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Admission Laboratory Values Accurately Predict In-hospital Mortality: a Retrospective Cohort Study.

N Blanco1, S Leekha2, L Magder2

  • 1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. nblanco@som.umaryland.edu.

Journal of General Internal Medicine
|August 22, 2019
PubMed
Summary

Hospital laboratory tests can predict patient mortality, offering a simple and accessible method for assessing illness severity. Abnormal bicarbonate or white blood cell counts significantly increase mortality risk, aiding in risk adjustment.

Keywords:
laboratory testsmortalityprediction modelseverity of illness

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Area of Science:

  • Clinical Medicine
  • Healthcare Analytics
  • Biostatistics

Background:

  • Assessing patient illness severity is crucial for predicting hospital outcomes.
  • Existing severity of illness scores are often complex, diagnosis-specific, or not widely available.
  • Laboratory tests present a potential alternative for estimating illness severity.

Purpose of the Study:

  • To evaluate the predictive ability of hospital laboratory tests for in-hospital mortality.
  • To assess the utility of laboratory tests for severity of illness risk adjustment.
  • To determine if laboratory tests can serve as a simpler alternative to existing scoring systems.

Main Methods:

  • Retrospective cohort study of 38,367 adult non-trauma patients.
  • Included laboratory tests: hemoglobin, platelets, white blood cell count, urea nitrogen, creatinine, glucose, sodium, potassium, and bicarbonate (HCO3).
  • Multivariable logistic regression model developed to predict in-hospital mortality.

Main Results:

  • Patient age and laboratory tests demonstrated good discrimination for mortality prediction (c-statistic = 0.79).
  • Abnormal bicarbonate (HCO3) or leukocyte counts at admission doubled the risk of in-hospital death.
  • The predictive model showed good calibration and fit (Hosmer-Lemeshow test p=0.18).

Conclusions:

  • Admission laboratory tests accurately predict in-hospital mortality.
  • These tests offer an objective and accessible method for severity of illness risk adjustment.
  • Laboratory test results can be effectively utilized for risk stratification in hospitalized patients.