Total cholesterol performance of Abell-Levy-Brodie-Kendall reference measurement procedure: Certification of Japanese in-vitro diagnostic assay manufacturers through CDC's cholesterol reference method laboratory network

Background: Accurate measurement of total cholesterol (TC) is important for cardiovascular disease risk management. The US Centers for Disease Control and Prevention (CDC) and Cholesterol Reference Method Laboratory Network (CRMLN) perform Abell-Levy-Brodie-Kendall (AK) reference measurement procedure (RMP) for TC as a secondary reference method, and implement Certification Protocol for Manufacturers. Japanese CRMLN laboratory at Osaka performed the AK RMP for 22. years, and conducted TC certification for reagent/calibrator/instrument systems of six Japanese manufacturers every 2. years for 16. years. Osaka TC performance was examined and compared to CDC's reference values. Methods: AK RMP involved sample hydrolysis, cholesterol extraction, and determination of cholesterol levels by spectrophotometry. The Certification Protocol for Manufacturers includes comparison with AK RMP using at least 40 fresh specimens. Demonstration of average bias ≤ 3% and total coefficient of variation ≤ 3% qualified an analytical system for certification. Results: In the AK RMP used in the Osaka CRMLN laboratory, the regression equation for measuring TC was y (Osaka)=1.000x (CDC)+0.032 (n=619, R²=1.000). Six Japanese manufacturers had allowable performance for certification. Conclusions: The AK RMP for TC measurement was accurate, precise, and stable for 22. years. Six Japanese manufacturers were certified for 16. years.