The usefulness of point-of-care (POC) tests in screening elevated glucose and ketone body levels postmortem

Abstract

The aim was to evaluate the performance of point-of-care (POC) tests in detecting glucose and ketone bodies in postmortem (PM) samples and to assess the usefulness of POC tests in sample screening for more precise analyses. Glucose and ketone body, β-hydroxybutyrate (BHB), were measured from vitreous humor (VH) in 52 autopsy cases with a POC blood glucose monitoring device (BGMD). In addition glucose and ketone bodies, acetone (Ac) and acetoacetate (AcAc), were measured from urine samples in another set of 59 cases with semi-quantitative stick tests. The results were compared to the concentration in VH measured with validated methods (values ≥ 7mmol/l indicate possible hyperglycemia and total ketone body levels ≥ 3mmol/l ketoacidosis). The sensitivity for glucose with the BGMD was 1.0 and specificity 0.94 when the threshold value for the meter to predict elevated glucose was set to ≥ 10mmol/l. The correlation between the BGMD and the validated method was strong (R(2)=0.89). For detecting ketoacidosis, the BGMD had a sensitivity of 1.0 and specificity of 0.73, when the threshold value was set to 2.5mmol/l. The urine stick test presented a sensitivity of 0.89 and specificity of 0.90 for detecting elevated VH glucose concentration. The sensitivity and specificity for the stick test to detect cases with possible ketoacidosis were 0.84 and 0.68, respectively. According to the results, BGMD can be reliably applied for sample screening, although more samples need to be analyzed for delineating the correct threshold values. In the case of glucose, the urine stick tests could be indicative in detecting cases with VH glucose ≥ 10mmol/l. For predicting possible ketoacidosis with elevated VH total ketone bodies, the stick test is not reliable as the test presented both false-positive and -negative results.

Efficacy and safety of a ketogenic diet in children with drug-resistant epilepsy

“…The test reduces pain in children and limits the need for nurses to collect blood intravenously. Walta et al [25] and Chong and Reineke [ 26 ] reported that when the blood ketone value is > 4 or 6 mmol/L, the detected value of the FreeStyle instrument will be lower than the actual value. Currently, all FreeStyle instruments used to detect blood ketones on the market are designed for diabetic patients, and lack speci c blood ketone assayers for KD patients.…”

The Post-Mortem Evaluation of Glucose Concentration in Blood and Its Diagnostical Value

“…According to Cornelius Hess et al glucose concentration in vitreous fluid correlate with glycaemia previous to death ( Cornelius Hess, Musshoff, & Madea, 2011;. Moreover, estimation of HbA1c, fructosamine, or anhydroglucitol may provide useful data on the long-term glycemic control for individuals with diabetes (C. Hess et al, 2013;Lepik, Tõnisson, Kuudeberg, & Väli, 2018;Walta, Keltanen, Lindroos, & Sajantila, 2016). Though it has been thought that the glucose concentration in blood doesn't have high diagnostic validity because of its broad variation after death there are some studies that suggest post-mortal blood glucose analysis can be a useful diagnostic tool.…”

Capillary blood sampling in adults

“…The rapid tests are used in public health-care settings such as nursing homes, physicians' offices, outpatient clinics, and in home healthcare where a physician or a nurse is able to run a quick test to decide if a patient should be diagnosed further in a hospital or whether the result is negative and a disease is excluded [4]. Checking of glucose and C-reactive protein levels are the most common tests run at outpatient sites and physicians' offices [5][6][7]. A small amount of blood lets physicians to take decision if a patient needs to be prescribed an antibiotic (CRP level) or his/her blood sugar level should be further diagnosed.…”