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Reexamining the Minimum Sweat Rate Requirement for Sweat Chloride Testing.

Catherine L Omosule1, Dennis J Dietzen1,2, Stephen M Roper1,2

  • 1Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States.

The Journal of Applied Laboratory Medicine
|September 27, 2023
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The minimum sweat rate for sweat chloride testing may be too strict, as sweat rate and chloride concentration show minimal correlation. Lowering the threshold could reduce test failures without impacting cystic fibrosis diagnosis accuracy.

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Area of Science:

  • Clinical Chemistry
  • Diagnostic Testing
  • Pediatric Medicine

Background:

  • Sweat chloride testing is crucial for diagnosing cystic fibrosis (CF).
  • Current guidelines mandate a minimum sweat rate for reliable results.
  • Failure to meet this rate (quantity not sufficient, QNS) necessitates test re-collection.

Purpose of the Study:

  • To investigate the correlation between sweat rate and sweat chloride concentration ([Cl-]).
  • To evaluate the accuracy of sweat specimens collected below the minimum rate.
  • To explore the utility of pooling bilateral specimens for chloride measurement.

Main Methods:

  • Pearson correlation analyzed sweat rate vs. [Cl-] in 674 macroduct collections.
  • Weighted kappa assessed CF diagnostic concordance for discordant sweat rates.
  • Deming regression compared [Cl-] in pooled vs. neat bilateral specimens.

Main Results:

  • A negligible correlation (r = -0.0735) was found between sweat rate and [Cl-].
  • Substantial agreement in CF diagnostic classification was observed despite discordant sweat rates.
  • Pooled specimens showed high concordance with neat specimens (slope=0.984, intercept=0.796).

Conclusions:

  • The minimum sweat rate for macroduct collectors may be unnecessarily stringent.
  • Reporting results from specimens with lower sweat rates (≥0.3 µL/min) may decrease QNS rates.
  • Pooling bilateral sweat collections appears feasible for achieving adequate sample volume.