The use of serial patient blood gas, electrolyte and glucose results to derive biologic variation: a new tool to assess the acceptability of intensive care unit testing

Background: Most estimates of biologic variation (s(b)) are based on periodically acquiring and storing specimens, followed by analysis within a single analytic run. We demonstrate for many intensive care unit (ICU) tests, only patient results need be statistically analyzed to provide reliable estimates of s(b). Methods: Over 11 months, approximately 28,000 blood gas measurements (including electrolyte panels and glucose) were performed on one of two Radiometer ABL800 FLEX analyzers (Radiometer, Copenhagen, Denmark) from 1676 ICU patients. We tabulated the measurements of paired intrapatient blood samples drawn within 24 h of each other. After removal of outliers, we calculated the standard deviations of duplicates (SDD) of the intra-patient pairs grouped in 2-h intervals: 0-2 h, 2-4 h, 4-6 h, ... 20-22 h and 22-24 h. The SDDs were then regressed against the time intervals of 2-14 h; extrapolation to zero time represents the sum of s(b) and short-term analytic variation (s(a)). Results: Substitution of experimentally derived analytic error permitted the calculation of coefficient of variation (biologic) (CVb) (100 s(b)/mean): pH, 0.3%; pCO(2), 5.7%; pO(2), 13%; Na+, 0.6%; K+, 4.8%; Cl-, 0.8%; HCO3-, 3.2%; iCa(++), 2.4%; and glucose, 10.3%. The CVb of the electrolytes very closely matches the lowest estimates obtained in the usual manner. Conclusions: Derivation of the ratio of biologic to analytic variation indicates that the ABL800 is extremely suitable for ICU testing. This analysis should be extended to other point of care instrument systems. Clin Chem Lab Med 2010;48:1447-54.