Omić Haris, Eder Michael, Hoffmann Simon, Gerges Daniela
Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2025 Sep 3;14(17):6220. doi: 10.3390/jcm14176220.
In hemodialysis patients, precise hemoglobin (Hb) monitoring is essential for anemia management. Point-of-care blood gas analyzers (BGAs), such as the ABL800 Flex, offer rapid Hb determinations, but their accordance and comparability with central laboratory measurements remains to be assessed in the hemodialysis setting. We performed a retrospective analysis (April 2017-February 2024) of 10,802 paired Hb measurements from 291 hemodialysis patients. BGA and laboratory values within 90 min were compared using paired -tests, non-inferiority testing (margin 0.5 g/dL), a Bland-Altman analysis, and linear regression. The mean ± standard deviation Hb (g/dL) values were 10.14 ± 1.64 (BGA) versus 9.90 ± 1.55 (laboratory). The overall mean difference (BGA-laboratory) was 0.24 ± 0.49 g/dL (95% CI: 0.23-0.25), demonstrating non-inferiority ( < 0.0001). Measurement delay correlated with increasing analysis discrepancies (mean difference in g/dL: 0.22 at <30 min vs. 0.27 at 60-90 min; < 0.001). We derived the equation of laboratory Hb = 0.90 × BGA Hb + 0.72; a simplified correction (BGA-0.3 g/dL) produced a mean absolute error (MAE) of 0.30 g/dL and root mean square error (RMSE) of 0.50 g/dL, and patient-level 10-fold cross-validation yielded MAE ≈ 0.30 and RMSE ≈ 0.49 g/dL. The Bland-Altman analysis confirmed a small systematic bias of 0.24 g/dL with 95% limits of agreement ranging from -0.73 to +1.21 g/dL. Conclusions: BGA Hb measurements via the ABL800 Flex are non-inferior to central laboratory values across clinical scenarios, with minimal bias. After regression correction, the estimated total error was ≈0.78 g/dL. If hemodialysis centers accept this level of total error and apply confirmatory testing near decision points, BGA could be used to guide anemia management.
在血液透析患者中，精确监测血红蛋白（Hb）对于贫血管理至关重要。即时检验血气分析仪（BGA），如ABL800 Flex，可快速测定Hb，但在血液透析环境中，其与中心实验室测量结果的一致性和可比性仍有待评估。我们对291例血液透析患者的10802对Hb测量值进行了回顾性分析（2017年4月至2024年2月）。使用配对t检验、非劣效性检验（界值为0.5 g/dL）、Bland-Altman分析和线性回归比较了90分钟内的BGA值和实验室值。Hb（g/dL）的均值±标准差分别为10.14±1.64（BGA）和9.90±1.55（实验室）。总体平均差异（BGA - 实验室）为0.24±0.49 g/dL（95%CI：0.23 - 0.25），显示出非劣效性（P < 0.0001）。测量延迟与分析差异增大相关（g/dL的平均差异：<30分钟时为0.22，60 - 90分钟时为0.27；P < 0.001）。我们得出实验室Hb = 0.90×BGA Hb + 0.72的方程；简化校正（BGA - 0.3 g/dL）产生的平均绝对误差（MAE）为0.30 g/dL，均方根误差（RMSE）为0.50 g/dL，患者水平的10倍交叉验证得出MAE≈0.30和RMSE≈0.49 g/dL。Bland-Altman分析证实存在0.24 g/dL的小系统偏差，95%一致性界限为 - 0.73至 + 1.21 g/dL。结论：通过ABL800 Flex进行的BGA Hb测量在所有临床场景中均不劣于中心实验室值，偏差最小。经过回归校正后，估计总误差约为0.78 g/dL。如果血液透析中心接受这一总误差水平，并在决策点附近应用验证性检测，BGA可用于指导贫血管理。
