Abstract
Real-time monitoring of patient’s blood metabolites, such as glucose and lactate, could potentially improve surgery and recovery outcomes for patients in surgical and intensive care units. Our enzyme thermometric biosensor which is based on flow injected calorimetric determination of immobilized enzyme reaction is capable of performing continuous, fast, and quantitative analysis of metabolites using whole blood. A key technical advantage the assay affords is the ability to use unpretreated whole blood. In this article, the enzyme thermometric biosensor was used, for the first time, to determine glucose and lactate concentrations in the blood of ICU patients. The linear detection range for glucose was 0.5–30 mM and 0.25–12 mM for lactate, using a 20 μL sample volume. A maximum sampling rate of 15 measurements per hour was achieved using venous blood samples, which corresponds to a 4-min measurement interval. In order to validate the accuracy of the results, a comparative analysis between the thermometric biosensor and the clinically applied instrument (LifeScan’s OneTouch®) which is based on disposable dry chemical reaction was performed using samples from 33 patients. The results showed a good correlation between the two methods for both glucose (r = 0.843, p < 0.0001) and lactate (r = 0.78, p = 0.0105). The ability to monitor metabolite levels and trends on a clinically relevant timescale of 5 min is critical for intensive monitoring of ICP and operative patients.
Highlights
Josefin Adlerberth and Qinglai Meng have contributed to this work.Pure and Applied Biochemistry, Department of Chemistry, Lund University, Naturvetarvägen 14, Box 124, 00 Lund, SwedenInstitute of Biomedical Sciences, Shanxi University, Taiyuan, Shanxi Province, ChinaBT Biomedical Technology, 22738 Lund, SwedenDepartment of Neurosurgery, Navy General Hospital, Beijing, ChinaInstitute of Environmental Medicine, Tongji MedicalCollege, Huazhong University of Science and Technology, Wuhan, ChinaMetabolites in human blood can provide valuable information for profiling and assessing health status
The results showed a good correlation between the two methods for both glucose (r = 0.843, p < 0.0001) and lactate (r = 0.78, p = 0.0105)
In order to analyze glucose and lactate in patients including diabetes, a sufficient measurement range of the glucose and lactate concentration should be investigated with enzyme thermometric (ET) biosensor, since blood glucose concentration of diabetic patient can be more than 20 mM, and lactate level can be elevated from normal 1.15 to 10 mM for some patients, e.g., cardiac disease [31]
Summary
In the management of stress-induced hyperglycemia, which is commonly observed in patients with or without diabetes in intensive care units (ICUs) [1], tight glucose control reportedly decreased morbidity or mortality or both in surgical, medical, and pediatric ICUs [2,3,4]. This is due to the fact that numerous drugs can alter laboratory test results and can confuse the physician; for instance, spurious data from drug interference have been reported for glucose measurements [5]. The attention of the anesthesiologist in managing the care of diabetic patients has centered around prevention of acute complications of abnormal blood glucose levels and ketosis during the surgery itself, but intraoperative glucose
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