Division of Renal Diseases and Hypertension/Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America.
PLoS One. 2018 Sep 27;13(9):e0204614. doi: 10.1371/journal.pone.0204614. eCollection 2018.
Acute kidney injury (AKI) occurs at high rates among agricultural workers (12-33%) in tropical environments. Because of the remote locations affected, traditional laboratory services are often unavailable. In this study we compare point of care (POC) creatinine values to standardized laboratory values, and examine the effect of POC testing on the interpretation of AKI rates under tropical field conditions.
Blood samples were collected from 104 sugarcane workers from two time points in January 2018 as a derivation cohort, and from 105 workers from February to April 2017 as a validation cohort. Finger stick and venipuncture samples were drawn at the end of a worker's shift to measure creatinine. Laboratory samples were tested in Guatemala City, Guatemala, in duplicate using the Jaffe Generation 2 method. An adjustment factor to improve agreement with serum creatinine was statistically derived and validated, and then used to determine impact on observed rates of acute kidney injury based on across shift changes in creatinine.
POC creatinine and serum creatinine measures showed that POC consistently overestimated the creatinine by an average of 22% (95% CI: 19.8%, 24.7%) and the disagreement appeared greater at higher values of serum creatinine. An adjustment factor of 0.7775 was applied, which led to significantly greater agreement between the two measures. Rates of AKI in the two combined groups fell from 72% before adjustment to 57% afterwards.
POC testing under tropical field conditions routinely overestimates creatinine compared to laboratory testing, which leads to overestimation of rates of acute kidney injury. The application of an adjustment factor significantly improved the accuracy of the POC value.
在热带环境中，农业工人（12-33%）中急性肾损伤（AKI）的发生率较高。由于受影响的地点偏远，传统的实验室服务往往无法提供。在这项研究中，我们比较了即时检测（POC）肌酐值与标准化实验室值，并研究了 POCT 在热带野外条件下对 AKI 发生率的解释的影响。
从 2018 年 1 月的两个时间点收集了来自 104 名甘蔗工人的血样作为推导队列，并从 2017 年 2 月至 4 月收集了 105 名工人的血样作为验证队列。在工人轮班结束时采集指尖和静脉血样，以测量肌酐。在危地马拉市的实验室样本用 Jaffe 第二代方法进行重复测试。统计得出并验证了一个调整因子，以提高与血清肌酐的一致性，然后根据肌酐跨班次变化来确定其对观察到的急性肾损伤发生率的影响。
POC 肌酐和血清肌酐测量结果表明，POC 始终平均高估肌酐 22%（95%CI：19.8%，24.7%），并且在血清肌酐值较高时，差异似乎更大。应用了 0.7775 的调整因子，这导致两种测量方法之间的一致性显著提高。在两个合并组中，AKI 发生率从调整前的 72%下降到调整后的 57%。
与实验室测试相比，热带野外条件下的 POCT 常规检测会高估肌酐，从而高估急性肾损伤的发生率。应用调整因子可显著提高 POCT 值的准确性。
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