Mission U120 Ultra Urine Analyzer, Mission Liquid Urine Controls, Mission Liquid Diptube Urine Control

K142543 · ACON Laboratories, Inc. · KQO · May 11, 2015 · Clinical Chemistry

Device Facts

• Record ID: K142543
• Device Name: Mission U120 Ultra Urine Analyzer, Mission Liquid Urine Controls, Mission Liquid Diptube Urine Control
• Applicant: ACON Laboratories, Inc.
• Product Code: KQO · Clinical Chemistry
• Decision Date: May 11, 2015
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 862.2900
• Device Class: Class 1

Indications for Use

The Mission® U120 Ultra Urine Analyzer is intended for use in conjunction with the Mission® Urinalysis Reagent Strips for the semi-quantitative detection of the following analytes in urine: glucose, bilirubin, ketone (acetoacetic acid), specific gravity, pH, blood, protein, urobilinogen, leukocytes and ascorbic acid as well as the qualitative detection of nitrite. The instrument is intended for point-of-care, in vitro diagnostic use only. The measurement can be used in general evaluation of health, and aids in the diagnosis and monitoring of metabolic or systemic diseases that affect kidney function, endocrine disorders and diseases or disorders of the urinary tract. It is intended for professional use only. The Mission® Liquid Urine Controls and Mission® Liquid Diptube Urine Controls are assayed urine controls, intended for use in validating the precision of analyzer reading of urinalysis for one or more of the following analytes: ascorbic acid, glucose, bilirubin, ketone (acetoacetic acid), specific gravity, blood, pH, protein, urobilinogen, nitrite and leukocytes. It is intended for professional in vitro diagnostic use only.

Device Story

Reflectance photometer analyzer; uses LED light source and CMOS image sensor to measure color intensity changes on urinalysis reagent strips; replaces manual visual color chart comparison. Used in point-of-care settings by professional operators. Features data management, internal thermal printer, and connectivity (USB, Bluetooth, RS232C, Ethernet). Provides semi-quantitative/qualitative results for 11 urine analytes. Aids clinicians in diagnosing/monitoring metabolic, kidney, and urinary tract conditions. Includes assayed liquid controls for precision validation.

Clinical Evidence

Clinical study at 3 sites with 9 intended users; 120 patient specimens per site plus contrived samples (total N=426-468 depending on analyte). Compared Mission U120 Ultra to predicate ACON U120. Results showed high agreement: exact agreement ranged from 85.5% (SG) to 100% (Nitrite); 100% agreement within one level for all analytes. Bench testing included precision, interference, temperature/voltage/humidity flex, and stability studies.

Technological Characteristics

Reflectance photometer; LED light source; CMOS image sensor. Dimensions: 26.0 x 15.0 x 17.5 cm; Weight: ≤1.66 kg. Power: 6 AA batteries or 100-240 VAC adapter. Connectivity: USB, Bluetooth, RS232C, RJ45 Ethernet. Operating conditions: 0-40°C, ≤85% RH. Touch screen LCD 640x480.

Indications for Use

Indicated for professional point-of-care in vitro diagnostic use to detect urine analytes (Glucose, Bilirubin, Ketone, Specific Gravity, pH, Blood, Protein, Urobilinogen, Leukocytes, Ascorbic Acid, Nitrite) for health evaluation and monitoring of metabolic, systemic, kidney, endocrine, or urinary tract diseases.

Regulatory Classification

Identification

An automated urinalysis system is a device intended to measure certain of the physical properties and chemical constituents of urine by procedures that duplicate manual urinalysis systems. This device is used in conjunction with certain materials to measure a variety of urinary analytes.

Predicate Devices

• ACON Urinalysis Reagent Strips, ACON U120 Urine Analyzer (k070929)
• Mission Liquid Urine Control, Mission Liquid Diptube Urine Control (k103387)

Submission Summary (Full Text)

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# 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY AND INSTRUMENT COMBINATION TEMPLATE

A. 510(k) Number:
k142543

B. Purpose for Submission:
New device

C. Measurand:
Glucose, Bilirubin, Ketone (Acetoacetic Acid), Specific Gravity, pH, Blood, Protein, Urobilinogen, Leukocytes, Ascorbic Acid and Nitrite

D. Type of Test:
Semi-quantitative and qualitative urinalysis

E. Applicant:
Acon Laboratories Inc.

F. Proprietary and Established Names:
Mission® Urinalysis Reagent Strips
Mission U120 Ultra Urine Analyzer
Mission Liquid Urine Controls
Mission Liquid Diptube Urine Controls

G. Regulatory Information:

| Regulation Description | Product Code | Device Class | Regulation |
| --- | --- | --- | --- |
| Occult blood test | JIO | II | 21 CFR § 864.6550 |
| Urinary glucose (non-quantitative) test system | JIL | II | 21 CFR § 862.1340 |
| Urinary protein or albumin (non-quantitative) test system | JIR | I | 21 CFR § 862.1645 |
| Urinary bilirubin and its conjugates (non-quantitative) test system | JJB | I | 21 CFR § 862.1115 |
| Ketones (non-quantitative) test system | JIN | I | 21 CFR § 862.1435 |
| Leukocyte peroxidase test | LJX | I | 21 CFR § 864.7675 |
| Nitrite (non-quantitative) test system | JMT | I | 21 CFR § 862.1510 |
| Urinary pH (non-quantitative) test system | CEN | I | 21 CFR § 862.1550 |
| Refractometer for clinical use (specific gravity) | JRE | I | 21 CFR § 862.2800 |

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| Regulation Description | Product Code | Device Class | Regulation |
| --- | --- | --- | --- |
| Urinary urobilinogen (non-quantitative) test system | CDM | I | 21 CFR § 862.1785 |
| Ascorbic acid test system | JMA | I | 21 CFR § 862.1095 |
| Quality control material (assayed and unassayed) | JJW | I, reserved | 21 CFR § 862.1660 |
| Automated urinalysis system | KQO | I | 21 CFR § 862.2900 |

Panel: Chemistry (75), Hematology (82).

## H. Intended Use:

1. Intended use(s):

Refer to indications for use below.

2. Indication(s) for use:

The Mission® U120 Ultra Urine Analyzer is intended for use in conjunction with the Mission® Urinalysis Reagent Strips for the semi-quantitative detection of the following analytes in urine: glucose, bilirubin, ketone (acetoacetic acid), specific gravity, pH, blood, protein, urobilinogen, leukocytes and ascorbic acid as well as the qualitative detection of nitrite.

The instrument is intended for point-of-care, in vitro diagnostic use only. The measurement can be used in general evaluation of health, and aids in the diagnosis and monitoring of metabolic or systemic diseases that affect kidney function, endocrine disorders and diseases or disorders of the urinary tract. It is intended for professional use only.

The Mission® Liquid Urine Controls and Mission® Liquid Diptube Urine Controls are assayed urine controls, intended for use in validating the precision of analyzer reading of urinalysis for one or more of the following analytes: ascorbic acid, glucose, bilirubin, ketone (acetoacetic acid), specific gravity, blood, pH, protein, urobilinogen, nitrite and leukocytes. It is intended for professional in vitro diagnostic use only.

3. Special conditions for use statement(s):

For prescription use only.

For point-of-care use.

4. Special instrument requirements:

Mission® U120 Ultra Urine Analyzer.

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I. Device Description:

The Mission® U120 Ultra Urine Analyzer is a reflectance photometer that analyzes the intensity and color of light reflected from the reagent areas of a urinalysis reagent strip. Mission® U120 Ultra Urine Analyzer also features data management and report generation capabilities. The analyzer is capable of adjusting specific gravity results based on the measured urinary pH to account for variance in ionic concentrations.

The analyzer is for use with the Mission® Urinalysis Reagent Strips.

The Mission Liquid Urine Control and Mission Liquid Diptube Urine Control are prepared from simulated human urine with purified chemicals, constituents of animal origin, preservatives and stabilizers. The controls are available in two levels, ready to use liquid format packaged in dropper bottles (Mission Liquid Urine Control) or in diptube containers (Mission Liquid Diptube Urine Control).

