lmo Laboratory Medicine Online Lab Med Online ∗∗ 2093-6338 The Korean Society for Laboratory Medicine 10.3343/lmo.2019.9.3.133 lmo-9-133 Original Article Evaluation of the Analytical Performance of Atellica CH 930 Automated Chemistry Analyzer KimDaewonM.D. 1 ChoYonggeunM.D. 1 ChoJooyoungM.D. 2 KimSun heeM.T. 1 LeeSang-GukM.D. 1 KimJeong-HoM.D. 1 Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Laboratory Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea Corresponding author: Sang-Guk Lee, M.D., Ph.D. https://orcid.org/0000-0003-3862-3660 Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2455, Fax: +82-2-364-1583, E-mail: comforter6@yuhs.ac 07 2019 20 07 2019 9 3 133 145 01082018 28102018 29102018 Copyright © 2019 The Korean Society for Laboratory Medicine 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Recently, a new automated chemistry analyzer, Atellica CH930 (Siemens, Germany), was introduced. It automatically measures internal quality control (QC) materials according to a pre-determined schedule. For this purpose, the instrument has space for storage of QC materials. We evaluated the analytical performance of chemistry items by using the Atellica system.

 Methods

The precision of 29 items was evaluated with three levels of QC materials with two storage methods. We stored the QC materials in the dedicated storage space in the instrument during the precision evaluation period. In addition, we aliquoted and stored the materials in the refrigerator, and then loaded the material in a timely manner. Linearity, carry-over, and agreement with current methods were also evaluated.

 Results

The within-laboratory coefficient of variation (CV) of most items, except for total CO2 (tCO2), was within 5.0% in both QC storage methods without significant differences in CV between storage methods. The CV of tCO2 was 5.2%, 5.8%, and 5.1% at three different levels when the QC materials were stored in a dedicated space in the instrument. The linearity was acceptable, showing <5% nonlinearity. Although good agreement was observed for most items, some items, such as calcium, total bilirubin, aspartate transaminase, and chloride, showed unequivalent results.

 Conclusions

Atellica CH930 showed acceptable precision, linearity, and agreement in routine chemistry items. The automatic QC function using the storage device has no problem with stability or precision. It can reduce the manual process, allowing technicians to focus on reviewing the QC results and reporting reliable results.

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Precision of the Siemens Atellica CH 930 Analyzer. Within-laboratory precision (A) and repeatability (B) of 29 analytes were calculated according to the CLSI guideline EP05-A3. QC materials used were supplied either by conventional manual loading after warming up to room temperature from refrigerator storage (black) or by automatic loading from the inner storage/supply system of the instrument (red). Mean CV value and the 95% confidence interval of each analyte are denoted as rectangles and flanking lines, respectively.

Agreement and correlation of 28 chemical analytes between the Atellica CH 930 analyzer (Y axis) and Hitachi 7600 analyzer (X axis).

Agreement and correlation of 25 chemical analytes between the Atellica CH 930 analyzer (Y axis) and Cobas c702 (X axis).

Precision of the Siemens Atellica CH 930 Analyzer for evaluating routine chemical analytes

