Evaluation of the Analytical Performance of Atellica CH 930 Automated Chemistry Analyzer

Daewon Kim; Yonggeun Cho; Jooyoung Cho; Sun hee Kim; Sang-Guk Lee; Jeong-Ho Kim

doi:10.3343/lmo.2019.9.3.133

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Kim, Cho, Cho, Kim, Lee, and Kim: Evaluation of the Analytical Performance of Atellica CH 930 Automated Chemistry Analyzer

Original Article

Lab Med Online 2019;9(3):133-145.

Published online: 20 July 2019

DOI: https://doi.org/10.3343/lmo.2019.9.3.133

Evaluation of the Analytical Performance of Atellica CH 930 Automated Chemistry Analyzer

Daewon Kim, M.D.¹, Yonggeun Cho, M.D.¹, Jooyoung Cho, M.D.², Sun hee Kim, M.T.¹, Sang-Guk Lee, M.D.^1,, Jeong-Ho Kim, M.D.¹

¹Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

²Department 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

Received 1 August 2018 Revised 28 October 2018 Accepted 29 October 2018

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.

Keywords: Atellica CH 930 Analyzer, Performance evaluation, Automated QC function

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Fig. 1.

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.

Fig. 2.

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

Fig. 3.

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

Table 1.

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

Analyte	Unit	Level	Mean	Repeatability		Within-Laboratory Precision
Analyte	Unit	Level	Mean	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.

Table 2.

Linearity of the Siemens Atellica CH 930 Analyzer

Analyte	Unit	Material	Insert AMR		Validated AMR		Best fit	Non-linearity (%)	Recovery (%)
Analyte	Unit	Material	Low	High	Low	High	Best fit	Non-linearity (%)	Recovery (%)
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).

Table 3.

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
Analyte	Unit	N	Decision level	Decision level reference	Allowable error (%)	Allowable total error reference	%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.

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