J. Substantial Equivalence Information:

1. Predicate device name(s):

ACON Urinalysis Reagent Strips, ACON U120 Urine Analyzer
Mission Liquid Urine Control, Mission Liquid Diptube Urine Control

2. Predicate 510(k) number(s):

k070929

k103387

3. Comparison with predicate:

Mission U120 Ultra Urine Analyzer

| Similarities | | |
| --- | --- | --- |
| Item | Mission® Urinalysis Reagent Strips, Mission® U120 Ultra Urine Analyzer, Candidate Device | ACON Urinalysis Reagent Strips, ACON U120 Urine Analyzer, Predicate (K070929) |
| Intended Use | Automated urine chemistry analyzer for the in vitro measurement of urine chemistry analytes. | Same |
| Methodology | Reflectance Photometer | Same |
| Principle | The Mission U120 Ultra Urine Analyzer measures the intensity of the light reflected from the reagent areas of a urinalysis reagent strip. | Same |
| Chemistry | Mission® Urinalysis | Same |

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| Similarities | | |
| --- | --- | --- |
| Item | Mission® Urinalysis Reagent Strips, Mission® U120 Ultra Urine Analyzer, Candidate Device | ACON Urinalysis Reagent Strips, ACON U120 Urine Analyzer, Predicate (K070929) |
| | Reagent Strips (k061559) | |
| Analytes Detected | Leukocytes, Nitrite, blood (Occult), Glucose, Protein, Ketone, Specific Gravity, pH, Bilirubin, Urobilinogen and Ascorbic Acid. | Same |
| Strip Incubation Time | One minute | Same |
| Available Languages on the Screen | English and Spanish | Same |
| Analyzer Operating Conditions | 0-40°C (32-104°F); ≤85% Relative Humidity (non-condensing). | Same |
| Line Leakage Current | <0.5mA | Same |
| Differences | | |
| --- | --- | --- |
| Item | Mission® Urinalysis Reagent Strips with Mission® U120 Ultra Urine Analyzer, Candidate Device | ACON Urinalysis Reagent Strips with ACON U120 Urine Analyzer, Predicate (K070929) |
| Detection Method | The Mission® U120 Ultra Urine Analyzer utilizes a CMOS image sensor to measure the intensity of light. | The ACON U120 Urine Analyzer utilizes a photodiode to measure the intensity of light. |
| Throughput | Single Test Mode: 55 tests/hour. Continuous Test Mode: 120 tests/hour. | Single Test Mode: 60 tests/hour. Continuous Test Mode: 120 tests/hour. |
| Memory | Last 2000 test results. | Last 500 test results. |
| PC Port | Standard RS232C Port (cable not included), USB Port (cable not included); (Not connect to PC) Bluetooth Wireless. | Standard RS232C Port (cable not included). |
| Capabilities | Internal thermal printer, Barcode reader Connector, External printer (optional), Barcode reader (optional), | Internal heat sensitive printer (included), 25 Pin Parallel External Printer Port (not included), and |

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| Differences | | |
| --- | --- | --- |
| Item | Mission® Urinalysis Reagent Strips with Mission® U120 Ultra Urine Analyzer, Candidate Device | ACON Urinalysis Reagent Strips with ACON U120 Urine Analyzer, Predicate (K070929) |
| | and RJ45 Ethernet (optional). | External printer (optional). |
| Power Source | 6 AA batteries with 100 tests/6 new batteries; 100-240 VAC (adapter), (50-60 Hz ± 1HZ). | 220 Volts AC (±10%), 50 Hz (±1); 110 Volts AC (±10%), 60 Hz (±1); 110-230 Volts AC, 50/60 Hz. |
| Optimum Strip Operating Conditions | 15-30°C (59-86°F); 20-80% Relative Humidity (non-condensing). | 15-30°C (59-86°F); ≤75% Relative Humidity (non-condensing). |
| User Interface | Touch Screen based UI. | MKB Key based UI. |
| Weight | ≤1.66 kg (3.65 lbs.) without batteries or power supply. | 2.6 Kg (5.73 lbs.) |
| Dimensions (L x W x H) | 26.0 (L) x 15.0 (W) x 17.5 (H) cm. | 27.1 (L) x 26.5 (W) x 14.6 (H) cm. |
| Display Dimensions (L x W) | Large touch screen Color LCD, TFT 640x480, 11.7 (W) x 8.8 (H) cm. | 240 x 128 blue and white, 10.6 (W) x 2.8 (H) cm. |

Mission Liquid Urine Control, Mission Liquid Diptube Urine Control

| Similarities | | |
| --- | --- | --- |
| Item | Mission® Liquid Urine Controls, Mission® Liquid Diptube Urine Controls, Candidate Device | Mission® Liquid Urine Controls, Mission® Liquid Diptube Urine Controls, Predicate (K103387) |
| Indications for Use | For use as an assayed quality control urine to monitor the precision of urinalysis test procedures for the analytes listed in the package insert. | Same |
| Levels | 2 | Same |
| Form | Liquid | Same |
| Analytes | Glucose, bilirubin, ketone (acetoacetic acid), specific | Same |

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| Similarities | | |
| --- | --- | --- |
| Item | Mission® Liquid Urine Controls, Mission® Liquid Diptube Urine Controls, Candidate Device | Mission® Liquid Urine Controls, Mission® Liquid Diptube Urine Controls, Predicate (K103387) |
| | gravity, blood, pH, protein, urobilinogen, nitrite, leukocytes, and ascorbic acid | |
| Storage | 2 to 8°C | Same |
| Open Vial | 24 months at 2-8°C
30 Days at 15-30°C | Same |
| Packaging Configuration | Dropper, Diptube | Same |
| Shelf Life | 24 months at 2-8°C | Same |
| Differences | | |
| --- | --- | --- |
| Item | Mission® Liquid Urine Controls, Mission® Liquid Diptube Urine Controls, Candidate Device | Mission® Liquid Urine Controls, Mission® Liquid Diptube Urine Controls, Predicate (K103387) |
| Test system | The Mission® Liquid Urine Control and Mission® Liquid Diptube Urine Control are for use with the Mission® Urinalysis Reagent Strips and Mission U120 Ultra Urine Analyzer | The Mission® Liquid Urine Control and Mission® Liquid Diptube Urine Control are for use with the Mission® Urinalysis Reagent Strips and Mission U120 Urine Analyzer (K070929) |

# K. Standard/Guidance Document Referenced (if applicable):

EN 61010-1:2001 - Safety Requirements for Electrical Equipment for Measurement, Control and Laboratory Use Part 1: General Requirements.

EN 61326-1:2006 Class A - Electrical Equipment for Measurement, Control and Laboratory Use - EMC Requirements. General Requirements.

EN ISO 14971:2007 - Medical Devices - Application of Risk Management to Medical Devices.

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CLSI EP07-A2: Interference Testing in Clinical Chemistry, Approved Guideline - Second Edition.

L. Test Principle:

The Mission® U120 Ultra Urine Analyzer is a reflectance photometer that analyzes the intensity and color of light reflected from the reagent areas of a urinalysis reagent strip. Using a light emitting diode (LED) as the light source and a CMOS image sensor as a light sensor, the optical system reads the color change in the urine test strips after a sample is applied.

The Mission® U120 Ultra Urine Analyzer is used in conjunction with the Mission® Urinalysis Reagent Strips and can detect qualitatively and/or semi-quantitatively the following analytes in urine: glucose, bilirubin, ketone (acetoacetic acid), specific gravity, pH, blood, protein, urobilinogen, leukocytes and ascorbic acid as well as the qualitative detection of nitrite. The chemical reactions between the analytes in the urine and each test pad on the Mission Urinalysis Reagent Strips that causes a change in color are described below:

Ascorbic acid: This test involves decolorization of Tillmann's reagent. The presence of ascorbic acid causes the color of the test field to change from blue-green to orange.

Glucose: This test is based on the enzymatic reaction that occurs between glucose oxidase, peroxidase and chromogen. Glucose is first oxidized to produce gluconic acid and hydrogen peroxide in the presence of glucose oxidase. The hydrogen peroxide reacts with potassium iodide chromogen in the presence of peroxidase. The extent to which the chromogen is oxidized determines the color which is produced, ranging from green to brown.

Bilirubin: This test is based on azo-coupling reaction of bilirubin with diazotized dichloroaniline in a strongly acidic medium. Varying bilirubin levels will produce a pinkish-tan color proportional to its concentration in urine.

Ketone: This test is based on ketones reacting with nitroprusside and acetoacetic acid to produce a color change ranging from light pink for negative results to a darker pink or purple color for positive results.

