Primerjava metod za določanje troponina I v diagnostiki srčnega infarkta

Krivic, Katja (author), Osredkar, Joško (mentor), Možina, Hugon (comentor)

Akutni miokardni infarkt ostaja v svetu eden od vodilnih zdravstvenih problemov z visoko stopnjo obolevnosti in umrljivosti. Diagnoza akutnega miokardnega infarkta temelji na porastu srčnih označevalcev, spremembah v EKG in na kliničnih znakih. Troponin I velja za zlati standard med srčnimi označevalci. Zgodnja in hitra diagnostika omogoča pravilno postavitev diagnoze in pričetek ustreznega zdravljenja, kar izboljša preživetje pacientov in kakovost življenja po prebolelem infarktu. Z napredkom tehnologije se je razvilo testiranje ob pacientu, katerega izvaja medicinsko osebje. Prednost takšnega testiranja je hitrejša analiza in dostopnost rezultatov, kar je izredno pomembno v nujnih primerih. V okviru naloge smo spremljali paciente, ki so poiskali pomoč zaradi bolečine v prsih in jim je bil izmerjen troponin I. Meritve smo sočasno izvajali na rutinskem laboratorijskem analizatorju ADVIA Centaur us-TnI in ADVIA Centaur TNIH ter na POCT analizatorju PATHFAST. Želeli smo ugotoviti ali analizatorji dajejo primerljive rezultate. V programu MedCalc smo za statistično analizo uporabili dve metodi, Passing-Bablok regresijsko analizo in Bland-Altmanovo analizo. Ugotovili smo, da v povprečju dajeta rutinska analizatorja za 1,8 oz. 1,9 µg/L višje rezultate kot analizator PATHFAST. Sistematična razlika v meritvah je statistično značilna. Analizator PATHFAST ne daje primerljivih rezultatov kot rutinska analizatorja. V sklopu naloge smo ovrednotili tudi ujemanje rezultatov meritev pridobljenih iz treh matriksov (serum, plazma, polna kri) merjenih z analizatorjem PATHFAST in rezultate meritev seruma na analizatorju ADVIA Centaur us-TnI. Visoki korelacijski koeficienti nakazujejo dobro ujemanje meritev. Bland-Altmanova analiza je pokazala, da dajejo meritve iz seruma na analizatorju ADVIA Centaur us-TnI v povprečju višje rezultate, vendar razlika v meritvah ni statistično pomembna. Zaključimo lahko, da se meritve na analizatorju PATHFAST lahko izvajajo tako iz vzorcev seruma, plazme ali polne krvi, saj dajejo primerljive rezultate kot meritve seruma z rutinsko laboratorijsko metodo. Na osnovi našega dela lahko zaključimo, da je potrebno ob morebitni uvedbi POCT analizatorja predhodno izobraževanje osebja in zagotoviti vse potrebne informacije o omejitvah, ki jih prinaša uporaba POC analizatorja. Interpretacija rezultatov POC analizatorja mora biti izvedena znotraj priporočil proizvajalca, rezultatov se ne sme primerjati s tistimi iz laboratorija. Pomembno je, da se vrednosti troponina spremljajo z isto metodo oziroma analizatorjem.

• Language: Slovenian
• Keywords: : akutni miokardni infarkt, laboratorijska diagnostika, troponin, testiranje ob pacientu, primerjava metod
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-115400
• Publication date in RUL: 26.04.2020

Secondary language

• Language: English
• Title: Comparison of methods for determining troponin I in cardiac arrest diagnostics

Abstract

Acute myocardial infarction is number one health problem and leads to higher rates of mortality and morbidity. Diagnosis is based on clinical signs, ECG changes and cardiac markers. Troponin I is a gold standard in the diagnosis of acute myocardial infarction. Early and rapid diagnostics leads to accurate diagnosis and begining of treatment which improves pacients survival and life quality after infarction. Medical staff can perform testing near the patient due to technology progress. Results are delivered rapidly for early recognition of life threatening conditions, which is the main advantage. Patients who presented to the UKC Ljubljana with chest pain were included in study. Measurments of troponin I were simultaneously performed on ADVIA Centaur is-TnI, ADVIA Centaur TNIH and on POCT PATHFAST device. The aim of the study was to determine wether this two methods give comparable results. We used two statistic methods, Passing-BaBlok and Bland-Altman, for assessing agreement between two methods in MedCalc program. We found that routine laboratory devices give higher results than PATHFAST device. The systematic difference between measurments was statistically significant. It has been statistically verified that these methods do not agree sufficiently. The purpose of thesis was to evaluate results matching of measurments acqiured from various matrices (whole blood, plasma, serum) on the POC analyzer and the serum measurments on ADVIA Centaur us-TnI. The correlation between different matrices was demonstrated to be strong. Bland- Altman analysis showed higher measurments on ADVIA Centaur us-TnI but difference between results was not statistically significant. The analysis can be done from various matrices on PATHFAST because the results are comparable with serum measurment in routine laboratory method. We can conclude that introduction of POCT device is possible only with a training of clinical staff and we need to provide all information about possible limitations. POCT is not a replacement for conventional laboratory services and we cannot compare results with results from them. It is important to monitor troponin values with same method or device.

• Keywords: : acute myocardial infarction, troponin, point of care testing, method comparison, laboratory diagnosis