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Identification and Quantification of Deranged Metabolites in Critically Ill Patients Using NMR-Based Metabolomics
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Outcome-Based Critical Result Thresholds in the Adult Patient Population.

Eng Hooi Tan1, Zhutian Yang2, Yingda Li3

  • 1Saw Swee Hock School of Public Health, National University Hospital, Singapore.

American Journal of Clinical Pathology
|May 9, 2019
PubMed
Summary

This study establishes critical laboratory value thresholds for adult patients, identifying abnormal results linked to a 90% predicted probability of death. These outcome-based thresholds aid clinical decision-making in critical care settings.

Keywords:
Critical reportingCritical resultsCritical valuePanic valuePostanalytical

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Area of Science:

  • Critical care medicine
  • Clinical pathology
  • Health informatics

Background:

  • Establishing reliable critical result thresholds is essential for timely clinical intervention.
  • Existing thresholds may not always align with patient outcomes, necessitating outcome-based derivation.

Purpose of the Study:

  • To derive outcome-based critical result thresholds for laboratory values in adult intensive care unit patients.
  • To identify specific laboratory value ranges associated with a high predicted probability of mortality.

Main Methods:

  • Utilized deidentified laboratory results and patient outcomes (death or discharge) from the Medical Information Mart for Intensive Care (MIMIC) database.
  • Defined critical thresholds based on laboratory values corresponding to a 90% predicted probability of death.

Main Results:

  • Defined critical thresholds for numerous analytes including sodium, potassium, bicarbonate, creatinine, glucose, hemoglobin, and lactate.
  • Specific critical values were identified, such as sodium <123 or >153 mmol/L, and lactate >5.0 mmol/L.

Conclusions:

  • The indirect, outcome-based approach provides clinically and operationally meaningful critical result thresholds.
  • These derived thresholds can enhance patient safety and guide critical care management.