Specific Gravity: This test is based on the apparent pKa change of certain pretreated polyelectrolytes in relation to ionic concentration. In the presence of an indicator, colors range from deep blue-green in urine of low ionic concentration to green and yellow-green in urine of increasing ionic concentration.

Blood: This test is based on the peroxidase-like activity of hemoglobin which catalyzes the reaction of diisopropylbenzene dihydroperoxide and 3,3',5,5'-tetramethylbenzidine. The resulting color ranges from light orange to dark green.

pH: This test is based on a double indicator system which gives a broad range of colors covering the entire urinary pH range. Colors range from orange to yellow and green to blue.

Protein: This reaction is based on the phenomenon known as the "protein error" of pH indicators where an indicator that is highly buffered will change color in the presence of proteins (anions) as the indicator releases hydrogen ions to the protein. At a constant pH, the development of any green color is due to the presence of protein. Colors range from yellow to yellow-green for negative results and green to green-blue for positive results.

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Urobilinogen: This test is based on a modified Ehrlich reaction between p-diethylaminobenzaldehyde and urobilinogen in strongly acidic medium to produce a pink color. Urobilinogen is one of the major compounds produced in heme synthesis and is a normal substance in urine.

Nitrite: This test depends upon the conversion of nitrate to nitrite by the action of Gram negative bacteria in the urine. In an acidic medium, nitrite in the urine reacts with p-arsanilic acid to form a diazonium compound. The diazonium compound in turn couples with 1N-(1-naphthyl) ethylenediamine to produce a pink color.

Leukocytes: This test reveals the presence of granulocyte esterases. The esterases cleave a derivatized pyrazole amino acid ester to liberate derivatized hydroxyl pyrazole. This pyrazole then reacts with a diazonium salt to produce a beige-pink to purple color.

## M. Performance Characteristics (if/when applicable):

### 1. Analytical performance:

#### a. Precision/Reproducibility:

**In-house Precision Study:**

The precision of the Mission U120 Ultra Urine Analyzer used with the Mission Urinalysis Reagent Strips was evaluated using control solutions at level 1 (negative), level 2 (low analyte concentration) and level 3 (high analyte concentration). The target concentration of the analytes in each control solution was confirmed using previously cleared methods. The total precision of the Mission U120 Ultra Urine Analyzer was evaluated by testing each control solution was tested by two operators with two lots of strip in duplicate per run, two runs each day for 20 days on two Mission U120 Ultra Urine analyzers. A total of 160 strips were used for each level control solution tested (2 strips x 2 run x 20 days x 2 operators/analyzers/strip lots = 160 tests per control). The repeatability of the Mission U120 Ultra Urine Analyzer was evaluated by testing each level control solution by three operators on three analyzers in replicates of 20 per run per day with three lots of strip for one day. A total of 180 strips were used for each level control solution tested (20 strips x 3 strip lots x 1 day x 3 operators/analyzers = 180 tests per control). The results from the in-house precision evaluation are summarized below:

**Analyte Levels Tested:**

| Analyte | Target Concentrations | | |
| --- | --- | --- | --- |
| | Level 1 | Level 2 | Level 3 |
| Ascorbic acid | 0 mg/dL | 10 mg/dL | 40 mg/dL |
| Glucose | 0 mg/dL | 100 mg/dL | 1000 mg/dL |
| Bilirubin | 0 mg/dL | 1 mg/dL | 4 mg/dL |
| Ketone | 0 mg/dL | 5 mg/dL | 80 mg/dL |
| Specific gravity | 1.000 | 1.015 | 1.030 |

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| Analyte | Target Concentrations | | |
| --- | --- | --- | --- |
| | Level 1 | Level 2 | Level 3 |
| Blood (erythrocytes) | Negative (0 Ery/μL) | Trace (15 Ery/μL) | 3+ (500 Ery/μL) |
| pH | 5.0 | 7.0 | 9.0 |
| Protein | 0 mg/dL | 15 mg/dL | 300 mg/dL |
| Urobilinogen | 0 mg/dL | 2 mg/dL | 8 mg/dL |
| Nitrite | 0 mg/dL | 0.05 mg/dL | 0.1 mg/dL |
| Leukocyte | Negative (0 cells/μL) | Trace (15 cells/μL) | 3+ (500 cells/μL) |

Results Summary:

Control Level 1:

| | Total Precision (N = 160) | | Repeatability (N = 180) | |
| --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Ascorbic acid | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Glucose | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Bilirubin | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Ketone | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Specific gravity | 95.0% (152/160) | 100% (160/160) | 95.6% (172/180) | 100% (180/180) |
| Blood (erythrocytes) | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| pH | 97.5% (156/160) | 100% (160/160) | 97.2% (175/180) | 100% (180/180) |
| Protein | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Urobilinogen | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Nitrite | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Leukocyte | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |

Control Level 2:

| | Total Precision (N = 120) | | Repeatability (N = 180) | |
| --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Ascorbic acid | 96.9% (155/160) | 100% (160/160) | 97.8% (176/180) | 100% (180/180) |

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| | Total Precision (N = 120) | | Repeatability (N = 180) | |
| --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Glucose | 98.1% (157/160) | 100% (160/160) | 96.7% (174/180) | 100% (180/180) |
| Bilirubin | 97.5% (156/160) | 100% (160/160) | 97.2% (175/180) | 100% (180/180) |
| Ketone | 98.1% (157/160) | 100% (160/160) | 97.2% (175/180) | 100% (180/180) |
| Specific gravity | 95.6% (153/160) | 100% (160/160) | 92.2% (166/180) | 100% (180/180) |
| Blood (erythrocytes) | 98.8% (158/160) | 100% (160/160) | 95.6% (172/180) | 100% (180/180) |
| pH | 96.9% (155/160) | 100% (160/160) | 93.9% (169/180) | 100% (180/180) |
| Protein | 96.9% (155/160) | 100% (160/160) | 97.2% (175/180) | 100% (180/180) |
| Urobilinogen | 97.5% (156/160) | 100% (160/160) | 95.6% (172/180) | 100% (180/180) |
| Nitrite | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Leukocyte | 99.4% (159/160) | 100% (160/160) | 98.3% (177/180) | 100% (180/180) |

Control Level 3:

| | Total Precision (N = 120) | | Repeatability (N = 180) | |
| --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Ascorbic acid | 100% (160/160) | 100% (160/160) | 98.9% (178/180) | 100% (180/180) |
| Glucose | 98.8% (158/160) | 100% (160/160) | 93.3% (168/180) | 100% (180/180) |
| Bilirubin | 98.1% (157/160) | 100% (160/160) | 97.2% (175/180) | 100% (180/180) |
| Ketone | 96.3% (154/160) | 100% (160/160) | 97.8% (176/180) | 100% (180/180) |
| Specific gravity | 94.4% (151/160) | 100% (160/160) | 97.8% (176/180) | 100% (180/180) |
| Blood (erythrocytes) | 99.4% (159/160) | 100% (160/160) | 96.7% (174/180) | 100% (180/180) |
| pH | 98.1% (157/160) | 100% (160/160) | 93.9% (169/180) | 100% (180/180) |
| Protein | 100% (160/160) | 100% (160/160) | 98.9% (178/180) | 100% (180/180) |
| Urobilinogen | 98.1% (157/160) | 100% (160/160) | 97.8% (176/180) | 100% (180/180) |
| Nitrite | 100% (160/160) | 100% (160/160) | 100% (180/180) | 100% (180/180) |
| Leukocyte | 98.1% (157/160) | 100% (160/160) | 97.8% (176/180) | 100% (180/180) |

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# Point-of-Care (POC) Precision Study:

The precision of the Mission® U120 Ultra Urine Analyzer at point-of-care (POC) sites was evaluated using control solutions at level 1 (negative), level 2 (low) and level 3 (high). Control solutions were prepared by spiking each analyte in negative urine pool to the target concentrations shown in the table below. The concentrations of the analytes were confirmed using previously cleared methods. The three level control solutions were dispensed in to different containers and were labeled randomly with coded numbers. Three set of coded samples were sent to three POC sites (in U.S.) for testing by three POC operators at each site. Each sample was tested once per run, two runs per day for 20 days ( $N = 40$ testing per sample). The results from the point-of-care precision study are summarized below.

