A laboratory-based risk score for medical intensive care patients
-
Axel Stachon
Abstract
Background: Established general risk score models for intensive care patients incorporate several clinical and laboratory data. However, the collection, documentation and classification of clinical data are time-consuming, incur labor-related costs, and are dependent on the experience of the examiner. Therefore, in the present study a general score for medical intensive care patients based solely on routine laboratory parameters is presented.
Methods: Parameter selection was performed using stepwise logistic regression analysis. The maximum likelihood estimate of variable influence on mortality provided a relative weighting for each variable. The new score was compared to two established risk models (Acute Physiology And Chronic Health Evaluation II, APACHE II; and Simplified Acute Physiology Score II, SAPS II).
Results: The study included 528 medical intensive care patients with a mean age of 65.4±0.7 years. The in-hospital mortality was 16.5% (87/528). Multiple logistic regression analysis revealed eight parameters with significant prognostic power: alanine aminotransferase, cholesterol, creatinine, leukocytes, sodium, thrombocytes, urea, and age. These parameters were used to build a new laboratory score called Critical Risk Evaluation by Early Keys (CREEK). The area under the receiver operating characteristics curve was 0.857 (0.814–0.900). Pearson correlation analysis showed significant correlation between CREEK and APACHE II (r=0.550) and SAPS II (r=0.516; p<0.001; n=387). The areas under curve of the APACHE II and the SAPS II were 0.869 and 0.874, respectively.
Conclusions: We show that a general risk score for medical intensive care patients on admission based solely on routine laboratory parameters is feasible. The quality of risk estimation using CREEK is comparable to established risk models. Furthermore, this new score is based on quality controlled low-cost laboratory parameters that are routinely measured on admission to the intensive care unit. Therefore, no additional costs are involved.
Clin Chem Lab Med 2008;46:855–62.
©2008 by Walter de Gruyter Berlin New York
Artikel in diesem Heft
- Reviews
- The STANISLAS Cohort: a 10-year follow-up of supposed healthy families. Gene-environment interactions, reference values and evaluation of biomarkers in prevention of cardiovascular diseases
- Cardiovascular biomarkers: increasing impact of laboratory medicine in cardiology practice
- Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories
- Cardiovascular Diseases
- APOA5 Ala315>Val, identified in patients with severe hypertriglyceridemia, is a common mutation with no major effects on plasma lipid levels
- Gender-modulated impact of apolipoprotein A5 gene (APOA5) −1131T>C and c.56C>G polymorphisms on lipids, dyslipidemia and metabolic syndrome in Turkish adults
- Oxidative stress markers, C-reactive protein and heat shock protein 70 levels in subjects with metabolic syndrome
- Development of sensitive and specific age- and gender-specific low-density lipoprotein cholesterol cutoffs for diagnosis of first-degree relatives with familial hypercholesterolaemia in cascade testing
- Distribution of plasma cardiac troponin I values in healthy subjects: pathophysiological considerations
- High-density lipoprotein cholesterol and paraoxonase 1 (PON1) genetics and serum PON1 activity in prepubertal children in Spain
- Genetics and Molecular Diagnostics
- Polymorphisms of CYP17A1, CYP19, and androgen in Brazilian women with uterine leiomyomas
- A novel MEN1 frameshift germline mutation in two Italian monozygotic twins
- The silent hemoglobin α chain variant Hb Riccarton [α51(CE9)Gly→Ser] may affect HbA1c determination on the HLC-723 G7 analyzer
- General Clinical Chemistry and Laboratory Medicine
- Urinary fructose-1,6-bisphosphatase activity as a marker of the damage to the renal proximal tubules in children with idiopathic nephrotic syndrome
- Antioxidant defense capacity in scleroderma patients
- Correction of ventricular cerebrospinal fluid (CSF) samples for blood content does not increase sensitivity and specificity for the detection of CSF infection
- Validation and Outcome Studies
- Preanalytical quality control program – an overview of results (2001–2005 summary)
- A laboratory-based risk score for medical intensive care patients
- Analytical performance evaluation of the Cobas 6000 analyzer – special emphasis on trueness verification
- Letters to the Editor
- Quality planning and analytical quality requirements derived from biology
- Importance of sample size in hospital point-of-care glucose measurements
- Reliability of M protein quantification: comparison of two peak integration methods on Capillarys 2
- What's in a name? Standardization of HbA1c
- Serum paraoxonase 1 activities and homocysteinemia in hemodialysis patients
Artikel in diesem Heft
- Reviews
- The STANISLAS Cohort: a 10-year follow-up of supposed healthy families. Gene-environment interactions, reference values and evaluation of biomarkers in prevention of cardiovascular diseases
- Cardiovascular biomarkers: increasing impact of laboratory medicine in cardiology practice
- Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories
- Cardiovascular Diseases
- APOA5 Ala315>Val, identified in patients with severe hypertriglyceridemia, is a common mutation with no major effects on plasma lipid levels
- Gender-modulated impact of apolipoprotein A5 gene (APOA5) −1131T>C and c.56C>G polymorphisms on lipids, dyslipidemia and metabolic syndrome in Turkish adults
- Oxidative stress markers, C-reactive protein and heat shock protein 70 levels in subjects with metabolic syndrome
- Development of sensitive and specific age- and gender-specific low-density lipoprotein cholesterol cutoffs for diagnosis of first-degree relatives with familial hypercholesterolaemia in cascade testing
- Distribution of plasma cardiac troponin I values in healthy subjects: pathophysiological considerations
- High-density lipoprotein cholesterol and paraoxonase 1 (PON1) genetics and serum PON1 activity in prepubertal children in Spain
- Genetics and Molecular Diagnostics
- Polymorphisms of CYP17A1, CYP19, and androgen in Brazilian women with uterine leiomyomas
- A novel MEN1 frameshift germline mutation in two Italian monozygotic twins
- The silent hemoglobin α chain variant Hb Riccarton [α51(CE9)Gly→Ser] may affect HbA1c determination on the HLC-723 G7 analyzer
- General Clinical Chemistry and Laboratory Medicine
- Urinary fructose-1,6-bisphosphatase activity as a marker of the damage to the renal proximal tubules in children with idiopathic nephrotic syndrome
- Antioxidant defense capacity in scleroderma patients
- Correction of ventricular cerebrospinal fluid (CSF) samples for blood content does not increase sensitivity and specificity for the detection of CSF infection
- Validation and Outcome Studies
- Preanalytical quality control program – an overview of results (2001–2005 summary)
- A laboratory-based risk score for medical intensive care patients
- Analytical performance evaluation of the Cobas 6000 analyzer – special emphasis on trueness verification
- Letters to the Editor
- Quality planning and analytical quality requirements derived from biology
- Importance of sample size in hospital point-of-care glucose measurements
- Reliability of M protein quantification: comparison of two peak integration methods on Capillarys 2
- What's in a name? Standardization of HbA1c
- Serum paraoxonase 1 activities and homocysteinemia in hemodialysis patients
