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Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda.

The American journal of tropical medicine and hygiene (2014-03-05)
Michael Hawkes, Andrea L Conroy, Robert O Opoka, Sophie Namasopo, W Conrad Liles, Chandy C John, Kevin C Kain
ABSTRACT

Severe malaria is frequently managed without access to laboratory testing. We report on the performance of point-of-care tests used to guide the management of a cohort of 179 children with severe malaria in a resource-limited Ugandan hospital. Correlation coefficients between paired measurements for glucose (i-STAT and One Touch Ultra), lactate (i-STAT and Lactate Scout), and hemoglobin (Hb; laboratory and i-STAT) were 0.86, 0.85, and 0.73, respectively. The OneTouch Ultra glucometer readings deviated systematically from the i-STAT values by +1.7 mmol/L. Lactate Scout values were systematically higher than i-STAT by +0.86 mmol/L. Lactate measurements from either device predicted subsequent mortality. Hb estimation by the i-STAT instrument was unbiased, with upper and lower limits of agreement of -34 and +34 g/L, and it was 91% sensitive and 89% specific for the diagnosis of severe anemia (Hb < 50 g/L). New commercially available bedside diagnostic tools, although imperfect, may expedite clinical decision-making in the management of critically ill children in resource-constrained settings.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Lactic acid solution, ACS reagent, ≥85%
Sigma-Aldrich
Lactic acid, 85%, FCC
Sigma-Aldrich
DL-Lactic acid, ~90% (T)
Sigma-Aldrich
Lactic acid, meets USP testing specifications
Sigma-Aldrich
Lactic acid, natural, ≥85%
Supelco
Lactic acid, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
DL-Lactic acid, 85 % (w/w), syrup
USP
Lactic acid, United States Pharmacopeia (USP) Reference Standard