A multicenter reference interval study of thromboelastography in the Chinese adult population

Time to maximum amplitude of thromboelastography can predict mortality in patients with severe COVID-19: a retrospective observational study

Objective

To predict mortality in severe patients with COVID-19 at admission to the intensive care unit (ICU) using thromboelastography (TEG).

Methods

This retrospective, two-center, observational study involved 87 patients with PCR-and chest CT-confirmed severe COVID-19 who were admitted to at Wuhan Huoshenshan Hospital and the 908th Hospital of Chinese PLA Logistic Support Force between February 2020 and February 2023. Clinic demographics, laboratory results, and outcomes were compared between those who survived and those who died during hospitalization.

Results

Thromboelastography showed that of the 87 patients, 14 were in a hypercoagulable state, 25 were in a hypocoagulable state, and 48 were normal, based on the time to maximum amplitude (TMA). Patients who died showed significantly lower α angle, but significantly longer R-time, K-time and TMA than patients who survived. Random forest selection showed that K-time, TMA, prothrombin time (PT), international normalized ratio (INR), D-dimer, C-reactive protein (CRP), aspartate aminotransferase (AST), and total bilirubin (Tbil) were significant predictors. Multivariate logistic regression identified that TMA and CRP were independently associated with mortality. TMA had a greater predictive power than CRP levels based on time-dependent AUCs. Patients with TMA ≥ 26.4 min were at significantly higher risk of mortality (hazard ratio 3.99, 95% Confidence Interval, 1.92-8.27, p < 0.01).

Conclusion

TMA ≥26.4 min at admission to ICU may be an independent predictor of in-hospital mortality for patients with severe COVID-19.

The BioRef Infrastructure, a Framework for Real-Time, Federated, Privacy-Preserving, and Personalized Reference Intervals: Design, Development, and Application

BACKGROUND

Reference intervals (RIs) for patient test results are in standard use across many medical disciplines, allowing physicians to identify measurements indicating potentially pathological states with relative ease. The process of inferring cohort-specific RIs is, however, often ignored because of the high costs and cumbersome efforts associated with it. Sophisticated analysis tools are required to automatically infer relevant and locally specific RIs directly from routine laboratory data. These tools would effectively connect clinical laboratory databases to physicians and provide personalized target ranges for the respective cohort population.

OBJECTIVE

This study aims to describe the BioRef infrastructure, a multicentric governance and IT framework for the estimation and assessment of patient group-specific RIs from routine clinical laboratory data using an innovative decentralized data-sharing approach and a sophisticated, clinically oriented graphical user interface for data analysis.

METHODS

A common governance agreement and interoperability standards have been established, allowing the harmonization of multidimensional laboratory measurements from multiple clinical databases into a unified "big data" resource. International coding systems, such as the International Classification of Diseases, Tenth Revision (ICD-10); unique identifiers for medical devices from the Global Unique Device Identification Database; type identifiers from the Global Medical Device Nomenclature; and a universal transfer logic, such as the Resource Description Framework (RDF), are used to align the routine laboratory data of each data provider for use within the BioRef framework. With a decentralized data-sharing approach, the BioRef data can be evaluated by end users from each cohort site following a strict "no copy, no move" principle, that is, only data aggregates for the intercohort analysis of target ranges are exchanged.

RESULTS

The TI4Health distributed and secure analytics system was used to implement the proposed federated and privacy-preserving approach and comply with the limitations applied to sensitive patient data. Under the BioRef interoperability consensus, clinical partners enable the computation of RIs via the TI4Health graphical user interface for query without exposing the underlying raw data. The interface was developed for use by physicians and clinical laboratory specialists and allows intuitive and interactive data stratification by patient factors (age, sex, and personal medical history) as well as laboratory analysis determinants (device, analyzer, and test kit identifier). This consolidated effort enables the creation of extremely detailed and patient group-specific queries, allowing the generation of individualized, covariate-adjusted RIs on the fly.

CONCLUSIONS

With the BioRef-TI4Health infrastructure, a framework for clinical physicians and researchers to define precise RIs immediately in a convenient, privacy-preserving, and reproducible manner has been implemented, promoting a vital part of practicing precision medicine while streamlining compliance and avoiding transfers of raw patient data. This new approach can provide a crucial update on RIs and improve patient care for personalized medicine.

Establishment of Multiple Parameter Reference Intervals for Different Age Groups in Qingdao, China

In this article, we have explored the establishment of multiple parameter reference intervals for different age groups in Qingdao, China. According to the age of subjects, the healthy adult population of different ages in Qingdao was randomly selected as the research object. According to the age of subjects, they were divided into 18–24-year-old, 25–39-year-old, 40–49-year-old, 50–64-year-old, and >65-year-old groups, respectively. The sample size of each age group was 120 male and female samples, and 60 male and female samples of >65-year-old subjects were selected. The data of subjects were collected, a questionnaire survey was completed, serum samples were collected, and the parameters of male and female groups of different ages in Qingdao were compared. The parameters of the male and female groups were compared in the same age group. The reference intervals of parameters of the male and female groups were compared in different ages. There were significant differences in the levels of FBG, AST, BUN, Cr, Hb, FT3, TT3, FT4, TT4, VB12, PROG, CYFRA 21-1, and SCC among men of different ages (P < 0.05). Among them, the levels of FBG, AST, BUN, VB12, CYFRA 21-1, and SCC in >65-year-old men were significantly higher than those in 18–24-years-old men, and the levels of Hb, FT3, TT3, FT4, TT4 in >65-year-old men were significantly lower than those in 18–24-year-old men (P < 0.05). There were significant differences in FBG, ALT, AST, BUN, Cr, Hb, TSH, FT3, TT3, FT4, TT4, VB12, CYFRA 21-1, anti-TPO, and ferritin levels among women of different ages (P < 0.05). Among them, the levels of FBG, ALT, AST, BUN, and ferritin in women aged >65 were significantly higher than those in women aged 18–24 (P < 0.05). The levels of FBG, ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4, TT4, and VB12 in women aged 50–64 were significantly higher than those in women aged 25–39, and the levels of TSH were significantly lower than those in women aged 25–39 and significantly higher than those of the female population aged 40–49 (P < 0.05). The levels of ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4 and ferritin in males aged 18–24 were significantly higher than those in females, while the levels of TSH, VB12 in males aged 18–24 were significantly lower than those in females (P < 0.05). The levels of FBG, ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4 and ferritin in males aged 25–39 were significantly higher than those in females, while the levels of TSH, VB12, CYFRA 21-1 in males aged 25–39 were significantly lower than those in females (P < 0.05). The levels of FBG, ALT, AST, BUN, Cr, Hb, FT3, TT3, FT4, CYFRA 21-1 and ferritin in males aged 40-49 were significantly higher than those in females, and the levels of VB12, anti-TG, anti-TPO in males aged 40-49 were significantly lower than those in females (P < 0.05). The levels of FBG, ALT, BUN, Cr, FT3, TT3 and ferritin in males aged 50-64 were significantly higher than those in females, while the levels of VB12, anti-TG in males aged 50-64 were significantly lower than those in females (P < 0.05). The levels of Cr, Hb and ferritin in males >65 years old were significantly higher than those in females (P < 0.05). The reference intervals of various parameters are different among different ages and genders. The establishment of multiparameter reference intervals for different age groups in Qingdao, China, is of great significance for the early diagnosis and evaluation of various diseases in Qingdao, China, so as to reduce the missed diagnosis rate of diseases and improve people's quality of life.