Clinica chimica acta; international journal of clinical chemistry · 2023
Reconsideration of "Albumin corrected total calcium" Determinations: Potential errors in the Clinical management of disorders of calcium metabolism.
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Albert Stewart G, Scott Isbell T
Аннотация
BACKGROUND: The formula, referenced in major textbooks, for albumin corrected calcium [Calcium(alb)] may not accurately depict ionized calcium [ICa]. We evaluated the accuracy of unadjusted calcium [Calcium(Unadjusted)] and [Calcium(alb)], and developed a protocol for local laboratory adjustment of calcium for albumin.
METHODS: Laboratory data were obtained from an electronic health record. Assessments were accuracy, false positive, and false negative rates. Clinical reliability was defined in "error zones" for calcium [Ca]: Zone A = Ca(normal), ICa(low); Zone B = Ca(low), ICa(normal); and Zone C = Ca(normal), ICa(high), Zone D = Ca(high), ICa(normal).
RESULTS: A linear regression from 468 laboratory tests was used to derive a formula for "revised corrected calcium" [Calcium (revised)] over a range of albumin concentrations where, [Calcium (revised)] = plasma calcium (mg/dl) + [(4- Albumin (g/d)L)]*(plasma calcium (mg/dl)*0.052)]. [Calcium(alb]] vs [Calcium(Unadjusted)] decreased zone B errors 12%, [95%CI;8-15%], vs 44% [95%CI;37-50%], p < 0.001. However, [Calcium(alb]] vs [Calcium(Unadjusted)] increased zone A error (60%,[95%CI;42-78%], vs 7% [95%CI;1-13%], p < 0.001). [Calcium (revised)] decreased zone A errors (15%, [95%CI;6-24%]) vs [Calcium(alb) ] (60% [95%CI;42-78%], p < 0.001) and Zone D errors from 9% [95%CI;6-12%] to 2% [95%CI;1:5%, p < 0.001].
CONCLUSIONS: [Calcium(alb)] is unreliable in hypo- or hypercalcemia. We provide a protocol for locally derived correction of calcium for albumin.
METHODS: Laboratory data were obtained from an electronic health record. Assessments were accuracy, false positive, and false negative rates. Clinical reliability was defined in "error zones" for calcium [Ca]: Zone A = Ca(normal), ICa(low); Zone B = Ca(low), ICa(normal); and Zone C = Ca(normal), ICa(high), Zone D = Ca(high), ICa(normal).
RESULTS: A linear regression from 468 laboratory tests was used to derive a formula for "revised corrected calcium" [Calcium (revised)] over a range of albumin concentrations where, [Calcium (revised)] = plasma calcium (mg/dl) + [(4- Albumin (g/d)L)]*(plasma calcium (mg/dl)*0.052)]. [Calcium(alb]] vs [Calcium(Unadjusted)] decreased zone B errors 12%, [95%CI;8-15%], vs 44% [95%CI;37-50%], p < 0.001. However, [Calcium(alb]] vs [Calcium(Unadjusted)] increased zone A error (60%,[95%CI;42-78%], vs 7% [95%CI;1-13%], p < 0.001). [Calcium (revised)] decreased zone A errors (15%, [95%CI;6-24%]) vs [Calcium(alb) ] (60% [95%CI;42-78%], p < 0.001) and Zone D errors from 9% [95%CI;6-12%] to 2% [95%CI;1:5%, p < 0.001].
CONCLUSIONS: [Calcium(alb)] is unreliable in hypo- or hypercalcemia. We provide a protocol for locally derived correction of calcium for albumin.