be involved in the pathophysiology of RP.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 28-38"},"PeriodicalIF":3.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based estimation of biological variation in plasma-free amino acid concentrations among healthy adults","authors":"Müjgan Ercan ,&nbsp;Emiş Deniz Akbulut ,&nbsp;Ayşen Caniklioğlu ,&nbsp;Esra Fırat Oğuz ,&nbsp;Yakup Dülgeroğlu ,&nbsp;Esin Avcı ,&nbsp;Şerif Ercan","doi":"10.1016/j.jmsacl.2025.04.010","DOIUrl":"10.1016/j.jmsacl.2025.04.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Free amino acid (FAA) analysis plays a crucial role in diagnosing and monitoring inborn errors of metabolism, assessing nutritional status, and identifying metabolic imbalances associated with various diseases. This study aimed to provide updated biological variation (BV) data to support the reliable clinical application of FAA concentrations in plasma samples, utilizing LC-MS/MS.</div></div><div><h3>Materials and methods</h3><div>Venous blood was collected from 22 healthy Turkish adults (9 men and 13 women) over approximately nine weeks. Plasma FAAs were measured in duplicate. BV estimates with 95 % confidence intervals were determined using nested ANOVA for the entire study group and sex-stratified subgroups, following analysis of outliers, normality, steady-state conditions, and variance homogeneity.</div></div><div><h3>Results</h3><div>Within-subject variation (CV_I) and between-subject variation (CV_G) estimates ranged from 9.5 % to 32.5 % and 8.6 % to 50.0 %, respectively. The estimated CV_I values for essential amino acids were significantly lower than those for non-essential amino acids (<em>P</em> = <em>0.03</em>). For most plasma FAAs, no significant differences in CV_I (except for alanine, arginine, glutamic acid, and threonine) or CV_G were observed between sexes. However, differences in the indices of individuality were noted between men and women for some plasma FAAs.</div></div><div><h3>Conclusions</h3><div>This Biological Variation Data Critical Appraisal Checklist-compliant study provides the first updated BV data for plasma FAAs. The significant variation observed in CV_I estimates is hypothesized to result from differences in the metabolic regulation of essential versus non-essential amino acids. The sex-stratified indices obtained in this study will aid in the appropriate application of population-based reference intervals for plasma FAA assessment.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 1-8"},"PeriodicalIF":3.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definitive urine drug testing in emergency medicine: Recreational and psychiatric drug findings","authors":"Thomas G. Rosano ,&nbsp;S.M.Touhidul Islam ,&nbsp;John M. Rumberger ,&nbsp;Robert M. Konetchy Jr. ,&nbsp;Michelle Wood ,&nbsp;Joseph A. Sorce ,&nbsp;Karl A. Robstad ,&nbsp;Heather Long","doi":"10.1016/j.jmsacl.2025.04.008","DOIUrl":"10.1016/j.jmsacl.2025.04.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical management of drug-related emergency department (ED) visits relies on available history, toxidrome findings and drug screening. In this study, definitive drug testing is used to assess ED drug prevalence and immunoassay drug screening performance.</div></div><div><h3>Methods</h3><div>Definitive testing for 116 drugs and metabolites was performed on urine from 400 ED patients, with comparison to immunoassay drug screening.</div></div><div><h3>Results</h3><div>Definitive testing resulted in 1,350 drug findings with prevalent use of nicotine (63%), cocaine (34%), ∆9 tetrahydrocannabinol (34%), fentanyl (17%), morphine or heroin (11%) and methamphetamine (6%). Forty percent of patients were also positive for antidepressants and 24% positive for antipsychotics. Significant patterns of co-drug use were found for cocaine, fentanyl, morphine and nicotine. Multi-serotonergic drug use was frequent, suggesting a risk for serotonin syndrome. Immunoassay performance showed high false negative rates for benzodiazepines (40%), amphetamines (38%), barbiturates (33%), opiates (25%), methadone (20%) and cocaine (16%), along with inaccuracy in phencyclidine detection. Immunoassay missed 890 of the 1,350 drug findings by definitive testing, due to either high cutoff thresholds or limited testing scope.</div></div><div><h3>Discussion</h3><div>A high prevalence of drugs use by ED patients is evidenced with frequent co-use of illicit and therapeutic drugs and with potential for unrecognized multi-serotonergic drug interactions. This study also shows the limitations of immunoassay drug testing in both scope and sensitivity, with a high rate of undetected drug use.</div></div><div><h3>Conclusion</h3><div>The study provides evidence-based support for recommended implementation of definitive drug testing in emergency medicine as a guide to clinical management in drug-related ED visits.</div></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"37 ","pages":"Pages 16-27"},"PeriodicalIF":3.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}