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Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase

Matthijs Oyaert (UGent) , Jonas Himpe (UGent) , Marijn Speeckaert (UGent) , Veronique Stove (UGent) and Joris Delanghe (UGent)
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Abstract
Background: Recently, urine test strip readers have become available for automated test strip analysis. We explored the possibilities of the Sysmex UC-3500 automated urine chemistry analyzer based on complementary metal oxide semiconductor (CMOS) sensor technology with regard to accuracy of leukocyte esterase and hemoglobin peroxidase results. We studied the influence of possible confounders on these measurements. Methods: Reflectance data of leukocyte esterase and hemoglobin peroxidase were measured using CMOS technology on the Sysmex UC-3500 automated urine chemistry analyzer. Analytical performance (imprecision, LOQ) as well as the correlation with white blood cell (WBC) and red blood cell (RBC) counts (Sysmex UF-5000) were studied. Furthermore, the influence of urinary dilution, haptoglobin, pH and ascorbic acid as confounders was determined. Results: Within- and between-run imprecision (reflectance signal) ranged from 1.1% to 3.6% and 0.9% to 4.2% for peroxidase and 0.4% to 2.5% and 0.4% to 3.3% for leukocyte esterase. Good agreement was obtained between the UF-5000 for RBCs and peroxidase reflectance (r = 0.843) and for WBCs and leukocyte esterase (r = 0.821). Specific esterase activity decreased for WBC counts exceeding 100 cells/mu L. Haptoglobin influenced the peroxidase activity, whereas leukocyte esterase and peroxidase activities showed a pH optimum between 5.0 and 6.5. A sigmoidal correlation was observed between urinary osmolality and peroxidase activity. Conclusions: CMOS technology allows to obtain high quality test strip results for assessing WBC and RBC in urine. Quantitative peroxidase and leukocyte esterase are complementary with flow cytometry and have an added value in urinalysis, which may form a basis for expert system development.
Keywords
FLOW-CYTOMETRY, BACTERIAL CULTURE, URINALYSIS, MULTICENTER, ANALYZER, hemoglobin peroxidase, leukocyte esterase, urine sediment analysis, urine test strip analysis

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Chicago
Oyaert, Matthijs, Jonas Himpe, Marijn Speeckaert, Veronique Stove, and Joris Delanghe. 2018. “Quantitative Urine Test Strip Reading for Leukocyte Esterase and Hemoglobin Peroxidase.” Clinical Chemistry and Laboratory Medicine 56 (7): 1126–1132.
APA
Oyaert, M., Himpe, J., Speeckaert, M., Stove, V., & Delanghe, J. (2018). Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase. CLINICAL CHEMISTRY AND LABORATORY MEDICINE, 56(7), 1126–1132.
Vancouver
1.
Oyaert M, Himpe J, Speeckaert M, Stove V, Delanghe J. Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase. CLINICAL CHEMISTRY AND LABORATORY MEDICINE. 2018;56(7):1126–32.
MLA
Oyaert, Matthijs et al. “Quantitative Urine Test Strip Reading for Leukocyte Esterase and Hemoglobin Peroxidase.” CLINICAL CHEMISTRY AND LABORATORY MEDICINE 56.7 (2018): 1126–1132. Print.
@article{8569328,
  abstract     = {Background: Recently, urine test strip readers have become available for automated test strip analysis. We explored the possibilities of the Sysmex UC-3500 automated urine chemistry analyzer based on complementary metal oxide semiconductor (CMOS) sensor technology with regard to accuracy of leukocyte esterase and hemoglobin peroxidase results. We studied the influence of possible confounders on these measurements. 
Methods: Reflectance data of leukocyte esterase and hemoglobin peroxidase were measured using CMOS technology on the Sysmex UC-3500 automated urine chemistry analyzer. Analytical performance (imprecision, LOQ) as well as the correlation with white blood cell (WBC) and red blood cell (RBC) counts (Sysmex UF-5000) were studied. Furthermore, the influence of urinary dilution, haptoglobin, pH and ascorbic acid as confounders was determined. 
Results: Within- and between-run imprecision (reflectance signal) ranged from 1.1\% to 3.6\% and 0.9\% to 4.2\% for peroxidase and 0.4\% to 2.5\% and 0.4\% to 3.3\% for leukocyte esterase. Good agreement was obtained between the UF-5000 for RBCs and peroxidase reflectance (r = 0.843) and for WBCs and leukocyte esterase (r = 0.821). Specific esterase activity decreased for WBC counts exceeding 100 cells/mu L. Haptoglobin influenced the peroxidase activity, whereas leukocyte esterase and peroxidase activities showed a pH optimum between 5.0 and 6.5. A sigmoidal correlation was observed between urinary osmolality and peroxidase activity. 
Conclusions: CMOS technology allows to obtain high quality test strip results for assessing WBC and RBC in urine. Quantitative peroxidase and leukocyte esterase are complementary with flow cytometry and have an added value in urinalysis, which may form a basis for expert system development.},
  author       = {Oyaert, Matthijs and Himpe, Jonas and Speeckaert, Marijn and Stove, Veronique and Delanghe, Joris},
  issn         = {1434-6621},
  journal      = {CLINICAL CHEMISTRY AND LABORATORY MEDICINE},
  language     = {eng},
  number       = {7},
  pages        = {1126--1132},
  title        = {Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase},
  url          = {http://dx.doi.org/10.1515/cclm-2017-1159},
  volume       = {56},
  year         = {2018},
}

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