Examining the utility of extended laboratory panel testing in the emergency department for risk stratification of patients with COVID-19: a single-centre retrospective service evaluation.

Autor:	Ponsford MJ; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK ponsfordm@cardiff.ac.uk.; Immunodeficiency Center for Wales, University Hospital of Wales, Cardiff, UK., Burton RJ; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK., Smith L; Information & Technology Team, University Hospital of Wales, Cardiff, UK., Khan PY; Department of Sexual Health, Cardiff and Vale UHB, Cardiff, UK.; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK., Andrews R; Systems Immunity Research Institute, Cardiff University, Cardiff, UK., Cuff S; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.; Systems Immunity Research Institute, Cardiff University, Cardiff, UK., Tan L; Adult Critical Care Directorate, Cardiff and Vale UHB, Cardiff, UK., Eberl M; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.; Systems Immunity Research Institute, Cardiff University, Cardiff, UK., Humphreys IR; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.; Systems Immunity Research Institute, Cardiff University, Cardiff, UK., Babolhavaeji F; Department of Emergency Medicine, Cardiff and Vale UHB, Cardiff, UK., Artemiou A; School of Mathematics, Cardiff University, Cardiff, UK., Pandey M; Adult Critical Care Directorate, Cardiff and Vale UHB, Cardiff, UK., Jolles SRA; Immunodeficiency Center for Wales, University Hospital of Wales, Cardiff, UK., Underwood J; Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.; Department of Infectious Diseases, Cardiff and Vale UHB, Cardiff, UK.
Jazyk:	angličtina
Zdroj:	Journal of clinical pathology [J Clin Pathol] 2022 Apr; Vol. 75 (4), pp. 255-262. Date of Electronic Publication: 2021 Feb 19.
DOI:	10.1136/jclinpath-2020-207157
Abstrakt:	Background: The role of specific blood tests to predict poor prognosis in patients admitted with infection from SARS-CoV-2 remains uncertain. During the first wave of the global pandemic, an extended laboratory testing panel was integrated into the local pathway to guide triage and healthcare resource utilisation for emergency admissions. We conducted a retrospective service evaluation to determine the utility of extended tests (D-dimer, ferritin, high-sensitivity troponin I, lactate dehydrogenase and procalcitonin) compared with the core panel (full blood count, urea and electrolytes, liver function tests and C reactive protein). Methods: Clinical outcomes for adult patients with laboratory-confirmed COVID-19 admitted between 17 March and 30 June 2020 were extracted, alongside costs estimates for individual tests. Prognostic performance was assessed using multivariable logistic regression analysis with 28-day mortality used as the primary endpoint and a composite of 28-day intensive care escalation or mortality for secondary analysis. Results: From 13 500 emergency attendances, we identified 391 unique adults admitted with COVID-19. Of these, 113 died (29%) and 151 (39%) reached the composite endpoint. 'Core' test variables adjusted for age, gender and index of deprivation had a prognostic area under the curve of 0.79 (95% CI 0.67 to 0.91) for mortality and 0.70 (95% CI 0.56 to 0.84) for the composite endpoint. Addition of 'extended' test components did not improve on this. Conclusion: Our findings suggest use of the extended laboratory testing panel to risk stratify community-acquired COVID-19 positive patients on admission adds limited prognostic value. We suggest laboratory requesting should be targeted to patients with specific clinical indications. Competing Interests: Competing interests: SRAJ has participated in advisory boards, trials and projects and has been a speaker CSL Behring, Takeda, Thermofisher, Swedish Orphan Biovitrum, Biotest, Binding Site, BPL, Octapharma, Sanofi, LFB, Pharming, Biocryst, Zarodex, Weatherden and UCB Pharma. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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