A comparison of automated urine analyzers cobas 6500, UN 3000-111b and iRICELL 3000 with manual microscopic urinalysis Piraya Tantisaranon a , Kanyarat Dumkengkhachornwong a , Peechana Aiadsakun b , Areerat Hnoonual c, * a Emergency Laboratory, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand b Clinical Microscopy Laboratory, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand c Division of Human Genetics, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand ARTICLE INFO Keywords: Urine sediment Automated urine analyzer Microscopic Urinalysis ABSTRACT Objectives: Microscopic examination is essential in urine analysis. This is a simple way to collect informative data but it is also labor-intensive, time-consuming, and requires experienced staff for accurate results and interpretation. Several automated urine analyzers have been introduced for urine analysis in medical laboratories. The aim of this study was to assess and compare the per- formance of the most common three automated urine analyzers, Cobas 6500, UN3000-111b and iRICELL 3000. Design: and Methods: A total of 100 routine urine samples were used in the study. Results from the three machines were compared with the routine procedure results including physical, chemical and sediment analysis. Results: There was good correlation of urine physical and chemical analyses between the three analyzers with an overall concordance level of more than 80%. For sediment analysis, the degree of concordance between manual analysis and the three instruments was very good to good for white blood cells, red blood cells and epithelial cells, and moderate for bacteria. There were fair to good agreements between manual microscopy and the three instruments, Cobas 6500, UN3000- 111b and iRICELL 3000, for casts (Cohen’s kappa 0.42, 0.38 and 0.62, respectively). Conclusions: The three automated urine analyzers showed similar performances and good corre- lation with manual microscopy. The results of this study indicate that automated urine analyzers could be used for initial urine testing to reduce high workloads and to save time, but manual microscopic analysis by experienced staff is still necessary to classify urine sediments for confir- mation, especially in pathologic specimens. 1. Introduction Urinalysis is an essential screening test in clinical laboratories in order to diagnose and plan treatment for urinary tract infections, kidney disease and diabetes. Urinalysis includes visual examination, evaluation of chemical parameters and microscopic examination. The traditional procedure for urinalysis recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Urinalysis Guidelines consists of two steps [1,2]. The first step includes visual inspection and a dipstick test, and the second step is * Corresponding author. Division of Human Genetics, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand., E-mail addresses: areerat.h@psu.ac.th, hareerat@medicine.psu.ac.th (A. Hnoonual). Contents lists available at ScienceDirect Practical Laboratory Medicine journal homepage: www.elsevier.com/locate/plabm https://doi.org/10.1016/j.plabm.2021.e00203 Received 15 October 2020; Accepted 13 January 2021 2352-5517/© 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/). Practical Laboratory Medicine 24 (2021) e00203