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Candel BGJ, Khoudja J, Gaakeer MI, Ter Avest E, Sir Ö, Lameijer H, Hessels RAPA, Reijnen R, van Zwet E, de Jonge E, de Groot B. Age-adjusted interpretation of biomarkers of renal function and homeostasis, inflammation, and circulation in Emergency Department patients. Sci Rep 2022; 12:1556. [PMID: 35091652 PMCID: PMC8799641 DOI: 10.1038/s41598-022-05485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/12/2022] [Indexed: 12/03/2022] Open
Abstract
Appropriate interpretation of blood tests is important for risk stratification and guidelines used in the Emergency Department (ED) (such as SIRS or CURB-65). The impact of abnormal blood test values on mortality may change with increasing age due to (patho)-physiologic changes. The aim of this study was therefore to assess the effect of age on the case-mix adjusted association between biomarkers of renal function and homeostasis, inflammation and circulation and in-hospital mortality. This observational multi-center cohort study has used the Netherlands Emergency department Evaluation Database (NEED), including all consecutive ED patients ≥ 18 years of three hospitals. A generalized additive logistic regression model was used to visualize the association between in-hospital mortality, age and five blood tests (creatinine, sodium, leukocytes, C-reactive Protein, and hemoglobin). Multivariable logistic regression analyses were used to assess the association between the number of abnormal blood test values and mortality per age category (18-50; 51-65; 66-80; > 80 years). Of the 94,974 included patients, 2550 (2.7%) patients died in-hospital. Mortality increased gradually for C-reactive Protein (CRP), and had a U-shaped association for creatinine, sodium, leukocytes, and hemoglobin. Age significantly affected the associations of all studied blood tests except in leukocytes. In addition, with increasing age categories, case-mix adjusted mortality increased with the number of abnormal blood tests. In summary, the association between blood tests and (adjusted) mortality depends on age. Mortality increases gradually or in a U-shaped manner with increasing blood test values. Age-adjusted numerical scores may improve risk stratification. Our results have implications for interpretation of blood tests and their use in risk stratification tools and acute care guidelines.Trial registration number Netherlands Trial Register (NTR) NL8422, 03/2020.
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Affiliation(s)
- Bart G J Candel
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
- Department of Emergency Medicine, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
| | - Jamèl Khoudja
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Menno I Gaakeer
- Department of Emergency Medicine, Admiraal de Ruyter Hospital, 's-Gravenpolderseweg 114, 4462 RA, Goes, The Netherlands
| | - Ewoud Ter Avest
- Department of Emergency Medicine, University Medical Center Groningen, Hanzeplein1, 9713 GZ, Groningen, The Netherlands
| | - Özcan Sir
- Department of Emergency Medicine, Radboud University Medical Center, Houtlaan 4, 6525 XZ, Nijmegen, The Netherlands
| | - Heleen Lameijer
- Department of Emergency Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Roger A P A Hessels
- Department of Emergency Medicine, Elisabeth-TweeSteden Hospital, Doctor Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - Resi Reijnen
- Department of Emergency Medicine, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
| | - Erik van Zwet
- Department of Biostatistics, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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Peng T, Su X, Cheng X, Wei Z, Su X, Li Q. A microfluidic cytometer for white blood cell analysis. Cytometry A 2021; 99:1107-1113. [PMID: 34369647 DOI: 10.1002/cyto.a.24487] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/07/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
Despite the wide use of cytometry for white blood cell classification, the performance of traditional cytometers in point-of-care testing remains to be improved. Microfluidic techniques have been shown with considerable potentials in the development of portable devices. Here we present a prototype of microfluidic cytometer which integrates a three-dimensional hydrodynamic focusing system and an on-chip optical system to count and classify white blood cells. By adjusting the flow speed of sheath flow and sample flow, the blood cells can be horizontally and vertically focused in the center of microchannel. Optical fibers and on-chip microlens are embedded for the excitation and detection of single-cell. The microfluidic chip was validated by classifying white blood cells from clinical blood samples.
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Affiliation(s)
- Tao Peng
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xinyue Su
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xingzhi Cheng
- Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Zewen Wei
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xuantao Su
- School of Microelectronics, Shandong University, Jinan, China
| | - Qin Li
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
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Disposition Decision Support by Laboratory Based Outcome Prediction. J Clin Med 2021; 10:jcm10050939. [PMID: 33804332 PMCID: PMC7957752 DOI: 10.3390/jcm10050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 12/05/2022] Open
Abstract
Disposition is one of the main tasks in the emergency department. However, there is a lack of objective and reliable disposition criteria, and diagnosis-based risk prediction is not feasible at early time points. The aim was to derive a risk score (TRIAL) based on routinely collected baseline (TRIage level and Age) and Laboratory data—supporting disposition decisions by risk stratification based on mortality. We prospectively included consecutive patients presenting to the emergency department over 18 weeks. Data sets of routinely collected baseline (triage level and age) and laboratory data were used for multivariable logistic regression to develop the TRIAL risk score predicting mortality. Routine laboratory variables and disposition cut-offs were chosen beforehand by expert consensus. Risk stratification was based on low risk (<1%), intermediate risk (1–10%), and high risk (>10%) of in-hospital mortality. In total, 8687 data sets were analyzed. Variables identified to develop the TRIAL risk score were triage level (Emergency Severity Index), age, lactate dehydrogenase, creatinine, albumin, bilirubin, and leukocyte count. The area under the ROC curve for in-hospital mortality was 0.93. Stratification according to the TRIAL score showed that 67.5% of all patients were in the low-risk category. Mortality was 0.1% in low-risk, 3.5% in intermediate-risk, and 26.2% in high-risk patients. The TRIAL risk score based on routinely available baseline and laboratory data provides prognostic information for disposition decisions. TRIAL could be used to minimize admission in low-risk and to maximize observation in high-risk patients.
