Abstract Background Copper (Cu) and zinc (Zn) are essential cofactors of enzymes involved in several metabolic processes required for the development of tissue structures and immune response, especially in pediatrics and pregnant women. Triple quadrupole inductively coupled plasma mass spectrometer (ICP-QQQ) enables simultaneous precise quantification of multiple elements with high throughput, sensitivity, and specificity. Samples are introduced into ICP-QQQ as a liquid and converted to fine aerosol with the help of a nebulizer and spray chamber. The precision and sensitivity of measured metals are dependent on the sample preparation thus, this study focuses on comparing the analytical performances between two sample preparations: 0.5% nitric acid (HNO3) as the only diluent (Diluent A) versus a combination of 0.5% HNO3 along with 1% ethanol, 0.5% Ammonium hydroxide, 0.02% TritonX-100, and 0.1% HNO3 (Diluent B) for Cu and Zn metal analysis in serum using ICP-QQQ. Methods Twenty deidentified randomly selected patient serum samples were prepared with either diluent A or diluent B and analyzed by ICP-QQQ (Agilent 8900). Data were analyzed using EP Evaluator. Bland-Altman analysis was used to determine the agreement between the two sample preparations. Deming regression analysis was used to determine other analytical performances, such as the proportional and constant bias of Zn and Cu concentration. Results There was a bias of -4.8 and -3.0 between the two sample preparation methods when analyzing Cu and Zn, respectively. The mean of Cu-Diluent B versus Cu—Diluent A was 125.2 ± 28.3 µg/dL and 120.4 ± 29.8 µg/dL, respectively, with a slope of 1.070. Conversely, the Zn comparison study shows a lower slope (0.769) with a mean of 71.0 ± 20.5 and 68.0 ± 16.1 µg/dL for Zn-Diluent B and Zn-Diluent A, respectively. Conclusions Samples prepared with nitric acid solution only (Diluent A) appeared to show negative bias compared to Diluent B solution containing triton-X for both metals. However, the bias is within the total allowable error for zinc and copper. Importantly, Zn-sample analysis with diluent A (HNO3 only) shows a 23% proportional bias, which is absent with copper sample analysis. A larger study is needed to further compare several methods of sample preparation in ICP-QQQ analysis while leveraging simple preparation without compromising analytical sensitivity. Overall, this study shows that both methods of sample preparation can be effectively used in the ICP-QQQ analysis of serum copper and zinc.
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