B-010 Comparison of Manual Urine Dipstick and Microscopy With Automated UC-3500 and UF-4000 Sysmex UN Series Urinalysis; A Comparative Experimental Research Approach at an Urban Referral Hospital in Ghana

Abstract Background Urine analysis is one of the most common tests for assessing urinary-tract and kidney diseases. In recent years several automated instruments examining urine have been introduced. Though the introduction of automated urine analyzers is expected to reduce the labour involved, turnaround time and potential assay variations, manual urine analysis remains the gold standard or reference method for the analysis of urine. The new Sysmex UN-Series is believed to offer superior performance than other automated systems and manual methods. Methodology A total of 67 routine freshly voided midstream urine samples were analyzed within 1 hour in our study. The results of the automated system were compared with the results of the manual processing which consisted of physical, dipstick chemistry and sediment analysis. Correlation and concordance/agreement between the automated and the manual system were assessed by Bland-Altman plot and Cohen’s Kappa analysis respectively. Results There was a significant fair agreement between the manual analysis and Sysmex UF-3500, in the determination of urine physicochemical parameters (k = 0.193, P = 0.004). Both showed a significant moderate correlation (r = 0.593, P < 0.001) and a significant fair agreement (κ = 0.109, P < 0.001) for specific gravity and pH determination respectively. The best concordance between the two methods was in the nitrates (κ = 1.000, P < 0.001). Both systems recorded strong positive correlation for RBC (r = 0.951 and R2 = 0.904) and WBC (r = 0.91 and R2 = 0.822, P < 0.001) counts. Together, they had a significant good agreement [(65/67(97.0%), κ = 0.734, P < 0.001)] and a significant fair agreement [(48/67 (71.6%) κ = 0.065, P = 0.491)] for cast and bacteria counts correspondingly. Conclusion We conclude that the new automated Sysmex-UN series urine analyzer can be safely used in our laboratory since it demonstrated good performance and compatibility with the manual method. We recommend that microscopy results of the automated platform should be confirmed by manual microscopy, particularly in pathological samples.