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Cited by 64Clinical Laboratory Practices and Quality ControlHyperglycemia and glycemic control in critically ill and hospitalized patientsSepsis Diagnosis and Treatment

Point-of-care versus central laboratory measurements of hemoglobin, hematocrit, glucose, bicarbonate and electrolytes: a prospective observational study in critically ill patients

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Allardet-Servent, Jérôme, Lebsir, Melissa, Dubroca, Christian, Fabrigoule, Martine, Jordana, Sylvie, Signouret, Thomas, Castanier, Matthias, Thomas, Guillemette +6 more·2017·PLOS ONE
DOI 10.1371/journal.pone.0169593PMC PMC5224825
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Abstract

INTRODUCTION: Rapid detection of abnormal biological values using point-of-care (POC) testing allows clinicians to promptly initiate therapy; however, there are concerns regarding the reliability of POC measurements. We investigated the agreement between the latest generation blood gas analyzer and central laboratory measurements of electrolytes, bicarbonate, hemoglobin, hematocrit, and glucose. METHODS: 314 paired samples were collected prospectively from 51 critically ill patients. All samples were drawn simultaneously in the morning from an arterial line. BD Vacutainer tubes were analyzed in the central laboratory using Beckman Coulter analyzers (AU 5800 and DxH 800). BD Preset 3 ml heparinized-syringes were analyzed immediately in the ICU using the POC Siemens RAPIDPoint 500 blood gas system. We used CLIA proficiency testing criteria to define acceptable analytical performance and interchangeability. RESULTS: Biases, limits of agreement (±1.96 SD) and coefficients of correlation were respectively: 1.3 (-2.2 to 4.8 mmol/L, r = 0.936) for sodium; 0.2 (-0.2 to 0.6 mmol/L, r = 0.944) for potassium; -0.9 (-3.7 to 2 mmol/L, r = 0.967) for chloride; 0.8 (-1.9 to 3.4 mmol/L, r = 0.968) for bicarbonate; -11 (-30 to 9 mg/dL, r = 0.972) for glucose; -0.8 (-1.4 to -0.2 g/dL, r = 0.985) for hemoglobin; and -1.1 (-2.9 to 0.7%, r = 0.981) for hematocrit. All differences were below CLIA cut-off values, except for hemoglobin. CONCLUSIONS: Compared to central Laboratory analyzers, the POC Siemens RAPIDPoint 500 blood gas system satisfied the CLIA criteria of interchangeability for all tested parameters, except for hemoglobin. These results are warranted for our own procedures and devices. Bearing these restrictions, we recommend clinicians to initiate an appropriate therapy based on POC testing without awaiting a control measurement.

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  • Some earlier studies noted positive bias in POCT potassium readings, especially in hemolyzed samples.

    “However, some of these studies also noted positive bias in POCT readings, especially in hemolyzed samples [7,8].”

    From Reliability of Point-of-Care Venous Blood Gas Testing for Potassium and Sodium Compared to Central Laboratory Results in Emergency Patients: A Clinical Audit (2025) · cites this paper as [8]

    The Results (Potassium; page not available) report a mean potassium difference of 0.2 mmol/L, with the laboratory reading higher than POC. The Discussion likewise reports more high-potassium readings by the laboratory than by POC. The paper does not link potassium bias to hemolyzed samples; its discussion of hemolysis concerns hemoglobin measurements. (LLM, conf=0.86)

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  • Sodium underestimation patterns are supported by studies attributing discrepancies to differences in ion-selective electrode calibration, matrix effects, and ambient temperature and humidity.

    “These patterns are supported by studies such as Kapoor et al. [7] and Allardet-Servent et al. [8], who attribute these discrepancies to differences in ISE calibration, matrix effects, and the influence of ambient temperature and humidity on POCT devices.”

    From Reliability of Point-of-Care Venous Blood Gas Testing for Potassium and Sodium Compared to Central Laboratory Results in Emergency Patients: A Clinical Audit (2025) · cites this paper as Allardet-Servent et al. [8]

    The Discussion (page not provided) attributes the sodium difference to direct versus indirect ISE measurement and the effect of protein content on dilution; it reports sodium averaging 1.3 mmol/L higher with indirect ISE. This supports a sample-matrix explanation for lower point-of-care readings relative to the laboratory, but the paper does not attribute the discrepancy to ISE calibration or ambient temperature and humidity. (LLM, conf=0.88)

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Research works printed but not linked: 3

  1. [12]CLSI: Procedures for the collection of Arterial Blood Specimens; Approved Standard-Fourth Edition CLSI document GP43-A4. Wayne, PA: Clinical and Laboratory Standards Institute 2004
  2. [21]CLSI: Measurement Procedure Comparison and Bias Estimation Using Patient Samples; Approved Guideline—Third Edition CLSI document EP09-A3. Wayne, PA: Clinical and Laboratory Standards Institute 2013
  3. [35]Tsuda I, Tatsumi N, Zhang Z, Kubota H, Takubo T: Evaluation of Coulter’s cyanide-free reagent for hemoglobinometry. Lab Hematol 1998; 4: 276– 280

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Authors
Allardet-Servent, J., Lebsir, M., Dubroca, C., Fabrigoule, M., Jordana, S., Signouret, T., Castanier, M., Thomas, G., Soundaravelou, R., Lepidi, A., Delapierre, L., Penaranda, G., Halfon, P., & Seghboyan, J.-M.
Affiliations
  • Hôpital Européen (FR)
  • Alphabio (FR)
Corresponding author
Allardet-Servent, Jérôme
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2017-01-10
Volume
12
Issue
1
Pages
e0169593
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0169593
PMC
PMC5224825
OpenAlex
W2568891751
Cited by
64
References
40
Citations by year
2026: 3 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 10 · 2020: 6 · 2019: 14 · 2018: 7 · 2017: 3
FWCI
6.07
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
point-of-care testing, blood gas analysis, central laboratory comparison, electrolytes, bicarbonate, hemoglobin, hematocrit, blood glucose, critically ill patients, measurement agreement, arterial blood sampling
MeSH terms
Aged, Aged, 80 and over, Bicarbonates, Blood Chemical Analysis, Blood Gas Analysis, Blood Glucose, Electrolytes, Female, Hematocrit, Hemoglobins, Humans, Male, Middle Aged, Reference Values, Critical Illness, Point-of-Care Systems

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