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 (BMJ)

Contributing to research themes:

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.

Author list:

  1. Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
  2. Immunodeficiency Center for Wales, University Hospital of Wales, Cardiff, UK
  3. Information & Technology Team, University Hospital of Wales, Cardiff, UK
  4. Department of Sexual Health, Cardiff and Vale UHB, Cardiff, UK
  5. Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
  6. Systems Immunity Research Institute, Cardiff University, Cardiff, UK
  7. Adult Critical Care Directorate, Cardiff and Vale UHB, Cardiff, UK
  8. Department of Emergency Medicine, Cardiff and Vale UHB, Cardiff, UK
  9. School of Mathematics, Cardiff University, Cardiff, UK
  10. Department of Infectious Diseases, Cardiff and Vale UHB, Cardiff, UK

Mark J Ponsford1,2 Ross J Burton1 Leitchan Smith3 Palwasha Y Khan4,5 Robert Andrews6 Simone Cuff1,6 Laura Tan7 Matthias Eberl1,6 Ian R Humphreys1,6 Farbod Babolhavaeji8 Andreas Artemiou9 Manish Pandey7 Stephen R A Jolles2 Jonathan Underwood1,10