Analyte Unit Level Mean Repeatability Within-Laboratory Precision
Storage∗ % CV (95% CI) Manual† % CV (95% CI) Storage∗ % CV (95% CI) Manual† % CV (95% CI)
Ca mg/dL 1 5.4 1.27 (1.04–1.63) 1.32 (1.08–1.69) 2.52 (2.08–3.26) 2.25 (1.85–2.96)
    2 9.8 1.17 (0.96–1.50) 0.85 (0.70–1.08) 1.52 (1.27–1.89) 1.39 (1.14–1.81)
    3 13.1 0.64 (0.53–0.82) 0.72 (0.59–0.92) 1.06 (0.87–1.37) 1.19 (0.98–1.54)
Mg mg/dL 1 0.42 2.51 (2.06–3.21) 1.48 (1.22–1.90) 4.33 (3.50–5.71) 4.61 (3.81–5.84)
    2 1.08 1.45 (1.19–1.85) 1.34 (1.10–1.71) 2.33 (1.87–3.10) 2.69 (2.23–3.45)
    3 1.68 0.81 (0.67–1.04) 0.84 (0.69–1.08) 3.60 (2.88–4.91) 2.27 (1.83–3.08)
Inorganic P mg/dL 1 2.2 1.75 (1.44–2.24) 1.44 (1.18–1.84) 2.15 (1.81–2.66) 1.79 (1.50–2.22)
    2 4.2 1.15 (0.95–1.48) 0.79 (0.65–1.01) 1.29 (1.12–1.56) 1.09 (0.91–1.36)
    3 7.8 0.73 (0.60–0.94) 0.65 (0.53–0.83) 2.55 (2.11–3.25) 1.26 (1.06–1.57)
BUN mg/dL 1 15.2 3.06 (2.51–3.92) 3.80 (3.12–4.86) 3.71 (3.19–4.51) 4.20 (3.59–5.07)
    2 40.9 2.59 (2.13–3.31) 2.85 (2.34–3.64) 3.15 (2.68–3.92) 3.37 (2.89–4.07)
    3 78.9 3.09 (2.54–3.96) 2.06 (1.69–2.64) 3.28 (2.82–3.92) 3.20 (2.64–4.05)
Creatinine (Jaffe) mg/dL 1 0.8 1.89 (1.55–2.42) 2.47 (2.03–3.16) 2.52 (2.12–3.19) 3.36 (2.81–4.28)
    2 1.8 1.78 (1.47–2.28) 1.66 (1.36–2.13) 1.82 (1.57–2.17) 1.86 (1.58–2.29)
    3 8.8 0.64 (0.52–0.82) 0.60 (0.49–0.76) 0.99 (0.83–1.26) 0.97 (0.80–1.27)
Creatinine (Enzymatic) mg/dL 1 0.8 2.16 (1.78–2.77) 2.16 (1.78–2.77) 2.21 (1.92–2.65) 2.29 (1.98–2.73)
    2 1.7 0.96 (0.79–1.23) 1.17 (0.96–1.49) 1.30 (1.10–1.60) 1.41 (1.21–1.70)
    3 8.8 0.33 (0.27–0.42) 0.43 (0.35–0.54) 0.59 (0.50–0.73) 0.70 (0.58–0.88)
Glucose mg/dL 1 59 0.89 (0.73–1.14) 0.78 (0.64–1.00) 1.18 (1.00–1.45) 1.02 (0.87–1.26)
    2 113 0.63 (0.52–0.81) 0.71 (0.59–0.91) 0.88 (0.75–1.09) 0.88 (0.75–1.09)
    3 352 0.58 (0.48–0.74) 0.56 (0.46–0.72) 0.74 (0.63–0.90) 0.71 (0.61–0.86)
Uric acid mg/dL 1 3.4 0.97 (0.80–1.24) 0.97 (0.80–1.24) 1.47 (1.22–1.88) 1.46 (1.22–1.84)
    2 5.8 0.27 (0.22–0.35) 0.54 (0.45–0.69) 1.02 (0.80–1.46) 0.99 (0.80–1.31)
    3 9.6 0.40 (0.33–0.52) 0.47 (0.38–0.60) 0.97 (0.77–1.34) 0.99 (0.79–1.36)
T. protein g/dL 1 4.1 0.83 (0.68–1.06) 0.62 (0.51–0.79) 1.54 (1.22–2.09) 1.49 (1.16–2.09)
    2 5.8 0.67 (0.55–0.86) 0.59 (0.48–0.75) 1.18 (0.95–1.56) 1.14 (0.94–1.52)
    3 6.7 0.63 (0.51–0.80) 0.61 (0.50–0.78) 0.96 (0.79–1.27) 0.97 (0.79–1.29)
