Evaluation of serum alkaline phosphatase measurement through the 4-year trueness verification program in China

Background Alkaline phosphatase (ALP) is critical for various diseases. The International Federation of Clinical Chemistry and Laboratory Medicine had recommended the new reference procedure in 2011, but many manufacturers did not trace results to the higher procedure. Since 2012, the National Center for Clinical Laboratories (NCCL) in China has organized the trueness verification program (TV) with commutable materials. The present study summarizes the 4-year TV program to give an overview of the measurement standardization for ALP results. Methods Commutable serum-based materials with different concentrations were prepared and sent to participating laboratories. The target values were assigned by the reference lab network. Results The analytical performance was evaluated according to three indexes: trueness (bias), imprecision (CV) and accuracy (total error [TE]). The number of participating laboratories increased from 115 in 2012 to 287 in 2016. The pass rates of precision for homogeneous and heterogeneous systems were all above 85% over the 4 years; however, the pass rates of bias were much lower (<50%). Among the homogeneous systems, Roche Cobas/Modular had an obvious negative bias, whereas the mean positive bias for Beckman AU was prominent. As to the heterogeneous systems, the pass rates of bias for Sichuan Maccura (57.1%-78.6%) were higher than Roche Cobas/Modular (4.4%-33.9%) and Beckman AU (35.7%-64.8%). Conclusions The PT/EQA program with commutable materials can be used to assess the trueness against target values assigned by reference procedures. For ALP, homogeneous systems did not perform better than heterogeneous systems. The bias for ALP performance was notable and was the main obstacle to its standardization in China.