Analyte Levels Tested:

| Analyte | Target Concentrations | | |
| --- | --- | --- | --- |
| | Level 1 | Level 2 | Level 3 |
| Ascorbic acid | 0 mg/dL | 10 mg/dL | 40 mg/dL |
| Glucose | 0 mg/dL | 250 mg/dL | 1000 mg/dL |
| Bilirubin | 0 mg/dL | 1 mg/dL | 4 mg/dL |
| Ketone | 0 mg/dL | 5 mg/dL | 80 mg/dL |
| Specific gravity | 1.005 | 1.015 | 1.030 |
| Blood (erythrocytes) | Negative (0Ery/μL) | Trace (15Ery/μL) | 3+ (500 Ery/μL) |
| pH | 5.0 | 6.0 | 7.0 |
| Protein | 0 mg/dL | 30 mg/dL | 300 mg/dL |
| Urobilinogen | 0 mg/dL | 2 mg/dL | 8 mg/dL |
| Nitrite | 0 mg/dL | + | N/A |
| Leukocyte | Negative (0cells/μL) | 1+ (70 cells/μL) | 3+ (500cells/μL) |

# Results Summary:

POC Site 1:

| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Ascorbic | 100% | 100% | 100% | 100% | 100% | 100% |
| Bilirubin | 0% | 0% | 0% | 0% | 0% | 0% |
| Ketone | 0% | 0% | 0% | 0% | 0% | 0% |
| Specific gravity | 1.005 | 1.015 | 1.030 | 1.030 | 1.030 | 1.030 |

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POC Site 2:

| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| acid | (40/40) | (40/40) | (40/40) | (40/40) | (40/40) | (40/40) |
| Glucose | 100% (40/40) | 100% (40/40) | 92.5% (37/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) |
| Bilirubin | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Ketone | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Specific gravity | 95.0% (38/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Blood | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| pH | 100% (40/40) | 100% (40/40) | 92.5% (37/40) | 100% (40/40) | 92.5% (37/40) | 100% (40/40) |
| Protein | 100% (40/40) | 100% (40/40) | 95.0% (38/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Urobilinogen | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 95.0% (38/40) | 100% (40/40) |
| Nitrite | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | N/A | N/A |
| Leukocyte | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| ascorbic acid | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) |
| Glucose | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |

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POC Site 3:

| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Bilirubin | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) |
| Ketone | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Specific gravity | 92.5% (37/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) |
| Blood | 100% (40/40) | 100% (40/40) | 95.0% (38/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| pH | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 92.5% (37/40) | 100% (40/40) |
| Protein | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Urobilinogen | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 95.0% (38/40) | 100% (40/40) |
| Nitrite | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | N/A | N/A |
| Leukocyte | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Ascorbic acid | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Glucose | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Bilirubin | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Ketone | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 92.5% (37/40) | 100% (40/40) |

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Three POC Sites Combined:

| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Specific gravity | 92.5% (37/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Blood | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| pH | 100% (40/40) | 100% (40/40) | 92.5% (37/40) | 100% (40/40) | 95.0% (38/40) | 100% (40/40) |
| Protein | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Urobilinogen | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| Nitrite | 100% (40/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) | N/A | N/A |
| Leukocyte | 100% (40/40) | 100% (40/40) | 97.5% (39/40) | 100% (40/40) | 100% (40/40) | 100% (40/40) |
| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| Ascorbic acid | 100% (120/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) |
| Glucose | 100% (120/120) | 100% (120/120) | 97.5% (117/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) |
| Bilirubin | 100% (120/120) | 100% (120/120) | 100% (120/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) |
| Ketone | 100% (120/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) | 97.5% (117/120) | 100% (120/120) |
| Specific gravity | 93.3% (112/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) |
| Blood | 100% (120/120) | 100% (120/120) | 97.5% (117/120) | 100% (120/120) | 100% (120/120) | 100% (120/120) |

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| | Control Level 1 | | Control Level 2 | | Control Level 3 | |
| --- | --- | --- | --- | --- | --- | --- |
| Analyte | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block | Exact match | Match within ±1 color block |
| pH | 100% (120/120) | 100% (120/120) | 95.0% (114/120) | 100% (120/120) | 95.0% (114/120) | 100% (120/120) |
| Protein | 100% (120/120) | 100% (120/120) | 97.5% (117/120) | 100% (120/120) | 100% (120/120) | 100% (120/120) |
| Urobilinogen | 100% (120/120) | 100% (120/120) | 99.2% (119/120) | 100% (120/120) | 96.7% (116/120) | 100% (120/120) |
| Nitrite | 100% (120/120) | 100% (120/120) | 100% (120/120) | 100% (120/120) | N/A | N/A |
| Leukocyte | 100% (120/120) | 100% (120/120) | 98.3% (118/120) | 100% (120/120) | 100% (120/120) | 100% (120/120) |

# b. Linearity/assay reportable range:

A study to evaluate the reportable range (percent recovery) for each analyte color block on the Mission® Urinalysis Reagent Strips was performed by measuring negative urine and negative urine spiked with known concentrations corresponding to the color blocks for each analyte on the test strip. The negative or expected value of each sample was confirmed using the previously cleared methods. Each sample was tested using three lots of strip, three strips per lot on three analyzers/operators for three days. A total of 81 strips were used for each analyte concentration tested (3 strips x 3 strip lots x 3 operators / analyzers x 3 days = 81 strips per sample). The percentages of exact block match of reported results at each analyte concentration were calculated and recorded.

The percent recovery for each analyte at each concentration block (N=81 per sample) is shown in the table below:

| Analyte | Color Block Output Units (Reportable Range) | | Concentration tested | Percent Exact Match |
| --- | --- | --- | --- | --- |
| | Arbitrary | Conventional | | |
| Ascorbic Acid | 3+ | 40 mg/dL | 40 mg/dL | 100% |
| | 2+ | 20 mg/dL | 20 mg/dL | 100% |
| | 1+ | 10 mg/dL | 10 mg/dL | 100% |
| | - | 0 mg/dL | 0 mg/dL | 100% |
| Glucose | 3+ | 1000 mg/dL | 1000 mg/dL | 100% |
| | 2+ | 500 mg/dL | 500 mg/dL | 100% |
| | 1+ | 250 mg/dL | 250 mg/dL | 100% |
| | ± | 100 mg/dL | 100 mg/dL | 100% |

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| Analyte | Color Block Output Units (Reportable Range) | | Concentration tested | Percent Exact Match |
| --- | --- | --- | --- | --- |
| | Arbitrary | Conventional | | |
| | - | 0 mg/dL | 0 mg/dL | 100% |
| Bilirubin | 3+ | 4 mg/dL | 4 mg/dL | 100% |
| | 2+ | 2 mg/dL | 2 mg/dL | 100% |
| | 1+ | 1 mg/dL | 1 mg/dL | 100% |
| | - | 0 mg/dL | 0 mg/dL | 100% |
| Ketone | 3+ | 80 mg/dL | 80 mg/dL | 100% |
| | 2+ | 40 mg/dL | 40 mg/dL | 100% |
| | 1+ | 15 mg/dL | 15 mg/dL | 100% |
| | ± | 5 mg/dL | 5 mg/dL | 100% |
| | - | 0 mg/dL | 0 mg/dL | 100% |
| Specific Gravity | 1.000 | 1.000 | 1.000 | 97.5% |
| | 1.005 | 1.005 | 1.005 | 95.1% |
| | 1.010 | 1.010 | 1.010 | 97.5% |
| | 1.015 | 1.015 | 1.015 | 96.3% |
| | 1.020 | 1.020 | 1.020 | 95.1% |
| | 1.025 | 1.025 | 1.025 | 96.3% |
| | 1.030 | 1.030 | 1.030 | 95.1% |
| Blood | 3+ | 200Ery/μL | 200Ery/μL | 100% |
| | 2+ | 80 Ery/μL | 80 Ery/μL | 100% |
| | 1+ | 25 Ery/μL | 25 Ery/μL | 100% |
| | ± | 10 Ery/μL | 10 Ery/μL | 100% |
| | - | 0 Ery/μL | 0 Ery/μL | 100% |
| pH | | 5.0 | 5.0 | 98.8% |
| | | 5.5 | 5.5 | 97.5% |
| | | 6.0 | 6.0 | 96.3% |
| | | 6.5 | 6.5 | 96.3% |
| | | 7.0 | 7.0 | 97.5% |
| | | 7.5 | 7.5 | 97.5% |
| | | 8.0 | 8.0 | 95.1% |
| | | 8.5 | 8.5 | 96.3% |
| | | 9.0 | 9.0 | 96.3% |
| Protein | 3+ | 300 mg/dL | 300 mg/dL | 100% |
| | 2+ | 100 mg/dL | 100 mg/dL | 100% |
| | 1+ | 30 mg/dL | 30 mg/dL | 100% |
| | ± | 15 mg/dL | 15 mg/dL | 100% |
| | - | 0 mg/dL | 0 mg/dL | 100% |
| Urobilinogen | 3+ | 8 mg/dL | 8 mg/dL | 100% |
| | 2+ | 4 mg/dL | 4 mg/dL | 100% |
| | 1+ | 2 mg/dL | 2 mg/dL | 100% |

