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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

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. and Underwood, Jonathan 2021. 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 10.1136/jclinpath-2020-207157

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Abstract

Background The 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). Methods Clinical 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. Results From 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. Conclusion Our 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.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Mathematics
Medicine
Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license
Publisher: BMJ Publishing Group
ISSN: 0021-9746
Funders: MRC, Wellcome Trust, MRC
Date of First Compliant Deposit: 23 February 2021
Date of Acceptance: 14 January 2021
Last Modified: 18 Mar 2021 11:58
URI: http://orca.cf.ac.uk/id/eprint/138693

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