Albumin g/dL 1 5.4 0.81 (0.67–1.04) 0.67 (0.55–0.85) 1.67 (1.34–2.31) 1.79 (1.42–2.45)
    2 3.4 0.57 (0.47–0.73) 1.28 (1.05–1.63) 1.06 (0.87–1.38) 1.36 (1.17–1.63)
    3 3.9 0.76 (0.62–0.97) 1.03 (0.85–1.32) 1.11 (0.95–1.38) 1.10 (0.93–1.35)
T. bilirubin mg/dL 1 0.7 0.00 (0.00–0.00) 0.00 (0.00–0.00) 0.00 (0.00–0.00) 0.00 (0.00–0.00)
    2 3.6 0.62 (0.51–0.79) 0.62 (0.51–0.79) 0.93 (0.76–1.23) 0.93 (0.76–1.23)
    3 7.8 0.48 (0.39–0.61) 0.48 (0.39–0.61) 0.56 (0.48–0.68) 0.56 (0.48–0.68)
D. bilirubin mg/dL 1 0.3 0.00 (0.00–0.00) 0.00 (0.00–0.00) 0.00 (0.00–0.00) 0.00 (0.00–0.00)
    2 1.5 1.06 (0.87–1.35) 1.06 (0.87–1.35) 1.05 (0.91–1.25) 1.05 (0.91–1.25)
    3 2.8 1.21 (0.99–1.55) 1.21 (0.99–1.55) 1.61 (1.36–1.96) 1.61 (1.36–1.96)
ALP U/L 1 33 1.23 (1.01–1.57) 3.08 (2.53–3.94) 2.15 (1.73–2.87) 3.45 (2.98–4.13)
    2 147 0.87 (0.71–1.11) 0.84 (0.69–1.07) 1.05 (0.90–1.29) 1.18 (1.00–1.47)
    3 285 0.86 (0.71–1.11) 0.63 (0.52–0.81) 1.08 (0.92–1.31) 1.03 (0.86–1.29)
AST U/L 1 46 1.10 (0.90–1.40) 1.41 (1.16–1.80) 1.51 (1.29–1.84) 1.85 (1.58–2.25)
    2 120 0.69 (0.56–0.88) 0.76 (0.63–0.97) 1.15 (0.96–1.43) 1.10 (0.92–1.37)
    3 278 0.50 (0.41–0.64) 0.50 (0.41–0.63) 0.94 (0.77–1.28) 0.99 (0.81–1.31)
ALT U/L 1 32 2.31 (1.90–2.95) 2.31 (1.90–2.95) 2.48 (2.12–2.97) 2.48 (2.12–2.97)
    2 101 0.62 (0.51–0.79) 0.62 (0.51–0.79) 1.01 (0.84–1.28) 1.01 (0.84–1.28)
    3 197 0.47 (0.39–0.61) 0.47 (0.39–0.61) 0.85 (0.71–1.08) 0.85 (0.71–1.08)
Amylase U/L 1 41 0.85 (0.70–1.09) 0.76 (0.63–0.98) 1.21 (1.02–1.48) 1.27 (1.07–1.59)
    2 130 0.36 (0.30–0.47) 0.42 (0.35–0.54) 0.84 (0.69–1.09) 0.75 (0.62–0.95)
    3 265 0.43 (0.35–0.54) 0.43 (0.35–0.55) 0.77 (0.64–1.00) 0.76 (0.62–0.99)
Lipase U/L 1 43 3.14 (2.58–4.02) 2.94 (2.42–3.77) 3.53 (3.06–4.23) 4.00 (3.41–4.87)
    2 77 2.01 (1.65–2.57) 2.07 (1.70–2.65) 2.28 (1.98–2.74) 2.28 (1.96–2.73)
    3 240 1.13 (0.92–1.44) 0.88 (0.72–1.13) 1.53 (1.30–1.88) 1.45 (1.23–1.79)
GGT U/L 1 32 3.75 (3.08–4.79) 3.51 (2.88–4.49) 3.55 (3.07–4.22) 3.88 (3.35–4.68)
    2 87 1.50 (1.23–1.92) 2.10 (1.73–2.69) 1.80 (1.53–2.18) 2.14 (1.84–2.57)
    3 136 1.69 (1.39–2.16) 1.44 (1.18–1.84) 1.69 (1.47–2.02) 1.59 (1.37–1.89)
LD mg/dL 1 119 1.88 (1.54–2.40) 1.88 (1.54–2.40) 2.59 (2.18–3.22) 2.59 (2.18–3.22)
    2 189 1.58 (1.30–2.02) 0.84 (0.69–1.07) 2.14 (1.77–2.78) 2.14 (1.72–2.93)
    3 435 0.66 (0.54–0.85) 0.64 (0.53–0.82) 1.70 (1.36–2.29) 1.81 (1.43–2.52)
