Nollen Jeanne-Marie, Brunsveld-Reinders Anja H, Biermasz Nienke R, Verstegen Marco J T, Leijtens Eline, Peul Wilco C, Steyerberg Ewout W, van Furth Wouter R
Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands.
Department of Quality and Patient Safety, Leiden University Medical Centre, Leiden, the Netherlands.
Clin Endocrinol (Oxf). 2025 Aug;103(2):201-208. doi: 10.1111/cen.15241. Epub 2025 Mar 27.
Detecting hypotonic urine (specific gravity < 1005 g/L) is crucial for the early identification of arginine vasopressin deficiency (AVP-deficiency), a common complication after pituitary surgery. This study aimed to evaluate the agreement between urine specific gravity measurements taken by patients using urine test strips and those taken by nurses using a refractometer, to assess the reliability of patient-conducted measurements for diagnosing this condition.
A prospective cohort study was conducted in a neurosurgical ward.
The study included 110 participants who collectively provided 609 specific gravity measurements.
Specific gravity measurements were taken using Combur-10 urine test strips by patients and using an ATAGO MASTER-SUR/Nα refractometer by nurses. Agreement was analysed using Weighted Kappa and intraclass correlation coefficient (ICC).
Moderate agreement was found between patient-conducted measurements and those from the refractometer (Kappa = 0.47, ICC = 0.69). Substantial to good agreement was observed between patient and nurse measurements using urine test strips (Kappa = 0.82, ICC = 0.89). A threshold of 1.015 g/L in test strip measurements ensured no cases of hypotonic urine were missed, reducing the need for nurse-led testing by 50%. Patient satisfaction was high (mean 7.8), while nurse satisfaction was lower (mean 6.4).
Although patients are less accurate than nurses in measuring specific gravity, they can reliably screen for hypotonic urine in AVP-deficiency diagnostics using urine test strips. A higher cut-off point improves diagnostic accuracy, enhances patient participation and reduces the screening workload for nurses.
检测低渗尿（比重<1005g/L）对于垂体手术后常见并发症精氨酸加压素缺乏症（AVP缺乏症）的早期识别至关重要。本研究旨在评估患者使用尿试纸条测量尿比重与护士使用折射仪测量尿比重之间的一致性，以评估患者自行测量对诊断该病症的可靠性。
在神经外科病房进行前瞻性队列研究。
该研究纳入了110名参与者，他们共提供了609次比重测量数据。
患者使用Combur-10尿试纸条测量比重，护士使用ATAGO MASTER-SUR/Nα折射仪测量比重。使用加权kappa系数和组内相关系数（ICC）分析一致性。
患者自行测量与折射仪测量结果之间存在中度一致性（kappa = 0.47，ICC = 0.69）。患者和护士使用尿试纸条测量结果之间观察到高度至良好的一致性（kappa = 0.82，ICC = 0.89）。尿试纸条测量中1.015g/L的阈值可确保不漏诊任何低渗尿病例，将护士主导的检测需求减少50%。患者满意度较高（平均7.8），而护士满意度较低（平均6.4）。
虽然患者在测量比重方面不如护士准确，但他们可以使用尿试纸条在AVP缺乏症诊断中可靠地筛查低渗尿。较高的截断点可提高诊断准确性，增强患者参与度并减少护士的筛查工作量。
