Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America
Background Despite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients. Objectives The aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected inte...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
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BMJ
2021
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| Online Access: | https://hdl.handle.net/1721.1/138301 |
| _version_ | 1826207583850987520 |
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| author | Xu, Haoran Agha-Mir-Salim, Louis O’Brien, Zachary Huang, Dora C Li, Peiyao Gómez, Josep Liu, Xiaoli Liu, Tongbo Yeung, Wesley Thoral, Patrick Elbers, Paul Zhang, Zhengbo Saera, María Bodí Celi, Leo Anthony |
| author2 | Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology |
| author_facet | Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology Xu, Haoran Agha-Mir-Salim, Louis O’Brien, Zachary Huang, Dora C Li, Peiyao Gómez, Josep Liu, Xiaoli Liu, Tongbo Yeung, Wesley Thoral, Patrick Elbers, Paul Zhang, Zhengbo Saera, María Bodí Celi, Leo Anthony |
| author_sort | Xu, Haoran |
| collection | MIT |
| description | Background Despite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients.
Objectives The aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected intensive care units (ICUs) across the USA, Amsterdam, Beijing and Tarragona; compare differences and similarities across different geographical locations and evaluate how they may be associated with differences in length of stay (LOS) and mortality in the ICU.
Methods A multi-centre, retrospective, cross-sectional study of data from five databases for adult patients first admitted to an ICU between 2001 and 2019 was conducted. The included databases contained patient-level data regarding demographics, interventions, clinical outcomes and laboratory results. Kernel density estimation functions were applied to the distributions of laboratory tests, and the overlapping coefficient and Cohen standardised mean difference were used to quantify differences in these distributions.
Results The 259 382 patients studied across five databases in four countries showed a high degree of heterogeneity with regard to demographics, case mix, interventions and outcomes. A high level of divergence in the studied laboratory results (creatinine, haemoglobin, lactate, sodium) from the locally used reference ranges was observed, even when stratified by outcome.
Conclusion Standardised reference ranges have limited relevance to ICU patients across a range of geographies. The development of context-specific reference ranges, especially as it relates to clinical outcomes like LOS and mortality, may be more useful to clinicians. |
| first_indexed | 2024-09-23T13:51:49Z |
| format | Article |
| id | mit-1721.1/138301 |
| institution | Massachusetts Institute of Technology |
| last_indexed | 2024-09-23T13:51:49Z |
| publishDate | 2021 |
| publisher | BMJ |
| record_format | dspace |
| spelling | mit-1721.1/1383012023-04-10T14:55:04Z Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America Xu, Haoran Agha-Mir-Salim, Louis O’Brien, Zachary Huang, Dora C Li, Peiyao Gómez, Josep Liu, Xiaoli Liu, Tongbo Yeung, Wesley Thoral, Patrick Elbers, Paul Zhang, Zhengbo Saera, María Bodí Celi, Leo Anthony Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology Harvard University--MIT Division of Health Sciences and Technology Background Despite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients. Objectives The aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected intensive care units (ICUs) across the USA, Amsterdam, Beijing and Tarragona; compare differences and similarities across different geographical locations and evaluate how they may be associated with differences in length of stay (LOS) and mortality in the ICU. Methods A multi-centre, retrospective, cross-sectional study of data from five databases for adult patients first admitted to an ICU between 2001 and 2019 was conducted. The included databases contained patient-level data regarding demographics, interventions, clinical outcomes and laboratory results. Kernel density estimation functions were applied to the distributions of laboratory tests, and the overlapping coefficient and Cohen standardised mean difference were used to quantify differences in these distributions. Results The 259 382 patients studied across five databases in four countries showed a high degree of heterogeneity with regard to demographics, case mix, interventions and outcomes. A high level of divergence in the studied laboratory results (creatinine, haemoglobin, lactate, sodium) from the locally used reference ranges was observed, even when stratified by outcome. Conclusion Standardised reference ranges have limited relevance to ICU patients across a range of geographies. The development of context-specific reference ranges, especially as it relates to clinical outcomes like LOS and mortality, may be more useful to clinicians. 2021-12-03T13:32:24Z 2021-12-03T13:32:24Z 2021-10 Article http://purl.org/eprint/type/JournalArticle 2632-1009 https://hdl.handle.net/1721.1/138301 Xu, Haoran, Agha-Mir-Salim, Louis, O’Brien, Zachary, Huang, Dora C, Li, Peiyao et al. 2021. "Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America." 28 (1). 10.1136/bmjhci-2021-100419 Creative Commons Attribution NonCommercial License 4.0 https://creativecommons.org/licenses/by-nc/4.0/ application/pdf BMJ BMJ Health & Care Informatics |
| spellingShingle | Xu, Haoran Agha-Mir-Salim, Louis O’Brien, Zachary Huang, Dora C Li, Peiyao Gómez, Josep Liu, Xiaoli Liu, Tongbo Yeung, Wesley Thoral, Patrick Elbers, Paul Zhang, Zhengbo Saera, María Bodí Celi, Leo Anthony Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America |
| title | Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America |
| title_full | Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America |
| title_fullStr | Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America |
| title_full_unstemmed | Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America |
| title_short | Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America |
| title_sort | varying association of laboratory values with reference ranges and outcomes in critically ill patients an analysis of data from five databases in four countries across asia europe and north america |
| url | https://hdl.handle.net/1721.1/138301 |
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