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| Analyte | Color Block Output Units (Reportable Range) | | Concentration tested | Percent Exact Match |
| --- | --- | --- | --- | --- |
| | Arbitrary | Conventional | | |
| | ± | 1 mg/dL | 1 mg/dL | 100% |
| | - | 0.2mg/dL | 0.2mg/dL | 100% |
| Nitrite | - | 0.1 mg/dL | 0.1 mg/dL | 100% |
| | + | 0 mg/dL | 0 mg/dL | 100% |
| Leukocyte | 3+ | 500 Leu/μL | 500 Leu/μL | 100% |
| | 2+ | 125 Leu/μL | 125 Leu/μL | 100% |
| | 1+ | 70 Leu/μL | 70 Leu/μL | 100% |
| | ± | 15 Leu/μL | 15 Leu/μL | 100% |
| | - | 0 Leu/μL | 0 Leu/μL | 100% |

c. Traceability, Stability, Expected values (controls, calibrators, or methods):

Traceability - The raw material for each analyte used for the two controls is purchased from supplier with a certificate of analysis and prepared gravimetrically to specific target analyte concentrations. The traceability chart provided by the sponsor is acceptable.

Value assignment - The Mission Liquid Urine Control and the Mission Liquid Diptube Urine Control (level 1 and 2) were value assigned by testing three lots of control on three Mission U120 Ultra Urine Analyzers using three lots of Mission Urinalysis Reagent Strips, for three consecutive days by three operators $(N = 243)$ . The assigned reference value range is printed in the "Expected Values" sheet included with the package insert for each lot of urine controls. The target concentrations for the two control levels are summarized in the table below:

| Urine Control format | Analyte | Target concentration for Control | |
| --- | --- | --- | --- |
| | | Level 1 | Level 2 |
| Mission Liquid Urine Control / Mission Liquid Diptube Urine Control | Leukocyte | Negative | 2+ (125 cells/μL) |
| | Nitrite | Negative | Positive |
| | Urobilinogen | Negative | 3+ (8 mg/dL) |
| | Protein | Negative | 3+ (300 mg/dL) |
| | pH | 6.0 | 7.5 |
| | Blood | Negative | 3+ (200 ery/μL) |
| | Specific gravity | 1.025 | 1.015 |
| | Ketone | Negative | 3+ (80 mg/dL) |
| | Bilirubin | Negative | 3+ (4 mg/dL) |
| | Glucose | Negative | 1+ (250 mg/dL) |

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18

| Urine Control format | Analyte | Target concentration for Control | |
| --- | --- | --- | --- |
| | | Level 1 | Level 2 |
| | Ascorbic acid | Negative | Negative |

Stability of the Mission Liquid Urine Control and the Mission Liquid Diptube Urine Control (level 1 and 2) – The real time stability study protocol for the open vial storage stability and shelf-life, and the acceptance criteria for the two controls was reviewed and cleared under k103387. The two controls have a claimed shelf life of 24 months when stored at 2 to 8 °C. Open control vials are stable for 30 days when stored at 15 to 30 °C and for 24 months when stored at 2 to 8 °C.

Stability of the Mission Urinalysis Reagent Strips – The stability study protocol and acceptance criteria for the reagent strips was reviewed and found acceptable. Based on the accelerated and real time studies, the claimed shelf life is 24 months when stored at 2 to 8 °C or at room temperature (30 ± 3 °C). Open canister strips (opened 100 times) are stable for 98 days when stored at room temperature and 50 to 80% relative humidity conditions.

d. Detection limit:

The cutoff of the assay at each color block was validated by spiking or diluting a pooled urine sample with the stock solution of an analyte to achieve several concentration levels. Each sample was tested with three test strips on three analyzer by three operators, using three test strip lots for three days (3 strips x 3 operators/analyzers x 3 strip lots x 3 days = 81 tests). The cutoffs for each color block are defined as the lowest and highest concentrations of analyte tested at which over 50% of the results are positive for each color block.

Summary of the performance at each color block for the tested analyte concentrations:

| Analyte | Color Block | Low Concentration cut-off | High Concentration cut-off |
| --- | --- | --- | --- |
| Ascorbic Acid | 40 mg/dL | 30 mg/dL | >40 mg/dL |
| | 20 mg/dL | 15 mg/dL | 27.0 mg/dL |
| | 10 mg/dL | 5 mg/dL | 13.5 mg/dL |
| | 0 mg/dL | 0 mg/dL | 4.5 mg/dL |
| Glucose | 1000 mg/dL | 750 mg/dL | >1000 mg/dL |
| | 500 mg/dL | 375 mg/dL | 675 mg/dL |
| | 250 mg/dL | 192.5 mg/dL | 337.5mg/dL |
| | 100 mg/dL | 50 mg/dL | 175 mg/dL |
| | 0 mg/dL | 0 mg/dL | 45mg/dL |
| Bilirubin | 4 mg/dL | 3 mg/dL | >4 mg/dL |
| | 2 mg/dL | 1.5 mg/dL | 2.7 mg/dL |
| | 1 mg/dL | 0.4 mg/dL | 1.35 mg/dL |

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| Analyte | Color Block | Low Concentration cut-off | High Concentration cut-off |
| --- | --- | --- | --- |
| | 0 mg/dL | 0 mg/dL | 0.35 mg/dL |
| Ketone | 80 mg/dL | 60 mg/dL | >80 mg/dL |
| | 40 mg/dL | 27.5 mg/dL | 54 mg/dL |
| | 15 mg/dL | 11 mg/dL | 24.75 mg/dL |
| | 5 mg/dL | 2.5 mg/dL | 10 mg/dL |
| | 0 mg/dL | 0 mg/dL | 2.25 mg/dL |
| Specific Gravity | 1.000~1.030 | 1.000 | 1.030 |
| Blood | 200Ery/μL | 140 Ery/μL | >200 Ery/μL |
| | 80 Ery/μL | 52.5 Ery/μL | 126 Ery/μL |
| | 25 Ery/μL | 12.5 Ery/μL | 47.25 Ery/μL |
| | 10 Ery/μL | 5 Ery/μL | 15.75 Ery/μL |
| | 0 Ery/μL | 0 Ery/μL | 4.5 Ery/μL |
| pH | 5.0~9.0 | 5.0 | 9.0 |
| Protein | 300 mg/dL | 200 mg/dL | >300 mg/dL |
| | 100 mg/dL | 65 mg/dL | 180 mg/dL |
| | 30 mg/dL | 22.5 mg/dL | 58.5 mg/dL |
| | 15 mg/dL | 7.5 mg/dL | 20.25 mg/dL |
| | 0 mg/dL | 0 mg/dL | 6.75 mg/dL |
| Urobilinogen | 8 mg/dL | 6 mg/dL | >8 mg/dL |
| | 4 mg/dL | 3 mg/dL | 5.4 mg/dL |
| | 2 mg/dL | 1.5 mg/dL | 2.7 mg/dL |
| | 1 mg/dL | 0.6 mg/dL | 1.35 mg/dL |
| | 0.2mg/dL | 0 mg/dL | 0.54mg/dL |
| Nitrite | 0.1 mg/dL | 0.05mg/dL | >0.1 mg/dL |
| | 0 mg/dL | 0 mg/dL | 0.045 mg/dL |
| Leukocyte | 500 Leu/μL | 312.5 Leu/μL | >500 Leu/μL |
| | 125 Leu/μL | 97.5 Leu/μL | 281.25 Leu/μL |
| | 70 Leu/μL | 42.5 Leu/μL | 87.75 Leu/μL |
| | 15 Leu/μL | 9 Leu/μL | 38.25 Leu/μL |
| | 0 Leu/μL | 0 Leu/μL | 8.25 Leu/μL |

