PMID- 29306908
OWN - NLM
STAT- MEDLINE
DCOM- 20190422
LR  - 20190422
IS  - 1437-4331 (Electronic)
IS  - 1434-6621 (Linking)
VI  - 56
IP  - 7
DP  - 2018 Jun 27
TI  - Systematic comparison of routine laboratory measurements with in-hospital 
      mortality: ICU-Labome, a large cohort study of critically ill patients.
PG  - 1140-1151
LID - 10.1515/cclm-2016-1028 [doi]
AB  - 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, gamma-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.
FAU - Alkozai, Edris M
AU  - Alkozai EM
AD  - Department of Critical Care, University of Groningen, University Medical Center 
      Groningen, Groningen, TheNetherlands.
AD  - Department of Surgery, University of Groningen, University Medical Center 
      Groningen, Groningen, TheNetherlands.
FAU - Mahmoodi, Bakhtawar K
AU  - Mahmoodi BK
AD  - Department of Cardiology, Sint Antonius Hospital, Nieuwegein, TheNetherlands.
FAU - Decruyenaere, Johan
AU  - Decruyenaere J
AD  - Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
FAU - Porte, Robert J
AU  - Porte RJ
AD  - Department of Surgery, University of Groningen, University Medical Center 
      Groningen, Groningen, TheNetherlands.
FAU - Oude Lansink-Hartgring, Annemieke
AU  - Oude Lansink-Hartgring A
AD  - Department of Critical Care, University of Groningen, University Medical Center 
      Groningen, Groningen, TheNetherlands.
FAU - Lisman, Ton
AU  - Lisman T
AD  - Department of Surgery, University of Groningen, University Medical Center 
      Groningen, Groningen, TheNetherlands.
FAU - Nijsten, Maarten W
AU  - Nijsten MW
AD  - Department of Critical Care, University of Groningen, University Medical Center 
      Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands, Phone: 
      00-31-50-3616161, Fax: 0031-50-3615644.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Germany
TA  - Clin Chem Lab Med
JT  - Clinical chemistry and laboratory medicine
JID - 9806306
RN  - EC 2.3.2.2 (gamma-Glutamyltransferase)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Blood Chemical Analysis/*standards
MH  - Cohort Studies
MH  - Critical Illness/*mortality
MH  - Female
MH  - *Hospital Mortality
MH  - Humans
MH  - Intensive Care Units
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Patient Readmission
MH  - Reference Values
MH  - Retrospective Studies
MH  - Statistics, Nonparametric
MH  - Survival Rate
MH  - gamma-Glutamyltransferase/blood
OTO - NOTNLM
OT  - critical care
OT  - lactate
OT  - outcome
OT  - reference interval
OT  - variability
OT  - gamma-glutamyltransferase
EDAT- 2018/01/08 06:00
MHDA- 2019/04/23 06:00
CRDT- 2018/01/08 06:00
PHST- 2016/11/08 00:00 [received]
PHST- 2017/11/23 00:00 [accepted]
PHST- 2018/01/08 06:00 [pubmed]
PHST- 2019/04/23 06:00 [medline]
PHST- 2018/01/08 06:00 [entrez]
AID - /j/cclm.ahead-of-print/cclm-2016-1028/cclm-2016-1028.xml [pii]
AID - 10.1515/cclm-2016-1028 [doi]
PST - ppublish
SO  - Clin Chem Lab Med. 2018 Jun 27;56(7):1140-1151. doi: 10.1515/cclm-2016-1028.