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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2017: 3.556

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
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Volume 46, Issue 6

Issues

A laboratory-based risk score for medical intensive care patients

Axel Stachon
  • 1Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
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/ Elmar Segbers
  • 2Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
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/ Steffen Hering
  • 3Department of Internal Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
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/ Reiner Kempf
  • 4Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
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/ Tim Holland-Letz
  • 5Department of Medical Informatics, Biometry, and Epidemiology, Ruhr-University, Bochum, Germany
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/ Michael Krieg
  • 6Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
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Abstract

Background: Established general risk score models for intensive care patients incorporate several clinical and laboratory data. However, the collection, documentation and classification of clinical data are time-consuming, incur labor-related costs, and are dependent on the experience of the examiner. Therefore, in the present study a general score for medical intensive care patients based solely on routine laboratory parameters is presented.

Methods: Parameter selection was performed using stepwise logistic regression analysis. The maximum likelihood estimate of variable influence on mortality provided a relative weighting for each variable. The new score was compared to two established risk models (Acute Physiology And Chronic Health Evaluation II, APACHE II; and Simplified Acute Physiology Score II, SAPS II).

Results: The study included 528 medical intensive care patients with a mean age of 65.4±0.7 years. The in-hospital mortality was 16.5% (87/528). Multiple logistic regression analysis revealed eight parameters with significant prognostic power: alanine aminotransferase, cholesterol, creatinine, leukocytes, sodium, thrombocytes, urea, and age. These parameters were used to build a new laboratory score called Critical Risk Evaluation by Early Keys (CREEK). The area under the receiver operating characteristics curve was 0.857 (0.814–0.900). Pearson correlation analysis showed significant correlation between CREEK and APACHE II (r=0.550) and SAPS II (r=0.516; p<0.001; n=387). The areas under curve of the APACHE II and the SAPS II were 0.869 and 0.874, respectively.

Conclusions: We show that a general risk score for medical intensive care patients on admission based solely on routine laboratory parameters is feasible. The quality of risk estimation using CREEK is comparable to established risk models. Furthermore, this new score is based on quality controlled low-cost laboratory parameters that are routinely measured on admission to the intensive care unit. Therefore, no additional costs are involved.

Clin Chem Lab Med 2008;46:855–62.

Keywords: Acute Physiology And Chronic Health Evaluation II (APACHE II); intensive care; risk score; Simplified Acute Physiology Score II (SAPS II)

About the article

Corresponding author: PD Dr. med. Axel Stachon, Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany Phone: +49-234-3020, Fax: +49-234-302-6614,


Received: 2007-07-20

Accepted: 2008-01-08

Published in Print: 2008-06-01


Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 46, Issue 6, Pages 855–862, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2008.136.

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