T. cholesterol mg/dL 1 111 0.72 (0.59–0.92) 0.72 (0.59–0.92) 2.05 (1.62–2.85) 2.05 (1.62–2.85)
    2 183 0.64 (0.52–0.82) 0.64 (0.52–0.82) 1.56 (1.23–2.17) 1.56 (1.23–2.17)
    3 249 0.48 (0.40–0.62) 0.48 (0.40–0.62) 1.50 (1.17–2.09) 1.50 (1.17–2.09)
Triglyceride mg/dL 1 84 1.15 (0.94–1.47) 0.73 (0.60–0.94) 1.48 (1.27–1.82) 1.29 (1.06–1.64)
    2 135 0.61 (0.50–0.78) 0.81 (0.67–1.04) 0.76 (0.65–0.91) 0.99 (0.85–1.20)
    3 199 0.44 (0.36–0.56) 0.61 (0.50–0.78) 0.54 (0.47–0.66) 0.74 (0.63–0.89)
HDLC mg/dL 1 27 1.61 (1.32–2.05) 1.17 (0.96–1.50) 1.72 (1.49–2.06) 1.57 (1.33–1.94)
    2 44 1.17 (0.96–1.50) 1.21 (0.99–1.54) 1.80 (1.52–2.23) 1.81 (1.51–2.25)
    3 60 0.94 (0.77–1.20) 0.96 (0.79–1.23) 1.83 (1.49–2.39) 2.09 (1.70–2.76)
LDLC mg/dL 1 65 1.14 (0.93–1.45) 1.14 (0.93–1.45) 1.92 (1.59–2.44) 1.92 (1.59–2.44)
    2 111 0.94 (0.77–1.20) 0.94 (0.77–1.20) 1.86 (1.55–2.37) 1.86 (1.55–2.37)
    3 133 0.59 (0.49–0.76) 0.59 (0.49–0.76) 2.13 (1.72–2.87) 2.13 (1.72–2.87)
Iron μg/dL 1 73 1.27 (1.05–1.63) 1.69 (1.39–2.16) 1.50 (1.26–1.87) 1.75 (1.52–2.10)
    2 153 0.74 (0.61–0.95) 0.78 (0.64–1.00) 0.86 (0.75–1.04) 0.82 (0.72–0.98)
    3 225 0.50 (0.41–0.64) 0.42 (0.34–0.53) 0.57 (0.49–0.69) 0.57 (0.49–0.70)
TIBC μg/dL 1 229 1.01 (0.83–1.29) 0.87 (0.71–1.11) 1.34 (1.14–1.68) 1.25 (1.07–1.54)
    2 303 1.10 (0.91–1.41) 0.76 (0.62–0.97) 1.50 (1.28–1.85) 1.46 (1.20–1.88)
    3 358 1.12 (0.92–1.43) 1.02 (0.84–1.30) 1.56 (1.29–1.97) 1.52 (1.29–1.89)
tCO2 mmol/L 1 15 1.17 (0.96–1.49) 1.42 (1.16–1.81) 5.20 (4.23–6.90) 3.45 (2.86–4.35)
    2 20 1.36 (1.12–1.75) 1.21 (0.99–1.54) 5.80 (4.72–7.83) 3.51 (2.93–4.49)
    3 24 1.62 (1.33–2.08) 1.00 (0.82–1.28) 5.11 (4.13–6.74) 2.75 (2.26–3.51)
Na mmol/L 1 114 0.62 (0.51–0.79) 0.39 (0.32–0.50) 0.88 (0.73–1.12) 0.79 (0.65–1.02)
    2 140 0.35 (0.29–0.44) 0.38 (0.31–0.49) 0.49 (0.42–0.60) 0.56 (0.48–0.69)
    3 158 0.37 (0.30–0.47) 0.30 (0.25–0.39) 0.49 (0.41–0.61) 0.59 (0.49–0.75)
K mmol/L 1 2.4 0.47 (0.38–0.60) 0.00 (0.00–0.00) 0.47 (0.41–0.56) 0.00 (0.00–0.00)
    2 3.9 0.41 (0.33–0.52) 0.76 (0.62–0.97) 0.56 (0.48–0.69) 1.01 (0.86–1.24)
    3 7.5 0.44 (0.37–0.57) 0.42 (0.34–0.53) 0.70 (0.59–0.89) 0.88 (0.73–1.11)
Cl mmol/L 1 78 0.70 (0.58–0.90) 0.70 (0.58–0.90) 1.17 (0.98–1.45) 1.17 (0.98–1.45)
    2 101 0.35 (0.28–0.44) 0.35 (0.28–0.44) 1.15 (0.94–1.49) 1.15 (0.94–1.49)
    3 118 0.28 (0.23–0.36) 0.28 (0.23–0.36) 1.08 (0.86–1.44) 1.08 (0.86–1.44)

