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Systematic comparison of routine laboratory measurements with in-hospital mortality: ICU-Labome, a large cohort study of critically ill patients

  • Edris M. Alkozai , Bakhtawar K. Mahmoodi , Johan Decruyenaere , Robert J. Porte , Annemieke Oude Lansink-Hartgring , Ton Lisman and Maarten W. Nijsten EMAIL logo
Published/Copyright: January 8, 2018
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 56 Issue 7

Abstract

Background:

In intensive care unit (ICU) patients, many laboratory measurements can be deranged when compared with the standard reference interval (RI). The assumption that larger derangements are associated with worse outcome may not always be correct. The ICU-Labome study systematically evaluated the univariate association of routine laboratory measurements with outcome.

Methods:

We studied the 35 most frequent blood-based measurements in adults admitted ≥6 h to our ICU between 1992 and 2013. Measurements were from the first 14 ICU days and before ICU admission. Various metrics, including variability, were related with hospital survival. ICU- based RIs were derived from measurements obtained at ICU discharge in patients who were not readmitted to the ICU and survived for >1 year.

Results:

In 49,464 patients (cardiothoracic surgery 43%), we assessed >20·106 measurements. ICU readmissions, in-hospital and 1-year mortality were 13%, 14% and 19%, respectively. On ICU admission, lactate had the strongest relation with hospital mortality. Variability was independently related with hospital mortality in 30 of 35 measurements, and 16 of 35 measurements displayed a U-shaped outcome-relation. Medians of 14 of 35 ICU-based ranges were outside the standard RI. Remarkably, γ-glutamyltransferase (GGT) had a paradoxical relation with hospital mortality in the second ICU week because more abnormal GGT-levels were observed in hospital survivors.

Conclusions:

ICU-based RIs for may be more useful than standard RIs in identifying ICU patients at risk. The association of variability with outcome for most of the measurements suggests this is a consequence and not a cause of a worse ICU outcome. Late elevation of GGT may confer protection to ICU patients.

Keywords: γ-glutamyltransferase; critical care; lactate; outcome; reference interval; variability

Acknowledgments

We thank Frank Doesburg for computer support and Iwan van der Horst for critically reading the manuscript.

  1. Author contributions: EA conceived, helped execute the study and drafted the manuscript. BM helped execute the study and drafted the manuscript. JD helped execute the study and drafted the manuscript. RP helped execute the study and revised the manuscript. AOL helped execute the study and drafted the manuscript. TL conceived, helped execute the study and drafted the manuscript. MN conceived, helped execute and drafted the manuscript. All authors read and approved final manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplemental Material:

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2016-1028).

Received: 2016-11-8
Accepted: 2017-11-23
Published Online: 2018-1-8
Published in Print: 2018-6-27

©2018 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2016-1028
Keywords for this article
γ-glutamyltransferase; critical care; lactate; outcome; reference interval; variability

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Free light chains in the cerebrospinal fluid. Do we still need oligoclonal IgG?
  4. Reviews
  5. Obese phenotype and natriuretic peptides in patients with heart failure with preserved ejection fraction
  6. Prognostic value of HE4 in patients with ovarian cancer
  7. Opinion Paper
  8. Laboratory hemostasis: from biology to the bench
  9. Genetics and Molecular Diagnostics
  10. Multicenter validation study for the certification of a CFTR gene scanning method using next generation sequencing technology
  11. General Clinical Chemistry and Laboratory Medicine
  12. IL8 and IL16 levels indicate serum and plasma quality
  13. “Send & hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C
  14. CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes
  15. Search for new biomarkers of pediatric multiple sclerosis: application of immunoglobulin free light chain analysis
  16. The importance of detecting anti-DFS70 in routine clinical practice: comparison of different care settings
  17. Higher D-lactate levels are associated with higher prevalence of small dense low-density lipoprotein in obese adolescents
  18. LC-MSMS assays of urinary cortisol, a comparison between four in-house assays
  19. Optimized angiotensin-converting enzyme activity assay for the accurate diagnosis of sarcoidosis
  20. Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase
  21. Performance evaluation of cobas HBV real-time PCR assay on Roche cobas 4800 System in comparison with COBAS AmpliPrep/COBAS TaqMan HBV Test
  22. Systematic comparison of routine laboratory measurements with in-hospital mortality: ICU-Labome, a large cohort study of critically ill patients
  23. Reference Values and Biological Variations
  24. Establishing reference intervals for sex hormones and SHBG in apparently healthy Chinese adult men based on a multicenter study
  25. Plasma midregional proadrenomedullin (MR-proADM) concentrations and their biological determinants in a reference population
  26. Cancer Diagnostics
  27. Analytical validation of the Hevylite assays for M-protein quantification
  28. Cardiovascular Diseases
  29. Assessing matrix, interferences and comparability between the Abbott Diagnostics and the Beckman Coulter high-sensitivity cardiac troponin I assays
  30. Infectious Diseases
  31. Evaluation of a novel prognostic score based on thrombosis and inflammation in patients with sepsis: a retrospective cohort study
  32. Letters to the Editor
  33. Independent evaluation using fresh patient samples under real clinical conditions is vital for confirming the suitability and marketability of any new HbA1c assay. An example
  34. Anti-streptavidin antibodies mimicking heterophilic antibodies in thyroid function tests
  35. Site-specific DNA methylation detection based on enzyme-linked immunosorbent assay using recombinant methyl-CpG binding protein
  36. 3q29 microduplication in a small family with complex metabolic phenotype from Southern Italy
  37. A D1424N mutation in the MYH9 gene results in macrothrombocytopenia and granulocytic inclusion bodies in a Chinese inherited macrothrombocytopenia pedigree
  38. Evaluation of analytical performance of a chemiluminescence enzyme immunoassay (CLEIA) for cTnI using the automated AIA-CL2400 platform
  39. Cellular markers of eryptosis are altered in type 2 diabetes
  40. Platelet serotonin is not elevated in patients with benign head and neck paragangliomas
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