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Eugene N, Oliver C, Bassett M, Poulton T, Kuryba A, Johnston C, Anderson I, Moonesinghe S, Grocott M, Murray D, Cromwell D, Walker K, Cripps M, Cripps P, Davies E, Drake S, Galsworthy M, Goodwin J, Salih T, Lourtie J, Papadimitriou D, Peden C. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. Br J Anaesth 2018; 121:739-748. [PMID: 30236236 DOI: 10.1016/j.bja.2018.06.026] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 01/03/2023] Open
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Fang Y, Yu N, Wang R, Su D. An on-chip instrument for white blood cells classification based on a lens-less shadow imaging technique. PLoS One 2017; 12:e0174580. [PMID: 28350891 PMCID: PMC5370127 DOI: 10.1371/journal.pone.0174580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
Routine blood tests provide important basic information for disease diagnoses. The proportions of three subtypes of white blood cells (WBCs), which are neutrophils, monocytes, lymphocytes, is key information for disease diagnosis. However, current instruments for routine blood tests, such as blood cell analyzers, flow cytometers, and optical microscopes, are cumbersome, time consuming and expensive. To make a smaller, automatic low-cost blood cell analyzer, much research has focused on a technique called lens-less shadow imaging, which can obtain microscopic images of cells in a lens-less system. Nevertheless, the efficiency of this imaging system is not satisfactory because of two problems: low resolution and imaging diffraction phenomena. In this paper, a novel method of classifying cells with the shadow imaging technique was proposed. It could be used for the classification of the three subtypes of WBCs, and the correlation of the results of classification between the proposed system and the reference system (BC-5180, Mindray) was 0.93. However, the instrument was only 10 × 10 × 10 cm, and the cost was less than $100. Depending on the lens-free shadow imaging technology, the main hardware could be integrated on a chip scale and could be called an on-chip instrument.
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Affiliation(s)
- Yuan Fang
- School of Automation and Information Engineering, Xi’an University and Technology, Xi’an, Shaanxi Province, China
- School of Electrical and Electronic Engineering, Baoji University of Arts and Sciences, Baoji, Shaanxi Province, China
| | - Ningmei Yu
- School of Automation and Information Engineering, Xi’an University and Technology, Xi’an, Shaanxi Province, China
- * E-mail:
| | - Runlong Wang
- School of Automation and Information Engineering, Xi’an University and Technology, Xi’an, Shaanxi Province, China
| | - Dong Su
- School of Automation and Information Engineering, Xi’an University and Technology, Xi’an, Shaanxi Province, China
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Doering TA, Plapp F, Crawford JM. Establishing an evidence base for critical laboratory value thresholds. Am J Clin Pathol 2014; 142:617-28. [PMID: 25319976 DOI: 10.1309/ajcpdi0fyz4unweq] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Critical values denote laboratory test results indicating a life-threatening situation. The outcomes of this premise have not been rigorously evaluated. METHODS Five years of inpatient admissions were examined for critical or "near-critical" results (total admissions = 165,066; total test results = 872,503). In-hospital mortality was examined as a function of time and degree of test result abnormality. RESULTS Some critical value thresholds appropriately identified patients at risk for death (eg, elevated potassium). Other thresholds were too conservative (elevated hematocrit, hemoglobin) or not conservative enough (elevated lactate). Mortality risk for most critical values was time dependent, but some critical values showed no temporal effect on mortality (elevated activated partial thromboplastin time [APTT], international normalized ratio [INR], and glucose). Following an initial critical result, further worsening was associated with increased mortality. Prior hospital admission within 30 days was a predictor of lower mortality for some (elevated APTT, INR, potassium, and sodium; low glucose, hematocrit, hemoglobin, and potassium) but not other critical values (elevated lactate, glucose, hematocrit, and hemoglobin; low sodium). CONCLUSIONS Only a subset of laboratory critical value thresholds was optimally chosen for increased risk of in-hospital mortality, with a time urgency for most but not all critical values. For many tests, a prior hospital admission imparted a decreased risk of in-hospital death.
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Affiliation(s)
| | | | - James M. Crawford
- Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
- Department of Pathology and Laboratory Medicine, North Shore-LIJ Health System, Manhasset, NY
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Jarvis SW, Kovacs C, Badriyah T, Briggs J, Mohammed MA, Meredith P, Schmidt PE, Featherstone PI, Prytherch DR, Smith GB. Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions. Resuscitation 2013; 84:1494-9. [DOI: 10.1016/j.resuscitation.2013.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/11/2013] [Accepted: 05/24/2013] [Indexed: 11/24/2022]
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