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DOI: 10.1016/j.medine.2019.06.005
Available online 27 June 2019
Concordance of the ions and GAP anion obtained by gasometry vs standard laboratory in critical care
Concordancia de los iones y anión GAP obtenidos mediante gasometría vs laboratorio estándar en cuidados críticos
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A. Lópeza,b,
Corresponding author
angel.orense@gmail.com

Corresponding author.
, B. Garcíaa,c, A. Gómeza,b, L. Gonzáleza,b, N. Gonzáleza,b, L. Martína,b, G. Jaimed
a Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
b Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, Spain
c Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Costa del Sol, Marbella, Málaga, Spain
d Servicio de Análisis Clínicos, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, Spain
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Received 09 March 2018. Accepted 25 June 2018
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Tables (6)
Table 1. Data from the concordance studies conducted between the ions obtained through blood gas testing and biochemical testing. 95% confidence intervals shown in brackets.
Table 2. Concordance of sodium values obtained through biochemical testing vs POC testing. Kappa correlation coefficient, 0.63 (0.57; 0.68) with a 95% confidence interval.
Table 3. Concordance of potassium values obtained through biochemical testing vs POC testing. Kappa correlation coefficient, 0.74 (0.70; 0.79), with a 95% confidence interval.
Table 4. Concordance of chloride values obtained through biochemical testing vs POC testing. Kappa correlation coefficient, 0.32 (0.26; 0.39), with a 95% confidence interval.
Table 5. Concordance of anion gap values obtained through biochemical testing vs POC testing. Kappa correlation coefficient, −00.2 (−0.08; 0.03), with a 95% confidence interval.
Table 6. Concordance of anion gap corrected for serum albumin values obtained through biochemical testing vs POC testing. Kappa correlation coefficient, −0.07 (−0.12; −0.03), with a 95% confidence interval.
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Abstract
Objective

To evaluate the differences observed in ion and GAP anion determinations obtained by point-of-care (POC) blood gas versus laboratory biochemical testing, and to analyze the possible errors according to the limits of normality.

Material and methods

A descriptive, cross-sectional retrospective study was made to assess concordance between two diagnostic tests in patients admitted to the Critical Care Unit of Ourense University Hospital Complex (Spain), between July and November 2015, involving at least one coinciding biochemical test and POC determination. Patients under 18years of age were excluded.

Results

A total of 1073 samples were analyzed. Lin's concordance correlation coefficients for sodium, potassium and chlorine were 0.87, 0.84 and 0.72, respectively. Kappa concordance of the normality limits for sodium, potassium and chlorine was 0.63, 0.74 and 0.32. The results indicated poor correlation of the anion GAP and null concordance between POC and biochemical testing, including the value corrected for albumin.

Conclusions

Poor concordance was observed between the ion values as determined by biochemistry and blood gases; the two methods are therefore not interchangeable. Kappa agreement with normality limits was good for sodium and potassium, and weak for chlorine. Possible validity was noted in orienting the classification within the ion limits, with the exception of chlorine. No agreement was recorded in relation to the anion GAP, even that corrected for albumin.

Keywords:
Critical care
Point-of-care systems
Sodium
Potassium
Chlorine
Acid–base equilibrium
Resumen
Objetivo

Evaluar las diferencias observadas en la determinación de los iones y del anión GAP obtenidos por gasometría (POC) y por bioquímica de laboratorio, y analizar los posibles errores en función de los límites de normalidad.

Material y métodos

Estudio descriptivo transversal retrospectivo para valorar la concordancia entre dos pruebas diagnósticas de los pacientes ingresados en la Unidad de Reanimación del Complexo Hospitalario Universitario de Ourense, entre julio y noviembre de 2015, con al menos una determinación coincidente de bioquímica y POC. Se excluyeron pacientes menores de 18años.

Resultados

Se analizaron 1.073 muestras. Coeficientes de correlación de concordancia de Lin en sodio, potasio y cloro de 0,87, 0,84 y 0,72, respectivamente. Concordancia kappa de los límites de normalidad para sodio, potasio y cloro de 0,63, 0,74 y 0,32. Pobre correlación del anión GAP y nula concordancia entre el POC y el calculado por la bioquímica, incluido el corregido por albúmina.

Conclusiones

Concordancia pobre entre los iones de la bioquímica y la gasometría, por lo que no son intercambiables. Concordancia kappa con los límites de normalidad buena para el sodio y potasio, y débil para el cloro. Posible validez para una orientación en la clasificación dentro de los límites de los iones, excepto para el cloro. Nula concordancia para el anión GAP, incluso el corregido por albúmina.

Palabras clave:
Cuidados críticos
Sistemas de atención de punto
Sodio
Potasio
Cloro
Equilibrio ácido-base

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