# e. Analytical specificity:

To evaluate interferences, known amounts of potential interfering substances commonly found in human urine were added to pooled urine samples and tested using the Mission Urinalysis Reagent Strips and the Mission U120 Ultra Urine Analyzers. Ten normal fresh urines were pooled and confirmed to be negative for the eleven analytes. The pooled urine was spiked with the eleven analytes at the target concentrations listed in the table below. The concentration of each analyte in the

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three level urine controls was confirmed with using previously cleared methods.

| Analyte | Target Concentrations | | |
| --- | --- | --- | --- |
| | Level 1 | Level 2 | Level 3 |
| Ascorbic acid | 0 mg/dL | 10 mg/dL | 40 mg/dL |
| Glucose | 0 mg/dL | 100 mg/dL | 1000 mg/dL |
| Bilirubin | 0 mg/dL | 1 mg/dL | 4 mg/dL |
| Ketone | 0 mg/dL | 5 mg/dL | 80 mg/dL |
| Specific gravity | 1.000 | 1.015 | 1.030 |
| Blood (erythrocytes) | Negative (0 Ery/μL) | Trace (15 Ery/μL) | 3+ (500 Ery/μL) |
| pH | 5.0 | 7.0 | 9.0 |
| Protein | 0 mg/dL | 15 mg/dL | 300 mg/dL |
| Urobilinogen | 0 mg/dL | 2 mg/dL | 8 mg/dL |
| Nitrite | 0 mg/dL | 0.05 mg/dL | 0.1 mg/dL |
| Leukocyte | Negative (0 cells/μL) | Trace (15 cells/μL) | 3+ (500 cells/μL) |

The three level urine controls were spiked with the interfering substances. Three levels of each analyte and at least two (or more when needed) levels of interfering substance per analyte were evaluated in the study as per the CLSI EP7-A2 guideline. Each urine sample was tested with one strip per lot and one analyzer. A total of three strip lots and three analyzers $(\mathrm{N} = 9$ testing per sample) were used for the study. Interference is defined when the testing result with spiked interfering substance is not the same color block as the expected result with the control solution with no interfering substance. No interference is defined when the testing result with spiked interfering substance is the same color block as the expected result with the control solution with no interfering substance.

Concentrations of the potentially interfering substances that will not have influence on the test results are shown below:

| Potential Interfering Substance | Concentration Not Affecting Test |
| --- | --- |
| Albumin | ≤ 150 mg/dL |
| Ascorbic Acid | ≤ 20 mg/dL |
| Hemoglobin | ≤ 10 mg/dL |
| Citric Acid | 75 mg/dL |
| Bilirubin | 170 mg/dL |
| Creatine | 10 mg/dL |
| Lithium Acetoacetate | ≤ 50 mg/dL |
| Ammonium Chloride | 100 mg/dL |
| Calcium Chloride | 275 mg/dL |

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| Potential Interfering Substance | Concentration Not Affecting Test |
| --- | --- |
| Creatinine | 600 mg/dL |
| Glucose | ≤ 1000 mg/dL |
| Glycine | 450 mg/dL |
| KCL | 1500 mg/dL |
| NaCl | 5500 mg/dL |
| Oxalic Acid | 70 mg/dL |
| Sodium Acetate | 25 mg/dL |
| Sodium Bicarbonate | 1500 mg/dL |
| Sodium Nitrate | 10 mg/dL |
| Sodium Nitrite | 10 mg/dL |
| Sodium Phosphate | 500 mg/dL |
| Uric Acid | 150 mg/dL |
| Urea | 4000 mg/dL |
| Riboflavin | 10 mg/L |
| Theophylline | 100 mg/L |
| Galactose | 80 mg/dL |
| Fructose | 100 mg/dL |
| Lactose | 10 mg/dL |
| Leucocytes | 2500 cells/μL |
| Blood | ≤0.01% |
| Human Immunoglobulins | 25 mg/dL |

The following substances were shown to interfere with specific analyte results at the listed concentrations:

| Reagent Pad | Interferent | Interferent Concentration | Mission U120 Ultra Urine Analyzer/Mission Urinalysis Reagent Strips Results |
| --- | --- | --- | --- |
| Glucose | Ascorbic acid | ≥ 25 mg/dL | Falsely decreased results (-1 to -3 color block change) |
| | Ketone (acetoacetate) | ≥ 100 mg/dL | Falsely decreased results (-1 color block change) |
| Bilirubin | Ascorbic acid | ≥ 50 mg/dL | Falsely decreased results (-1 to -2 color block change) |
| | Blood | ≥ 5% | Falsely increased results (+1 color block change) |
| Ketone | Blood | ≥ 5% | Falsely increased results (+1 color block change) |
| Specific Gravity | Protein (albumin) | ≥ 300 mg/dL | Falsely increased results (+1 to +2 color block change) |

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| Reagent Pad | Interferent | Interferent Concentration | Mission U120 Ultra Urine Analyzer/Mission Urinalysis Reagent Strips Results |
| --- | --- | --- | --- |
| Blood | Ascorbic acid | ≥ 50 mg/dL | Falsely decreased results (-1 to -4 color block change) |
| Urobilinogen | Blood | ≥ 5% | Falsely increased results (+1 color block change) |
| Protein | Hemoglobin | ≥ 20 mg/dL | Falsely increased results (+1 to +4 color block change) |
| | Blood | ≥ 0.05% | Falsely increased results (+1 to +4 color block change) |
| Nitrite | Ascorbic acid | ≥ 30 mg/dL | Falsely decreased results (positive to negative color block change) |
| | Blood | ≥ 1% | Falsely increased results (negative to positive color block change) |
| Leukocyte | Glucose | ≥ 2000 mg/dL | Falsely decreased results (-1 to -2 color block change) |
| | Blood | ≥ 0.05% | Falsely increased results (+1 to +4 color block change) |

# pH Interference:

The sponsor performed an additional study to evaluate the effect of sample pH on the test results for the ten analytes in human urine. The study result shows that sample pH from 5.0 to 9.0 does not affect the test results for urobilinogen, ketone, bilirubin and glucose. Samples with pH greater than 8.0 affected the protein test resulting in a false high result, and the blood test resulting in a false low result. Samples with pH greater than 9.0 affected leukocyte and specific gravity tests giving falsely high results and affected nitrite and ascorbic acid tests giving falsely low results.

# Specific Gravity Interference:

The sponsor performed an additional study to evaluate the effect of sample specific gravity on the test results for the ten analytes in human urine. The study result shows that sample specific gravity from 1.000 to 1.040 does not affect the test results for urobilinogen, pH, blood, ketone, bilirubin and ascorbic acid. Samples with specific gravity higher than 1.025 affected nitrite, protein and glucose tests giving false low results. Samples with specific gravity higher than 1.020 affected leukocyte test giving false low result.

The sponsor has included the effects from above interfering substances in the

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labeling as limitations of the device.

f. Assay cut-off:

Not applicable.

## 2. Comparison studies:

a. Method comparison with predicate device:

Comparison studies were performed at five different POC sites to evaluate the performance of the Mission® Urinalysis Reagent strip read by the Mission® U120 Ultra Urine Analyzer compared to the performance of the predicate method, Mission® Urinalysis Reagent strip read by ACON U120 Urine Analyzer. A total of 120 patient urine specimens were randomly collected from patients at each of the three POC sites (combined total of 360 clinical specimens), and tested by three POC users at each site (total of nine users for all sites). In order to evaluate the performance of the candidate device over the entire measuring range of each analyte, additional samples, including contrived urine samples, were tested at two additional POC sites resulting in up to 468 samples evaluated at all sites. Results of the comparison study for the combined sites are shown in the tables below.

