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Examining the utility of extended laboratory panel testing in the emergency department for risk stratification of patients with COVID-19: a single-centre retrospective service evaluation

Journal of clinical pathology, 2022-04, Vol.75 (4), p.255-262 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. ;Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. ;2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. 2022 ;ISSN: 0021-9746 ;EISSN: 1472-4146 ;DOI: 10.1136/jclinpath-2020-207157 ;PMID: 33608408

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Title:
Examining the utility of extended laboratory panel testing in the emergency department for risk stratification of patients with COVID-19: a single-centre retrospective service evaluation
Author: Ponsford, Mark J ; Burton, Ross J ; Smith, Leitchan ; Khan, Palwasha Y ; Andrews, Robert ; Cuff, Simone ; Tan, Laura ; Eberl, Matthias ; Humphreys, Ian R ; Babolhavaeji, Farbod ; Artemiou, Andreas ; Pandey, Manish ; Jolles, Stephen R A ; Underwood, Jonathan
Subjects: Adult ; biochemistry ; Clinical medicine ; Cost control ; Cost estimates ; costs and cost analysis ; COVID-19 ; COVID-19 - diagnosis ; Datasets ; Emergency medical care ; Emergency Service, Hospital ; Gender ; haematology ; Hospitals ; Humans ; Infections ; inflammation ; Intensive care ; Laboratories ; Medical prognosis ; Mortality ; Original Research ; Patients ; Regression analysis ; Retrospective Studies ; Risk Assessment ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Statistical significance ; Variables
Is Part Of: Journal of clinical pathology, 2022-04, Vol.75 (4), p.255-262
Description: BackgroundThe role of specific blood tests to predict poor prognosis in patients admitted with infection from SARS-CoV-2 remains uncertain. During the first wave of the global pandemic, an extended laboratory testing panel was integrated into the local pathway to guide triage and healthcare resource utilisation for emergency admissions. We conducted a retrospective service evaluation to determine the utility of extended tests (D-dimer, ferritin, high-sensitivity troponin I, lactate dehydrogenase and procalcitonin) compared with the core panel (full blood count, urea and electrolytes, liver function tests and C reactive protein).MethodsClinical outcomes for adult patients with laboratory-confirmed COVID-19 admitted between 17 March and 30 June 2020 were extracted, alongside costs estimates for individual tests. Prognostic performance was assessed using multivariable logistic regression analysis with 28-day mortality used as the primary endpoint and a composite of 28-day intensive care escalation or mortality for secondary analysis.ResultsFrom 13 500 emergency attendances, we identified 391 unique adults admitted with COVID-19. Of these, 113 died (29%) and 151 (39%) reached the composite endpoint. ‘Core’ test variables adjusted for age, gender and index of deprivation had a prognostic area under the curve of 0.79 (95% CI 0.67 to 0.91) for mortality and 0.70 (95% CI 0.56 to 0.84) for the composite endpoint. Addition of ‘extended’ test components did not improve on this.ConclusionOur findings suggest use of the extended laboratory testing panel to risk stratify community-acquired COVID-19 positive patients on admission adds limited prognostic value. We suggest laboratory requesting should be targeted to patients with specific clinical indications.
Publisher: England: BMJ Publishing Group Ltd and Association of Clinical Pathologists
Language: English
Identifier: ISSN: 0021-9746
EISSN: 1472-4146
DOI: 10.1136/jclinpath-2020-207157
PMID: 33608408
Source: BMJ Open Access Journals
AUTh Library subscriptions: ProQuest Central
MEDLINE
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Examining the utility of extended laboratory panel testing in the emergency department for risk stratification of patients with COVID-19: a single-centre retrospective service evaluation

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