Related Experiment Video
Updated: Nov 28, 2025
Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes
Published on: March 22, 2022
The Association of Laboratory Test Abnormalities With Mortality Risk in Pediatric Intensive Care
Murray M Pollack1, James M Chamberlain2, Anita K Patel1
1Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.
Insights
Abnormalities in common laboratory tests significantly impact pediatric intensive care unit (PICU) mortality risk. Analyzing test panels reveals how risk is distributed, aiding in critical value development and risk assessment for children.
Area of Science:
- Pediatric critical care medicine
- Clinical pathology
- Biostatistics
Background:
- Laboratory test abnormalities are common in critically ill children.
- Understanding the association between laboratory values and mortality is crucial for patient management.
- Evaluating tests individually versus in panels may alter risk perception.
Purpose of the Study:
- To determine bivariable associations between 28 common laboratory tests and hospital mortality in children.
- To assess how mortality risk changes when laboratory test ranges are evaluated within common test panels.
- To identify specific laboratory test abnormalities associated with increased mortality or survival in pediatric ICUs.
Main Methods:
- Utilized a large cohort (2009-2016) from the Health Facts database, including over 71,000 children in ICUs.
- Performed logistic regression analysis to link laboratory test values (grouped by population percentiles) to hospital mortality.
- Combined significant test ranges from bivariable analyses into commonly used laboratory test panels to assess combined risk.
Main Results:
- Midrange laboratory test values were generally normal, except when significant abnormalities were suspected.
- Deviant test ranges strongly associated with increased mortality (OR > 5.0) included acidosis, coagulation issues, immune function, liver function, nutrition, and basic metabolic profiles.
- Normal ranges for chloride, pH, and bicarbonate/total CO2 were most associated with survival.
Conclusions:
- The predictive value of laboratory test ranges for mortality varies significantly.
- When analyzed in panels, mortality odds ratios decreased but often remained significant, indicating distributed risk.
- Findings can inform the development of critical values, risk stratification, and educational tools for pediatric critical care.
Objectives:
To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.
Design:
A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.
Setting:
Hospitals caring for children in ICUs.
Patients:
Children cared for in ICUs with laboratory data.
Interventions:
None.
Measurements And Main Results:
There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with acidosis, coagulation abnormalities and blood loss, immune function, liver function, nutritional status, and the basic metabolic profile. The test ranges most associated with survival included normal values for chloride, pH, and bicarbonate/total Co2. When the significant test ranges from bivariable analyses were combined in commonly used test panels, they generally remained significant but were reduced as risk was distributed among the tests.
Conclusions:
The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:30Pneumonia III: Complications and Assessment
01:22Acute Kidney Injury I: Introduction
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:20Comparing the Survival Analysis of Two or More Groups