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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 2018: 3.638

CiteScore 2018: 2.44

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

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Volume 51, Issue 9


Risks of mortality associated with common laboratory tests: a novel, simple and meaningful way to set decision limits from data available in the Electronic Medical Record

Alan B. Solinger / Steven I. Rothman
Published Online: 2013-05-14 | DOI: https://doi.org/10.1515/cclm-2013-0167


Background: Laboratory tests provide objective measurements of physiologic functions, but are usually evaluated by demographic reference-intervals (RI), instead of risk-based decision-limits (DL). We show that hospital electronic medical record (EMR) data can be utilized to associate all-cause mortality risks with analyte test values, thereby providing more information than RIs and defining new DLs.

Methods: Our cohort was 39,964 patients admitted for any reason and discharged alive, during two 1-year periods, at Sarasota Memorial Hospital, Florida, USA. We studied five routinely-performed in-hospital laboratory tests: serum creatinine, blood urea nitrogen, serum sodium, serum potassium, and serum chloride. By associating a mortality odds ratio with small intervals of values for each analyte, we calculated relative risk of all-cause mortality as a function of test values.

Results: We found mortality risks below the population average within these proposed DLs: potassium 3.4–4.3 mmol/L; sodium 136–142 mmol/L; chloride 100–108 mmol/L; creatinine 0.6–1.1 mg/dL; blood urea nitrogen (BUN) 5–20 mg/dL. The DLs correspond roughly to the usually-quoted RIs, with a notable narrowing for electrolytes. Potassium and sodium have reduced upper limits, avoiding a “high-normal” area where the odds ratio rises 2 to 3 times the population average.

Conclusions: Any clinical laboratory test can be transformed into a mortality odds ratio function, associating mortality risk with each value of the analyte. This provides a DL determined by mortality risk, instead of RI assumptions about distribution in a “healthy” population. The odds ratio function also provides important risk information for analyte values outside the interval.

Keywords: blood chemical analysis/standards; blood urea nitrogen (BUN); chloride; clinical chemistry tests; creatinine; decision limits; potassium; reference standards; reference values; sodium


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About the article

Corresponding author: Steven I. Rothman, 5019 Kestral Park Drive, Sarasota, FL 34231, USA, Phone: +1 866 794 0837, Fax: +1 866 255 0783

Received: 2013-03-04

Accepted: 2013-04-04

Published Online: 2013-05-14

Published in Print: 2013-09-01

Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 51, Issue 9, Pages 1803–1813, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2013-0167.

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