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Zhou, Yufeng, Dliso, Silothabo, Craske, Jennie, Gill, Andrea, Bracken, Louise, Landa, Kiran, Arnold, Philip, Walker, Laura, Grasim, Ionela, Seddon, Gabrielle, Chen, Tao 
ORCID: https://orcid.org/0000-0002-5489-6450, Davison, Andrew S., Sham, Tung-Ting, Smith, Barry, Hawcutt, Daniel B. and Maher, Simon
(2024)
'Rapid and non-invasive analysis of paracetamol overdose using paper arrow-mass spectrometry: a prospective observational study'. BMC Medicine, Vol 22, Issue 1, p. 553.
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Abstract
Background
Paracetamol is the most consumed medicine globally. Its accessibility contributes to common overdose. Paracetamol overdose is responsible for > 50% of acute liver failure cases, making it the second most common reason for a liver transplant. Rapid quantitation of paracetamol is crucial to guide treatment of paracetamol overdose. Current tests require invasive sampling and relatively long turnaround times. Paper arrow-mass spectrometry (PA-MS) combines sample collection, extraction, separation, enrichment and ionisation onto a single paper strip, achieving rapid, accurate, cost-effective and eco-friendly analysis direct from raw human saliva.
Methods
To validate PA-MS against an established test, 17 healthy adults were recruited. Samples were collected before and at 15, 30, 60, 120 and 240 min after ingesting 1 g of paracetamol. Plasma measured with an established clinical test served as the reference standard to validate PA-MS with three biofluids—plasma, resting saliva (RS) and stimulated saliva (SS). Participants’ views of blood, RS and SS sampling procedures were assessed qualitatively. Cross-validation was assessed using Lin’s concordance correlation coefficients (CCC), Bland–Altman difference plots, and ratios of PA-MS to the reference standard test.
Results
PA-MS using stimulated saliva offers a reliable alternative to intravenous blood sampling. The CCC is 0.93, the mean difference with the reference test is − 0.14 mg/L, and the ratios compared to the reference test are 0.84–1.27 from correlated samples collected at 5 intervals over 4 h for each participant.
Conclusions
Paracetamol detection from SS with PA-MS provides a reliable result that can aid timely treatment decisions. Differences between paracetamol concentration in resting and stimulated saliva were also identified for the first time, highlighting the importance of standardising saliva collection methods in general. This study marks a major milestone towards rapid and convenient saliva analysis.
| Item Type: | Article |
|---|---|
| Subjects: | QY Clinical Pathology > Diagnostic Tests > QY 125 Saliva WB Practice of Medicine > WB 25 Technique of research in internal medicine WI Digestive System > WI 700 Liver |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1186/s12916-024-03776-3 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 28 Nov 2024 09:27 |
| Last Modified: | 28 Nov 2024 09:27 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/25687 |
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