| Leukocytes | ACON U120 Urine Analyzer | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | | - | ± | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 285 | 2 | 0 | 0 | 0 | 287 |
| | ± | 3 | 15 | 4 | 0 | 0 | 22 |
| | 1+ | 0 | 1 | 37 | 4 | 0 | 42 |
| | 2+ | 0 | 0 | 2 | 45 | 3 | 50 |
| | 3+ | 0 | 0 | 0 | 3 | 64 | 67 |
| | Total | 288 | 18 | 43 | 52 | 67 | 468 |
| Agreement within same color block | | 99.0% (285/288) | 83.3% (15/18) | 86.0% (37/43) | 86.5% (45/52) | 95.5% (64/67) | |
| Agreement within ±1 color block | | 100.0% (288/288) | 100.0% (18/18) | 100.0% (43/43) | 100.0% (52/52) | 100.0% (67/67) | |
| Nitrite | ACON U120 Urine Analyzer | | | |
| --- | --- | --- | --- | --- |
| | | - | + | Total |
| Mission U120 Ultra Urine Analyzer | - | 348 | 0 | 348 |
| | + | 0 | 103 | 103 |
| | Total | 348 | 103 | 451 |
| Agreement within same color block | | 100.0% (348/348) | 100.0% (103/103) | |
| Agreement within ±1 color block | | 100.0% (348/348) | 100.0% (103/103) | |

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| Urobilinogen | ACON U120 Urine Analyzer | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | | - | ± | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 352 | 0 | 0 | 0 | 0 | 352 |
| | ± | 1 | 23 | 2 | 0 | 0 | 26 |
| | 1+ | 0 | 2 | 13 | 1 | 0 | 16 |
| | 2+ | 0 | 0 | 1 | 10 | 2 | 13 |
| | 3+ | 0 | 0 | 0 | 2 | 17 | 19 |
| | Total | 353 | 25 | 16 | 13 | 19 | 426 |
| Agreement within same color block | | 99.7% (352/353) | 92.0% (23/25) | 81.2% (13/16) | 76.9% (10/13) | 89.5% (17/19) | |
| Agreement within ±1 color block | | 100.0% (353/353) | 100.0% (25/25) | 100.0% (16/16) | 100.0% (13/13) | 100.0% (19/19) | |
| Protein | ACON U120 Urine Analyzer | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | | - | ± | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 196 | 6 | 0 | 0 | 0 | 202 |
| | ± | 8 | 81 | 2 | 0 | 0 | 91 |
| | 1+ | 0 | 5 | 51 | 3 | 0 | 59 |
| | 2+ | 0 | 0 | 4 | 60 | 2 | 66 |
| | 3+ | 0 | 0 | 0 | 4 | 46 | 50 |
| | Total | 204 | 92 | 57 | 67 | 48 | 468 |
| Agreement within same color block | | 96.1% (196/204) | 88.0% (81/92) | 89.5% (51/57) | 89.6% (60/67) | 95.8% (46/48) | |
| Agreement within ±1 color block | | 100.0% (204/204) | 100.0% (92/92) | 100.0% (57/57) | 100.0% (67/67) | 100.0% (48/48) | |

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| pH | ACON U120 Urine Analyzer | | | | |
| --- | --- | --- | --- | --- | --- |
| 5.0 | 5.5 | 6.0 | 6.5 | 7.0 | 7.5 | 8.0 | 8.5 | 9.0 | Total |
| Mission U120 Ultra Urine Analyzer | 5.0 | 50 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 53 |
| 5.5 | 4 | 70 | 6 | 0 | 0 | 0 | 0 | 0 | 0 | 80 |
| 6.0 | 0 | 9 | 103 | 0 | 0 | 0 | 0 | 0 | 0 | 112 |
| 6.5 | 0 | 0 | 9 | 30 | 8 | 0 | 0 | 0 | 0 | 47 |
| 7.0 | 0 | 0 | 0 | 6 | 63 | 3 | 0 | 0 | 0 | 72 |
| 7.5 | 0 | 0 | 0 | 0 | 1 | 28 | 3 | 0 | 0 | 32 |
| 8.0 | 0 | 0 | 0 | 0 | 0 | 5 | 29 | 1 | 0 | 35 |
| 8.5 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 17 | 0 | 19 |
| 9.0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 16 | 18 |
| Total | 54 | 82 | 118 | 36 | 72 | 36 | 34 | 20 | 16 | 468 |
| Agreement within same color block | 92.6% (50/54) | 85.4% (70/82) | 87.3% (103/118) | 83.3% (30/36) | 87.5% (63/72) | 77.8% (28/36) | 85.3% (29/34) | 85.0% (17/20) | 100.0% (16/16) | |
| Agreement within ±1 color block | 100.0% (54/54) | 100.0% (82/82) | 100.0% (118/118) | 100.0% (36/36) | 100.0% (72/72) | 100.0% (36/36) | 100.0% (34/34) | 100.0% (20/20) | 100.0% (16/16) | |
| Blood | ACON U120 Urine Analyzer | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | | - | ± | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 237 | 5 | 0 | 0 | 0 | 242 |
| | ± | 1 | 70 | 5 | 0 | 0 | 76 |
| | 1+ | 0 | 1 | 38 | 6 | 0 | 45 |
| | 2+ | 0 | 0 | 0 | 45 | 8 | 53 |
| | 3+ | 0 | 0 | 0 | 3 | 49 | 52 |
| | Total | 238 | 76 | 43 | 54 | 57 | 468 |
| Agreement within same color block | | 99.6% (237/238) | 92.1% (70/76) | 88.4% (38/43) | 83.3% (45/54) | 86.0% (49/57) | |
| Agreement within ±1 color block | | 100.0% (238/238) | 100.0% (76/76) | 100.0% (43/43) | 100.0% (54/54) | 100.0% (57/57) | |

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| Specific gravity | ACON U120 Urine Analyzer | | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | 1.000 | 1.005 | 1.010 | 1.015 | 1.020 | 1.025 | 1.030 | Total |
| Mission U120 Ultra Urine Analyzer | 1.000 | 23 | 3 | 0 | 0 | 0 | 0 | 0 | 26 |
| | 1.005 | 0 | 33 | 9 | 0 | 0 | 0 | 0 | 42 |
| | 1.010 | 0 | 4 | 87 | 5 | 0 | 0 | 0 | 96 |
| | 1.015 | 0 | 0 | 5 | 80 | 5 | 0 | 0 | 90 |
| | 1.020 | 0 | 0 | 0 | 10 | 78 | 7 | 0 | 95 |
| | 1.025 | 0 | 0 | 0 | 0 | 12 | 49 | 2 | 63 |
| | 1.030 | 0 | 0 | 0 | 0 | 0 | 6 | 50 | 56 |
| | Total | 23 | 40 | 101 | 95 | 95 | 62 | 52 | 468 |
| Agreement within same color block | | 100.0% (23/23) | 82.5% (33/40) | 86.1% (87/101) | 84.2% (80/95) | 82.1% (78/95) | 79.0% (49/62) | 96.2% (50/52) | |
| Agreement within ±1 color block | | 100.0% (23/23) | 100.0% (40/40) | 100.0% (101/101) | 100.0% (95/95) | 100.0% (95/95) | 100.0% (62/62) | 100.0% (52/52) | |
| Ketone | ACON U120 Urine Analyzer | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | | - | ± | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 350 | 0 | 0 | 0 | 0 | 350 |
| | ± | 1 | 44 | 3 | 0 | 0 | 48 |
| | 1+ | 0 | 3 | 15 | 2 | 0 | 20 |
| | 2+ | 0 | 0 | 1 | 23 | 1 | 25 |
| | 3+ | 0 | 0 | 0 | 1 | 14 | 15 |
| | Total | 351 | 47 | 19 | 26 | 15 | 458 |
| Agreement within same color block | | 99.7% (350/351) | 93.6% (44/47) | 78.9% (15/19) | 88.5% (23/26) | 93.3% (14/15) | |
| Agreement within ±1 color block | | 100.0% (351/351) | 100.0% (47/47) | 100.0% (19/19) | 100.0% (26/26) | 100.0% (15/15) | |
| Bilirubin | ACON U120 Urine Analyzer | | | | | |
| --- | --- | --- | --- | --- | --- | --- |
| | | - | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 353 | 0 | 0 | 0 | 353 |
| | 1+ | 1 | 49 | 1 | 0 | 51 |
| | 2+ | 0 | 1 | 19 | 2 | 22 |
| | 3+ | 0 | 0 | 1 | 23 | 24 |
| | Total | 354 | 50 | 21 | 25 | 450 |
| Agreement within same color block | | 99.7% (353/354) | 98.0% (49/50) | 90.5% (19/21) | 92.0% (23/25) | |
| Agreement within ±1 color block | | 100.0% (354/354) | 100.0% (50/50) | 100.0% (21/21) | 100.0% (25/25) | |

