Risks of mortality associated with common laboratory tests: a novel, simple and meaningful way to set decision limits from data available in the Electronic Medical Record
| Autor: | Steven I. Rothman, Alan B Solinger |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Analyte medicine.medical_specialty Clinical Biochemistry Population Cohort Studies chemistry.chemical_compound Animal science Predictive Value of Tests Risk Factors medicine Electronic Health Records Humans Serum chloride Hospital Mortality education Blood urea nitrogen Aged Retrospective Studies education.field_of_study Creatinine Clinical Laboratory Techniques business.industry Biochemistry (medical) General Medicine Odds ratio Middle Aged Prognosis Surgery chemistry Predictive value of tests Relative risk business Blood Chemical Analysis |
| Zdroj: | Clinical Chemistry and Laboratory Medicine. 51 |
| ISSN: | 1437-4331 1434-6621 |
| DOI: | 10.1515/cclm-2013-0167 |
| Popis: | Background: Laboratory tests provide objective measure-ments of physiologic functions, but are usually evalu-ated by demographic reference-intervals (RI), instead of risk-based decision-limits (DL). We show that hospi-tal electronic medical record (EMR) data can be utilized to associate all-cause mortality risks with analyte test values, thereby providing more information than RIs and defining new DLs. Methods: Our c ohort was 39,964 patients admitted for any reason and discharged alive, during two 1-year periods, at Sarasota Memorial Hospital, Florida, USA. We studied five routinely-performed in-hospital laboratory tests: serum creatinine, blood urea nitrogen, serum sodium, serum potassium, and serum chloride. By associating a mortality odds ratio with small intervals of values for each analyte, we calculated relative risk of all-cause mortality as a func-tion of test values. Results: We found mortality risks below the popula-tion average within these proposed DLs: potassium 3.4 – 4.3 mmol/L; sodium 136 – 142 mmol/L; chloride 100 – 108 mmol/L; creatinine 0.6 – 1.1 mg/dL; blood urea nitrogen (BUN) 5 – 20 mg/dL. The DLs correspond roughly to the usually-quoted RIs, with a notable narrowing for electrolytes. Potassium and sodium have reduced upper limits, avoiding a “ high-normal ” area where the odds ratio rises 2 to 3 times the population average. Conclusions: Any clinical laboratory test can be trans-formed into a mortality odds ratio function, associating mortality risk with each value of the analyte. This provides a DL determined by mortality risk, instead of RI assump-tions about distribution in a “ healthy ” population. The odds ratio function also provides important risk informa-tion for analyte values outside the interval. Keywords: blood chemical analysis/standards; blood urea nitrogen (BUN); chloride; clinical chemistry tests; creatinine; decision limits; potassium; efer r ence stand-ardsefer; r ence uesval ; sodium. |
| Databáze: | OpenAIRE |
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