Abstract
Objectives: To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels. Design: A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database. Setting: Hospitals caring for children in ICUs. Patients: Children cared for in ICUs with laboratory data. Interventions: None. Measurements and Main Results: There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with acidosis, coagulation abnormalities and blood loss, immune function, liver function, nutritional status, and the basic metabolic profile. The test ranges most associated with survival included normal values for chloride, pH, and bicarbonate/total Co2. When the significant test ranges from bivariable analyses were combined in commonly used test panels, they generally remained significant but were reduced as risk was distributed among the tests. CONCLUSIONS: The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 147-160 |
| Number of pages | 14 |
| Journal | Pediatric Critical Care Medicine |
| DOIs | |
| State | Accepted/In press - 2021 |
| Externally published | Yes |
Bibliographical note
Funding Information:Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal). Supported, in part, by philanthropic support from Mallinckrodt LLC, and award numbers UL1TR001876 from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences, and KL2TR001877 from the NIH National Center for Advancing Translational Sciences (to Dr. Patel). Drs. Pollack’s, Chamberlain’s, and Patel’s institutions received funding from Mallinckrodt LLC. Dr. Pollack’s institution received funding from the National Institutes of Health (NIH). Drs. Pollack, Patel, and Kim received support for article research from the NIH. Dr. Patel’s institution received funding from Awards Ul1TR001876 and KL2TR001877 from the NIH, National Center for Advancing Translational Sciences. Drs. Trujillo Rivera, Kim, and Bost received funding from Mallinckrodt LLC. Dr. Heneghan disclosed that she does not have any potential conflicts of interest.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
Keywords
- intensive care
- laboratory tests
- pediatric intensive care unit
- pediatrics
- severity of illness