Using quality control materials automatically supplied from built in storage;

Using quality control materials supplied from refrigerator by manual procedure.

Abbreviations: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; Ca, calcium; CI, confidence interval; Cl, chloride; CV, coefficient variation; D. bilirubin, direct bilirubin; GGT, gamma (γ)-glutamyl transferase; HDLC, high density lipoprotein cholesterol; Inorganic P, inorganic phosphorus; K, potassium; LD, lactate dehydrogenase; LDLC, low density lipoprotein cholesterol; Mg, magnesium; Na, sodium; T. bilirubin, total bilirubin; T. cholesterol, total cholesterol; tCO2, total carbon dioxide; TIBC, total iron-binding capacity; T. protein, total protein.

Linearity of the Siemens Atellica CH 930 Analyzer

Analyte Unit Material Insert AMR Validated AMR Best fit Non-linearity (%) Recovery (%)
Low High Low High
Ca mg/dL Validate® GC1∗ 1 15 1 15 Linear – 96.3–101.7
Mg mmol/L Validate® GC1 0.5 5 0.8 5 3rd order polynomial Less than 5% 97.9–101.3
Inorganic P mg/dL Validate® GC1 0.3 20 0.5 19 Linear – 97.7–100.1
BUN mg/dL Validate® GC1 5 150 10 135 2nd order polynomial Less than 5% 100.0–103.2
Creatinine mg/dL Validate® GC1 0.15 30.0 0.25 25.60 3rd order polynomial Less than 5% 100.0–106.5
Glucose mg/dL Validate® GC1 4 700 10 676 2nd order polynomial Less than 5% 100.0–103.6
Uric Acid mg/dL Validate® GC1 0.5 20.0 0.7 21.5 Linear – 96.1–100.0
T. protein g/dL Validate® GC1 2 12 2 12 Linear – 97.7–100.0
Albumin g/dL Validate® GC1 1.0 6.0 1.0 6.0 2nd order polynomial Less than 5% 100.0–102.9
T. Bilirubin mg/dL Patient serum 0.1 35.0 0.5 27.0 Linear – 99.0–100.3
D. Bilirubin mg/dL Patient serum 0.1 15.0 0.2 14.3 Linear – 99.5–100.7
ALP IU/L Validate® GC3† 10 1,000 12 942 3rd order polynomial Less than 5% 99.6–102.4
AST IU/L Validate® GC3 8 1,000 9 863 Linear – 97.7–100.1
ALT IU/L Validate® GC3 7 1,100 8 1,121 Linear – 98.5–103.1
Amylase U/L Validate® GC3 5 1,500 5 1,375 Linear – 93.9–118.8
Lipase U/L Validate® GC3 8 700 18 715 Linear – 100.0–105.9
GGT U/L Validate® GC3 7 1,200 9 1,110 Linear – 97.7–100.0
LD IU/L Validate® GC3 20 700 21 663 2nd order polynomial Less than 5% 100.0–108.3
T. cholesterol mg/dL Validate® GC1 25 618 28 558 2nd order polynomial Less than 5% 100.0–103.4
Triglyceride mg/dL Validate® GC1 10 550 12 521 2nd order polynomial Less than 5% 100.0–105.2
HDLC mg/dL Patient serum 20 129 5 115 2nd order polynomial Less than 5% 100.0–104.1
LDLC mg/dL Patient serum 5 1,000 17 241 Linear – 98.9–100.4
Iron μg/dL Validate® GC2‡ 2 1,000 12 951 3rd order polynomial Less than 5% 99.6–102.4
TIBC μg/dL Patient serum 40 670 94 431 Linear – 96.9–104.6
tCO2 mmol/L Validate® GC2 10 40 12 36 Linear – 100.0–103.7
Na mmol/L Patient serum 50 200 49 167 Linear – 100.0–100.3
K mmol/L Patient serum 1.0 10.0 1.0 9.4 Linear – 99.0–100.5
Cl mmol/L Patient serum 50 200 44 202 2nd order polynomial Less than 5% 97.8–100.0