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| Glucose | ACON U120 Urine Analyzer | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- |
| | | - | ± | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 316 | 0 | 0 | 0 | 0 | 316 |
| | ± | 1 | 14 | 4 | 0 | 0 | 19 |
| | 1+ | 0 | 2 | 32 | 4 | 0 | 38 |
| | 2+ | 0 | 0 | 2 | 34 | 6 | 42 |
| | 3+ | 0 | 0 | 0 | 1 | 52 | 53 |
| | Total | 317 | 16 | 38 | 39 | 58 | 468 |
| Agreement within same color block | | 99.7% (316/317) | 87.5% (14/16) | 84.2% (32/38) | 87.2% (34/39) | 89.7% (52/58) | |
| Agreement within ±1 color block | | 100.0% (317/317) | 100.0% (16/16) | 100.0% (38/38) | 100.0% (39/39) | 100.0% (58/58) | |
| Ascorbic acid | ACON U120 Urine Analyzer | | | | | |
| --- | --- | --- | --- | --- | --- | --- |
| | | - | 1+ | 2+ | 3+ | Total |
| Mission U120 Ultra Urine Analyzer | - | 203 | 9 | 0 | 0 | 212 |
| | 1+ | 12 | 104 | 7 | 0 | 123 |
| | 2+ | 0 | 9 | 59 | 5 | 73 |
| | 3+ | 0 | 0 | 5 | 55 | 60 |
| | Total | 215 | 122 | 71 | 60 | 468 |
| Agreement within same color block | | 94.4% (203/215) | 85.2% (104/122) | 83.1% (59/71) | 91.7% (55/60) | |
| Agreement within ±1 color block | | 100.0% (215/215) | 100.0% (122/122) | 100.0% (71/71) | 100.0% (60/60) | |

b. Matrix comparison:
Not applicable. This device is for testing with human urine only.

3. Clinical studies:
a. Clinical Sensitivity:
Not applicable.
b. Clinical specificity:
Not applicable.
c. Other clinical supportive data (when a. and b. are not applicable):
Not applicable.

4. Clinical cut-off:
Not applicable.

5. Expected values/Reference range:
Expected values are included in the strips instructions for use and shown in the table below:

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| Analyte | Expected Values |
| --- | --- |
| Urobilinogen | 0.2-1 mg/dL |
| Bilirubin | Negative |
| Ketone | Negative |
| Blood | Negative |
| Protein | Negative or ± |
| Nitrite | Negative |
| Leukocytes | Negative |
| Glucose | Negative |
| Ascorbic Acid | 0-200 mg/dL |
| Specific Gravity | 1.000-1.035 |
| pH | 4.5-8.0 |

The above listed expected values are from the following references cited and discussed in detail in the package insert.

Yoder J, Adams EC, Free, AH. Simultaneous Screening for Urinary Occult Blood, Protein, Glucose, and pH. Amer. J. Med Tech. 31:285, 1965.

Shchersten B, Fritz H. Subnormal Levels of Glucose in Urine. JAMA 201:129-132, 1967.

McGarry JD, Lilly. Lecture, 1978: New Perspectives in the Regulation of Ketogenesis. Diabetes 28: 517-523 May, 1978.

Williamson DH. Physiological Ketoses, or Why Ketone Bodies? Postgrad. Med. J. (June Suppl.): 372-375, 1971.

Paterson P, et al. Maternal and Fetal Ketone Concentrations in Plasma and Urine. Lancet: 862-865; April 22, 1967.

Fraser J, et al. Studies with a Simplified Nitroprusside Test for Ketone Bodies in Urine, Serum, Plasma and Milk. Clin. Chem. Acta II: 372-378, 1965.

Henry JB, et al. Clinical Diagnosis and Management by Laboratory Methods, $20^{th}$ Ed. Philadelphia. Saunders. 371-372, 375, 379, 382, 385, 2001.

Tietz NW. Clinical Guide to Laboratory Tests. W.B. Saunders Company. 1976.

Burtis CA, Ashwood ER. Tietz Textbook of Clinical Chemistry 2nd Ed. 2205, 1994.

# N. Instrument Name:

Mission® U120 Ultra Urine Analyzer.

# O. System Descriptions:

1. Modes of Operation:

Single Test Mode: 55 tests/hour.

Continuous Test Mode: 120 tests/hour.

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Semi-automatic reading of Mission reagent strips on Mission U120 Ultra urine analyzer. Each reagent strip is single use and must be replaced with a new strip for additional readings. The labeling and user guide specify that the strips are for single use.

2. Software:
FDA has reviewed applicant’s Hazard Analysis and software development processes for this line of product types:
Yes ☐ X ☐ or No ☐

3. Specimen Identification:
The Patient ID is entered either manually using the keyboard or scanned using the barcode reader (Barcode ID).

4. Specimen Sampling and Handling:
It is recommended that collection of the urine is in a clean and dry container and testing is completed as soon as possible. The use of urine preservatives is not recommended. If testing cannot be done within an hour after voiding, the specimen should be refrigerated. The refrigerated specimen should be brought to room temperature before testing.

The labeling also warns as “Prolonged storage of unpreserved urine at room temperature may result in microbial proliferation with resultant changes in pH. A shift to alkaline pH may cause false positive results with the protein test area. Urine containing glucose may decrease in pH as organisms metabolize the glucose. Contamination of the urine specimen with skin cleansers containing chlorhexidine may affect protein (and to a lesser extent, specific gravity and bilirubin) test results.”

5. Calibration:
The Mission® U120 Ultra Urine Analyzer performs an automatic calibration each time a test is run.

6. Quality Control:
Recommendations for quality control are described in the labeling. Additionally, the users should follow local, state and federal regulations.

P. Other Supportive Instrument Performance Characteristics Data Not Covered In The "Performance Characteristics" Section above:
A study to validate the pH versus specific gravity correction function (pH compensation) of the Mission U120 Ultra Urine analyzer. pH compensation corrects the effect of sample pH on the test results of specific gravity. The study evaluated the effect of sample pH (4.0, 4.5,

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5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5 and 10.0) on the sample specific gravity (1.000, 1.005, 1.010, 1.015, 1.020, 1.025 and 1.030) test results before and after pH compensation adjustment activated on the candidate analyzer. The results of the study are summarized below:

Results Before pH Compensation:

| Before Correction | Specific Gravity by Refractometer | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | 1.000 | 1.005 | 1.010 | 1.015 | 1.020 | 1.025 | 1.030 |
| Specific gravity by Mission U120 Ultra Urine Analyzer | 1.000 | 117 | 45 | | | | | |
| | 1.005 | | 54 | 54 | | | | |
| | 1.010 | | 18 | 18 | 45 | | | |
| | 1.015 | | | 45 | 27 | 54 | 9 | 9 |
| | 1.020 | | | | 36 | 18 | 45 | 18 |
| | 1.025 | | | | 9 | 36 | 36 | 27 |
| | 1.030 | | | | | 9 | 27 | 63 |
| Agreement with same block | | | 40.66% | | | | | |
| Agreement with ± one block | | | 93.41% | | | | | |

Results After pH Compensation:

| After Correction | Specific Gravity by Refractometer | | | | | | | |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| | | 1.000 | 1.005 | 1.010 | 1.015 | 1.020 | 1.025 | 1.030 |
| Specific gravity by Mission U120 Ultra Urine Analyzer | 1.000 | 117 | | | | | | |
| | 1.005 | | 117 | | | | | |
| | 1.010 | | | 117 | | | | |
| | 1.015 | | | | 105 | | | |
| | 1.020 | | | | 12 | 108 | | |
| | 1.025 | | | | | 9 | 117 | 9 |
| | 1.030 | | | | | | | 108 |
| Agreement with same block | | | 96.34% | | | | | |
| Agreement with ± one block | | | 100.00% | | | | | |

Above summary results show that the agreement versus expected value on the same block is increased by $55.68\%$ and agreement versus expected value within $\pm$ one block is increased by $6.59\%$ after pH compensation is activated on the Mission U120 Ultra Urine Analyzer. The interference from the sample pH on the sample specific gravity test results is decreased with

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application of pH compensation on the analyzer.

Q. Proposed Labeling:
The labeling is sufficient and it satisfies the requirements of 21 CFR Part 809.10.

R. Conclusion:
The submitted information in this premarket notification is complete and supports a substantial equivalence decision.

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