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Anion gap reference intervals show instrument dependence and weak correlation with albumin levels
Busadee Pratumvinit1, Leslie Lam2, Narisorn Kongruttanachok3
1Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clinica Chimica Acta; International Journal of Clinical Chemistry
|November 1, 2019
Summary
Different laboratory instruments yield varying anion gap (AG) reference intervals, impacting acid-base disorder diagnosis. Albumin levels show a weak correlation with AG, necessitating verification of laboratory reference ranges.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Diagnostic Accuracy
Background:
- The anion gap (AG) is crucial for diagnosing acid-base disorders.
- New analytical methods have led to decreased AG values.
- Variations in AG reference intervals across different laboratory instruments and populations require investigation.
Purpose of the Study:
- To compare anion gap (AG) reference intervals across different analytical instruments.
- To assess AG variations in Southeast Asian populations.
- To evaluate the influence of albumin levels on AG measurements.
Main Methods:
- Anion gap (AG) was measured at three hospitals using cobas 8000 and Architect c16000 instruments.
- Consecutive adult patients (≥18 years) with electrolyte and creatinine tests were included.
- AG was assessed for all patients and a subgroup with normal electrolytes.
Main Results:
- Significant differences (P < 0.001) in AG means were observed between hospitals for all patients and the normal electrolyte subgroup.
- AG reference intervals varied substantially across instruments, ranging from 5-15 mmol/L to 9-19 mmol/L.
- Hypoalbuminemia and hyperalbuminemia showed significant associations with lower and higher AG, respectively (P < 0.001).
Conclusions:
- Analytical instruments significantly impact anion gap (AG) measurements and their reference intervals.
- A weak correlation exists between albumin levels and AG, highlighting the need for careful interpretation.
- Laboratorians must verify reference intervals to ensure accurate laboratory error detection and support clinical diagnosis.
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