Validate® GC1

GC3

GC2 linearity and calibration verification kits (Maine Standards, Cumberland Foreside, ME, USA).

Abbreviations: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; Ca, calcium; CI, confidence interval; Cl, chloride; CV, coefficient variation; D. bilirubin, direct bilirubin; GGT, gamma (γ)-glutamyl transferase; HDLC, high density lipoprotein cholesterol; Inorganic P, inorganic phosphorus; K, potassium; LD, lactate dehydrogenase; LDLC, low density lipoprotein cholesterol; Mg, magnesium; Na, sodium; T. bilirubin, total bilirubin; T. cholesterol, total cholesterol; tCO2, total carbon dioxide; TIBC, total iron-binding capacity; T. protein, total protein.

Agreement of the Siemens Atellica CH 930 Analyzer with the Hitachi 7600 analyzer and Cobas c702 at medical decision levels

Analyte Unit N Decision level Decision level reference Allowable error (%) Allowable total error reference vs. Hitachi 7600 analyzer vs. Cobas c702
%difference Decision %difference Decision
Ca mg/dL 90 7.0 [9] 2.6 [11] –5.37 Nonequivalent –10.26 Nonequivalent
      10.8 [9] 2.6 [11] –4.59 Nonequivalent –3.32 Nonequivalent
      13.0 [9] 2.6 [11] –4.35 Nonequivalent –1.25 Equivalent
Mg mmol/L 40 1.20 [8] 4.8 [11] –2.33 Equivalent –5.57 Nonequivalent
      2.00 [8] 4.8 [11] 2.12 Equivalent –3.30 Equivalent
Inorganic P mg/dL 40 2.5 [8] 10.1 [11] 1.06 Equivalent 1.98 Equivalent
      4.5 [9] 10.1 [11] 2.52 Equivalent 1.10 Equivalent
BUN mg/dL 90 6.0 [8] 15.55 [11] 6.96 Equivalent 12.61 Equivalent
      27.0 [9] 15.55 [11] 1.82 Equivalent 7.16 Equivalent
Creatinine mg/dL 90 0.60 [8] 8.8 [11] 1.52 Equivalent –6.25 Equivalent
      1.60 [8] 8.8 [11] –3.02 Equivalent –6.71 Equivalent
Glucose mg/dL 90 50 [9] 7 [11] –3.63 Equivalent –2.14 Equivalent
      126 [9] 7 [11] –5.89 Equivalent –2.40 Equivalent
      200 [9] 7 [11] –6.45 Equivalent –2.47 Equivalent
Uric Acid mg/dL 90 2.0 [8] 12 [11] –6.07 Equivalent 2.47 Equivalent
      8.0 [8] 12 [11] 2.18 Equivalent 0.62 Equivalent
T. protein g/dL 90 4.5 [8] 3.6 [11] 3.28 Equivalent –1.68 Equivalent
      6.0 [8] 3.6 [11] 2.47 Equivalent –1.26 Equivalent
      8.0 [8] 3.6 [11] 1.86 Equivalent –0.94 Equivalent
Albumin g/dL 90 3.5 [8] 10 [11] –2.75 Equivalent –9.14 Equivalent
      5.2 [8] 10 [11] 3.70 Equivalent –1.44 Equivalent
T. bilirubin mg/dL 50 1.0 [9] 26.94 [11] 13.26 Equivalent 27.61 Nonequivalent
      20.0 [9] 26.94 [11] 14.98 Equivalent 18.44 Equivalent
D. bilirubin mg/dL 50 1.0 [9] 44.5 [11] 10.27 Equivalent 10.77 Equivalent
