Noninvasive Assessment of Excessive Erythrocytosis as a Screening Method for Chronic Mountain Sickness at High Altitude

Kaetan J. Vyas, David Danz, Robert H Gilman, Robert A Wise, Fabiola León-Velarde, J. Jaime Miranda, William Checkley

Research output: Contribution to journalArticle

Abstract

Globally, over 140 million people are at risk of developing chronic mountain sickness, a common maladaptation to life at high altitude (>2500 meters above sea level). The diagnosis is contingent upon the identification of excessive erythrocytosis (EE). Current best practices to identify EE require a venous blood draw, which is cumbersome for large-scale surveillance. We evaluated two point-of-care biomarkers to screen for EE: noninvasive spot-check tests of total hemoglobin and oxyhemoglobin saturation (Pronto-7, Masimo Corporation). We conducted paired evaluations of total serum hemoglobin from a venous blood draw and noninvasive, spot-check testing of total hemoglobin and oxyhemoglobin saturation with the Pronto-7 in 382 adults aged ≥35 years living in Puno, Peru (3825 meters above sea level). We used the Bland-Altman method to measure agreement between the noninvasive hemoglobin assessment and the gold standard lab hemoglobin analyzer. Mean age was 58.8 years and 47% were male. The Pronto-7 test was unsuccessful in 21 (5%) participants. Limits of agreement between total hemoglobin measured via venous blood draw and the noninvasive, spot-check test ranged from -2.8 g/dL (95% CI -3.0 to -2.5) to 2.5 g/dL (95% CI 2.2 to 2.7), with a bias of -0.2 g/dL (95% CI -0.3 to -0.02) for the difference between total hemoglobin and noninvasive hemoglobin concentrations. Overall, the noninvasive spot-check test of total hemoglobin had a better area under the receiver operating characteristic curve compared to oxyhemoglobin saturation for the identification of EE as measured by a gold standard laboratory hemoglobin analyzer (0.96 vs. 0.82; p

Original languageEnglish (US)
Pages (from-to)162-168
Number of pages7
JournalHigh Altitude Medicine and Biology
Volume16
Issue number2
DOIs
StatePublished - Jun 1 2015

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Altitude Sickness
Polycythemia
Hemoglobins
Oxyhemoglobins
Oceans and Seas
Point-of-Care Systems
Peru
Practice Guidelines
ROC Curve
Biomarkers

Keywords

  • Chronic mountain sickness
  • Excessive erythrocytosis
  • Noninvasive methods
  • Screening

ASJC Scopus subject areas

  • Medicine(all)
  • Physiology
  • Public Health, Environmental and Occupational Health

Cite this

Noninvasive Assessment of Excessive Erythrocytosis as a Screening Method for Chronic Mountain Sickness at High Altitude. / Vyas, Kaetan J.; Danz, David; Gilman, Robert H; Wise, Robert A; León-Velarde, Fabiola; Miranda, J. Jaime; Checkley, William.

In: High Altitude Medicine and Biology, Vol. 16, No. 2, 01.06.2015, p. 162-168.

Research output: Contribution to journalArticle

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