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AACC Academy guidance in three key practice areas takes center stage on December 15 at the 2020 AACC Annual Scientific Meeting & Clinical Lab Expo. These sessions will cover: the role of procalcitonin in predicting mortality and monitoring antibiotic therapy; the clinical indications, analytical considerations, testing, and communicating of acute kidney injury (AKI) biomarkers; and updated point-of-care testing (POCT) recommendations. This is a chance for attendees to learn the latest evidence-based recommendations to support optimal patient outcomes. “It is definitely something attendees will want to see to stay current in our field,” Paul Jannetto, PhD, DABCC, FADLM, chair of the Annual Meeting Organizing Committee, told CLN Stat.

AACC Academy guidance documents address some of the most important issues in laboratory diagnostics, according to Gyorgy Abel, MD, PhD, president of AACC Academy. “The presentations will help disseminate these expert recommendations, enrich the program of the Annual Scientific Meeting, and ultimately will have an impact on laboratory practice and patient care.”

In addition to the less expensive and widely available C-reactive protein assay, interest has grown in using procalcitonin (PCT) as a biomarker to help guide antibiotic treatment, said Abel. The Clinical and Diagnostic Utility of Procalcitonin: An Update on the AACC Academy Guidance Document (33231) addresses this issue in depth. Speakers will summarize and review the findings of large meta-analyses and randomized control trials of PCT-guided antibiotic stewardship programs, said Alison Woodworth, PhD, DABCC, FADLM, who chairs the procalcitonin guidance document committee. The panelists also will review evidence supporting the role of PCT in predicting mortality in patients with lower respiratory tract infections and sepsis.

“Most studies suggest that while PCT-based algorithms don’t necessarily improve patient outcomes, they don’t harm patients and they do reduce antibiotic use. Reduction in antibiotic use may lead to a decrease in antibiotic resistance and significant cost savings for patients and hospitals,” said Woodworth, an associate professor of pathology and laboratory medicine at the University of Kentucky. Some PCT assays have been approved by the Food and Drug Administration to predict all-cause 28-day mortality as well, she added.

In her talk, Woodworth will explain the role of clinical laboratorians in establishing PCT testing strategies in patients with sepsis and other infections. Sophie Katz, MD, MPH, assistant professor of pediatric infectious diseases at Vanderbilt University Medical Center, will speak on the clinical utility of PCT testing in adult, pediatric, and neonatal patients with sepsis and other infections, to guide antimicrobial therapy. Allison Chambliss, PhD, DABCC, FADLM, assistant professor of clinical pathology at the University of Southern California’s Keck School of Medicine, will discuss the analytical and preanalytical considerations of PCT testing.

Chambliss said her discussion will cover the following questions:

  • Which preanalytical factors affect procalcitonin results and/or interpretation?
  • Which methods are available to measure procalcitonin, and how do they compare?
  • Are clinical decision points (cutoffs) comparable across procalcitonin assays?
  • What are possible confounding factors for interpreting procalcitonin results?

This AACC Academy guidance document is in the final stages of the writing process. “We plan to have the completed recommendations to the AACC Academy and up for public review by the end of the year,” said Woodworth. This session, worth 2.5 ACCENT credits, takes place on December 15 from 2–4:30 p.m. Central Time.

Affecting up to 15% of hospitalized patients, AKI is associated with increased morbidity, mortality, and cost. “Early recognition of AKI is critically important, and timely diagnosis can be achieved by using a robust laboratory testing strategy,” noted Abel. Laboratory Investigation of Acute Kidney Injury: Highlights from the New AACC Academy Guidance Document (33227) will discuss the new recommendations.

“Today, we are seeing up to a third of COVID-19 patients who are admitted to the hospital develop AKI, with up to half of them developing severe complications, leading to renal replacement therapy and death,” Joe El-Khoury, PhD, DABCC, FADLM, chair of the document’s writing committee and one of the session presenters, told CLN Stat. “Our ability to detect AKI is severely limited using the current definition of a 0.3 mg/dL increase in creatinine concentration from baseline. That definition does not factor in analytical and biological variability data, or the existence of newer biomarkers for AKI detection on the market.”

The AACC Academy guidance document provides an update on these issues, serving to guide clinicians and laboratorians in AKI laboratory investigations, said El-Khoury, who will present on AKI biomarkers. He joins Melanie Hoenig, MD, associate professor of medicine at Beth Israel Deaconess Medical Center, who will discuss clinical indications for AKI testing and appropriate patient evaluation, and Nicole Tolan, PhD, DABCC, assistant professor of pathology at Brigham and Women’s Hospital and Harvard Medical School, who will inform participants about identifying AKI via automated laboratory alerts.

Labs play a crucial role in assessing and identifying AKI, “especially by making decisions on the appropriate assay to use and biomarkers to measure in AKI,” El-Khoury continued. They also have a responsibility in guiding clinical colleagues to appropriately use tests, explaining to them what changes in values mean based on their current understanding of biological and analytical variability for a given assay, like creatinine. “Finally, we are also responsible for alerting our clinical teams of significant changes and critical results, which is very important in AKI to prevent further irreversible damage to the patient’s kidneys,” said El-Khoury.

Attendees should walk away from this session knowing that analytical and biological variability data can improve the current definition of AKI, that analytical assays for creatinine with poor precision profiles are not appropriate for detecting AKI, and that emerging biomarkers like TIMP2 and IGFBP7 are not yet ready for clinical use. “I also hope attendees will gain an appreciation of the evidence behind the rest of the recommendations in the AACC Academy’s AKI guideline and that they will work to implement these recommendations in their clinical practice,” said El-Khoury.

The scientific session takes place on December 15 from 2–4:30 p.m. Central Time and is worth 2.5 ACCENT credits.

POCT is one of the fastest growing segments in laboratory diagnostics. The new AACC Academy POCT Guidance Document updates previous evidence-based practice guidelines, focusing on recommendations for managing POCT. “Fast technological and practice changes in POCT, which now include molecular diagnostics, warranted an update,” said Abel.

The guidance offers best practices that hospitals and other healthcare institutions should follow when running a POCT program. Management of Point-of-Care Testing: An AACC Academy Guidance Document (33107) features three presenters. James Nichols, PhD, DABCC, FADLM, professor of pathology, microbiology, and immunology at Vanderbilt University Medical Center, plans to speak on improving POCT performance through proficiency testing and data management usage.

Ellis Jacobs, PhD, DABCC, FADLM, a senior consultant at EJ Clinical Consulting, follows with a talk on selecting a POCT system and educating users to improve test performance. David Alter, MD, MPH, DABCC, associate professor with Emory University School of Medicine’s Department of Pathology and Laboratory Medicine, will discuss POCT uses and the correlation between reality and theory.

Speakers will provide a literature overview and describe key recommendations. Among these are:

  • An interdisciplinary committee is essential for a successful POCT program.
  • A single training event is not sufficient, and ongoing competency, training, and support from laboratories are needed to maintain test performance.
  • Oversight of a POCT program should be provided by individuals with experience in clinical laboratory sciences and quality management, including defined roles and responsibilities for a POCT director, POCT coordinators, and POCT operators.

“We hope that the AACC Academy Guidance Document will help institutions improve the organization and management of POCT, and the recommendations will provide best practices that POCT programs can gain support from hospital administration for the role of faster turnaround of laboratory test results and POCT in patient care,” Nichols told CLN Stat. The scientific session takes place on December 15 from 11 a.m.–12:30 p.m. and is worth 1.5 ACCENT credit hours.