ALP IU/L 40 150 [8] 12 [11] 6.88 Equivalent 10.41 Equivalent
      400 [8] 12 [11] 7.33 Equivalent 10.42 Equivalent
AST IU/L 40 60 [8] 16.69 [11] 16.79 Nonequivalent 9.13 Equivalent
      300 [8] 16.69 [11] 17.24 Nonequivalent 10.46 Equivalent
ALT IU/L 50 60 [8] 27.48 [11] 18.65 Equivalent 13.21 Equivalent
      300 [8] 27.48 [11] 19.20 Equivalent 14.43 Equivalent
Amylase U/L 90 120 [8] 14.6 [11] –3.65 Equivalent –5.35 Equivalent
      200 [8] 14.6 [11] –3.73 Equivalent –5.50 Equivalent
Lipase U/L 90 60 [9] 37.88 [11] 9.16 Equivalent 13.23 Equivalent
GGT U/L 90 50 [8] 22.11 [11] 11.82 Equivalent 2.88 Equivalent
      150 [8] 22.11 [11] 12.49 Equivalent 2.67 Equivalent
LD IU/L 90 300 [8] 11.4 [11] –3.12 Equivalent –0.78 Equivalent
      500 [8] 11.4 [11] –3.72 Equivalent –0.59 Equivalent
T. cholesterol mg/dL 50 200 [10] 9.01 [11] –3.78 Equivalent –2.02 Equivalent
      240 [10] 9.01 [11] –4.20 Equivalent –2.76 Equivalent
Triglyceride mg/dL 40 150 [8] 25.99 [11] –8.63 Equivalent –4.11 Equivalent
      400 [8] 25.99 [11] –2.11 Equivalent –0.77 Equivalent
HDLC mg/dL 50 40 [10] 11.63 [11] –4.86 Equivalent –0.20 Equivalent
      60 [10] 11.63 [11] –3.83 Equivalent –8.25 Equivalent
LDLC mg/dL 50 100 [10] 11.9 [11] –0.28 Equivalent –2.17 Equivalent
      160 [10] 11.9 [11] 1.84 Equivalent 0.19 Equivalent
Iron μg/dL 90 50 [8] 30.7 [11] –1.74 Equivalent –20.48 Equivalent
      220 [8] 30.7 [11] –5.63 Equivalent –2.63 Equivalent
UIBC μg/dL 90 250 [9] 12 [12] –2.12 Equivalent –2.32 Equivalent
tCO2 mmol/L 90 20 [9] 4.86 [11] 2.62 Equivalent –2.12 Equivalent
      33 [9] 4.86 [11] –3.99 Equivalent –2.08 Equivalent
Na mmol/L 40 135 [8] 0.73 [11] 0.74 Nonequivalent – –
      150 [8] 0.73 [11] 0.66 Equivalent – –
K mmol/L 40 3.0 [9] 5.61 [11] –3.39 Equivalent – –
      6.0 [9] 5.61 [11] –1.68 Equivalent – –
Cl mmol/L 40 90 [9] 1.5 [11] 2.20 Nonequivalent – –
      110 [9] 1.5 [11] 1.80 Nonequivalent – –

Abbreviations: ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; Ca, calcium; Cl, chloride; D. bilirubin, direct bilirubin; GGT, gamma (γ)-glutamyl transferase; HDLC, high density lipoprotein cholesterol; Inorganic P, inorganic phosphorus; K, potassium; LD, lactate dehydrogenase; LDLC, low density lipoprotein cholesterol; Mg, magnesium; Na, sodium; T. bilirubin, total bilirubin; T. cholesterol, total cholesterol; tCO2, total carbon dioxide; T. protein, total protein; UIBC, unsaturated iron-binding capacity.