Validation of a multi-analyte panel with cell-bound complement activation products for systemic lupus erythematosus

BackgroundWe describe the analytical validation of an assay panel intended to assist clinicians with the diagnosis of systemic lupus erythematosus (SLE). The multi-analyte panel includes quantitative assessment of complement activation and measurement of autoantibodies.MethodsThe levels of the complement split product C4d bound to erythrocytes (EC4d) and B-lymphocytes (BC4d) (expressed as mean fluorescence intensity [MFI]) are measured by quantitative flow cytometry, while autoantibodies (inclusive of antinuclear and anti-double stranded DNA antibodies) are determined by immunoassays. Results of the multi-analyte panel are reported as positive or negative based on a 2-tiered index score. Post-phlebotomy stability of EC4d and BC4d in EDTA-anticoagulated blood is determined using specimens collected from patients with SLE and normal donors. Three-level C4 coated positive beads are run daily as controls. Analytical validity is reported using intra-day and inter-day coefficient of variation (CV).ResultsEC4d and BC4d are stable for 2 days at ambient temperature and for 4 days at 4 °C post-phlebotomy. Median intra-day and inter-day CV range from 2.9% to 7.8% (n = 30) and 7.3% to 12.4% (n = 66), respectively. The 2-tiered index score is reproducible over 4 consecutive days upon storage of blood at 4 °C. A total of 2,888 three-level quality control data were collected from 6 flow cytometers with an overall failure rate below 3%. Median EC4d level is 6 net MFI (Interquartile [IQ] range 4-9 net MFI) and median BC4d is 18 net MFI (IQ range 13-27 net MFI) among 86,852 specimens submitted for testing. The incidence of 2-tiered positive test results is 13.4%.ConclusionWe have established the analytical validity of a multi-analyte assay panel for SLE.