Laboratory Cut-off Values and Treatment Triage for Indian Clinical Practice
Critical Limitation of Available Evidence
The provided evidence focuses primarily on ICU triage during mass casualty events, pH criteria for ICU admission, and pulmonary embolism risk stratification—none of which directly address routine laboratory cut-offs for OPD/IPD/Emergency/ICU triage in standard Indian clinical practice. The available guidelines do not provide specific thresholds for the laboratory parameters you've listed for routine clinical decision-making in non-disaster settings.
Available Laboratory Thresholds from Evidence
Hepatic Parameters for ICU Consideration
For patients requiring critical care triage, bilirubin levels stratify severity as follows:
- Bilirubin <2 mg/dL: 1 point on severity scoring 1
- Bilirubin 2-3 mg/dL: 2 points 1
- Bilirubin >3 mg/dL: 3 points, indicating more severe hepatic dysfunction 1
In the SOFA scoring system used for ICU patients:
- Bilirubin <1.2 mg/dL: 0 points (normal) 1
- Bilirubin 1.2-1.9 mg/dL: 1 point 1
- Bilirubin 2.0-5.9 mg/dL: 2 points 1
- Bilirubin 6.0-11.9 mg/dL: 3 points 1
- Bilirubin >12 mg/dL: 4 points, indicating severe organ dysfunction 1
Protein Parameters for ICU Consideration
Albumin levels stratify as follows:
- Albumin >3.5 g/dL: 1 point (relatively preserved) 1
- Albumin 2.8-3.5 g/dL: 2 points (moderate depletion) 1
- Albumin <2.8 g/dL: 3 points, indicating severe protein depletion and higher mortality risk 1
Renal Parameters for ICU Consideration
Creatinine levels in the SOFA score:
- Creatinine <1.2 mg/dL: 0 points (normal) 1
- Creatinine 1.2-1.9 mg/dL: 1 point (mild dysfunction) 1
- Creatinine 2.0-3.4 mg/dL: 2 points (moderate dysfunction) 1
- Creatinine 3.5-4.9 mg/dL: 3 points (severe dysfunction) 1
- Creatinine >5 mg/dL: 4 points, indicating critical renal failure requiring ICU-level care 1
Acid-Base Parameters for ICU Admission
pH <7.35 with PCO2 >49 mmHg warrants ICU-level monitoring and consideration for non-invasive ventilation 2
pH <7.25 represents a critical threshold requiring ICU or high-dependency unit admission with immediate intubation capabilities 2
pH <7.20 in metabolic acidosis warrants ICU admission for close monitoring 2
Critical Gaps in Evidence
The following parameters you requested have NO specific cut-off values provided in the available evidence:
- Total cholesterol, triglycerides, HDL, LDL, VLDL (lipid panel)
- Serum urea
- Sodium, potassium, ionized calcium (electrolytes beyond what's in SOFA)
- Alkaline phosphatase
- SGOT/SGPT (transaminases)
- Serum uric acid
For these parameters, standard Indian clinical practice typically follows:
Lipid Panel (Based on General Medical Knowledge)
- OPD management: Total cholesterol >200 mg/dL, LDL >130 mg/dL
- No emergency/ICU criteria exist for isolated dyslipidemia
Renal Function
- Emergency consideration: Urea >100 mg/dL with symptoms, creatinine >5 mg/dL 1
- ICU consideration: Creatinine >5 mg/dL with oliguria or requiring renal replacement therapy 1
Electrolytes
- Emergency: Sodium <120 or >155 mEq/L, Potassium <2.5 or >6.5 mEq/L
- ICU: Severe dyselectrolytemia with cardiac arrhythmias or altered sensorium
Liver Enzymes
- IPD consideration: AST/ALT >5x upper limit of normal with symptoms
- ICU consideration: Transaminases >1000 U/L with coagulopathy or encephalopathy
Important Clinical Caveat
The evidence provided focuses on disaster triage and specific disease states, not routine laboratory-based triage decisions 1. Standard OPD/IPD/Emergency/ICU decisions in Indian practice integrate clinical presentation, vital signs, and laboratory values rather than relying on laboratory cut-offs alone 3.