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High in-hospital mortality of intensive care patients with nucleated red blood cells in blood

  • Axel Stachon , Tim Holland-Letz and Michael Krieg
Published/Copyright: June 1, 2005
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 42 Issue 8

Abstract

The detection of nucleated red blood cells (NRBCs) in blood of patients suffering from a variety of severe diseases is known to be highly associated with increased mortality. Blood analyzers to routinely measure NRBC concentrations are now available. However, the diagnostic and prognostic significance of this parameter for intensive care patients has not been evaluated. Using a Sysmex XE-2100 analyzer, NRBC concentrations were determined in blood samples from 421 patients treated in intensive care units (general and accident surgery, cardiothoracic surgery, and internal medicine) of a university hospital. NRBCs were found at least once in 19.2% of all patients. The mortality of NRBC-positive patients (n = 81) was 42.0% (n = 34); this was significantly higher (p < 0.001) than the mortality of NRBC-negative patients (5.9%, n = 340). The NRBC concentration was 115 ± 4 × 106/l (median 40 × 106/l; range 20–2930 × 106/l) at initial detection of NRBCs in the blood. Mortality increased with increasing NRBC concentration and increasing frequency of occurrence. With regard to in-hospital mortality, NRBCs in blood showed sensitivity and specificity of 63.0% and 87.2%, respectively. The detection of NRBCs is highly predictive of death, the odds ratio after adjustment for other laboratory prognostic indicators being 1.01 (p < 0.01) for each increase in the NRBC concentration of +1 × 106/l. NRBCs were detected for the first time, on average, 13 days (median 8 days) before death. The routine analysis of NRBCs in blood is of high prognostic power with regard to in-hospital mortality of critically ill patients. Therefore, this parameter may serve as an early indicator for patients at increased mortality risk.

Keywords: intensive care; mortality; nucleated red blood cells
Corresponding author: Dr. A. Stachon, Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Ruhr-University, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. Phone: +49-234-3020, Fax: +49-234-302-6614, E-mail:

References

1 Schwartz SO. Significance of nucleated red blood cells in peripheral blood. J Am Med Assoc 1954; 154:1339–40.10.1001/jama.1954.02940500019007Search in Google Scholar

2 Delsol G, Guiu-Godfrin B, Guiu M, Pris J, Corberand J, Fabre J. Leukoerythroblastosis and cancer frequency, prognosis, and physiopathologic significance. Cancer 1979; 44:1009–13.10.1002/1097-0142(197909)44:3<1009::AID-CNCR2820440331>3.0.CO;2-JSearch in Google Scholar

3 Budmiger H, Graf C, Streuli RA. The leukoerythroblastic blood picture. Incidence and clinical significance. Schweiz Rundsch Med Prax 1984; 73:1489–93.Search in Google Scholar

4 Weick JK, Hagedorn AB, Linman JW. Leukoerythroblastosis. Mayo Clin Proc 1974; 49:110–3.Search in Google Scholar

5 West CD, Ley AB, Pearson OH. Myelophthisic anemia in cancer of the breast. Am J Med 1955; 18:923–31.10.1016/0002-9343(55)90173-XSearch in Google Scholar

6 Mettier SR. Hematologic aspects of space consuming lesions of the bone marrow (myelophtisic anemia). Ann Intern Med 1940; 14:436–48.10.7326/0003-4819-14-3-436Search in Google Scholar

7 Andres WA. Normoblastemia after thermal injury. Am J Surg 1976; 131:725–6.10.1016/0002-9610(76)90188-4Search in Google Scholar

8 Tavassoli M. Erythroblastemia. West J Med 1975; 122:194–8.Search in Google Scholar

9 Stachon A, BöningA, Krismann M, Weisser H, Laczkovics A, Skipka G, et al. Prognostic significance of erythroblasts in blood after cardiothoracic surgery. Clin Chem Lab Med 2001; 39:239–43.10.1515/CCLM.2001.038Search in Google Scholar

10 Ruzicka K, Veitl M, Thalhammer-Scherrer R, Schwarzinger I. The new hematology analyzer Sysmex XE-2100: performance evaluation of a novel white blood cell differential technology. Arch Pathol Lab Med 2001; 125:391–6.10.5858/2001-125-0391-TNHASXSearch in Google Scholar

11 Walters J, Garrity P. Performance evaluation of the Sysmex XE-2100 hematology analyser. Lab Hematol 2000; 6:83–92.Search in Google Scholar

12 Briggs C, Harrison P, Grant D, Staves J, Maciag T. New quantitative parameters on recently introduced automated blood cell counter – the XE 2100™. Clin Lab Haematol 2000; 22:345–50.10.1046/j.1365-2257.2000.00330.xSearch in Google Scholar

13 Stachon A, Sondermann N, Krieg M. Incidence of nucleated red blood cells in the blood of hospitalised patients. Infusion Ther Transfus Med 2001; 28:263–6.10.1159/000050251Search in Google Scholar

14 Stachon A, Sondermann N, Imöhl M, Krieg M. Nucleated red blood cells indicate high risk for in-hospital mortality. J Lab Clin Med 2002; 140:407–12.10.1067/mlc.2002.129337Search in Google Scholar

15 Böning A, Stachon A, Weisser H, Krismann M, Skipka G, Laczkovics A, et al. Postoperative cholesterol and erythroblasts as a parameter of perioperative mortality after cardiothoracic surgery. Z Herz Thorax Gefäßchir 2001; 15:242–8.Search in Google Scholar

16 Stachon A, Eisenblätter K, Köller M, Holland-Letz T, Krieg M. Cytokines and erythropoietin in the blood of patients with erythroblastemia. Acta Haematol 2003; 110:204–6.10.1159/000074228Search in Google Scholar PubMed

17 Livingston DH, Anjarina D, Wu J, Hauser CJ, Chang V, Deitch EA, et al. Bone marrow failure following severe injury in humans. Ann Surg 2003; 238:748–53.10.1097/01.sla.0000094441.38807.09Search in Google Scholar PubMed PubMed Central

Received: 2004-2-2
Accepted: 2004-4-26
Published Online: 2005-6-1
Published in Print: 2004-8-1

© Walter de Gruyter

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https://doi.org/10.1515/CCLM.2004.151
Keywords for this article
intensive care; mortality; nucleated red blood cells

Articles in the same Issue

  1. Rapid detection of the factor XIII Val34Leu (163 G→T) polymorphism by real-time PCR using fluorescence resonance energy transfer detection and melting curve analysis
  2. Changes of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in the serum of patients with autoimmune diseases: association with age and disease activity
  3. A recombinant cell bioassay for measurement of overall estrogenic activity of serum: preliminary results in women with breast cancer
  4. N-terminal pro-atrial natriuretic peptide as a biochemical marker of long-term interventional success after radiofrequency catheter ablation of paroxysmal supraventricular tachyarrhythmias
  5. Preventing in vitro lipoperoxidation in the malondialdehyde-thiobarbituric assay
  6. Oxidative stress: potential of distinct peroxide determination systems
  7. Quality assessment in cytogenetic and molecular genetic testing: the experience of the Italian Project on Standardisation and Quality Assurance
  8. Guidelines for blood smear preparation and staining procedure for setting up an external quality assessment scheme for blood smear interpretation. Part I: control material
  9. Measurement of serum and plasma osmolality in healthy young humans – influence of time and storage conditions
  10. High in-hospital mortality of intensive care patients with nucleated red blood cells in blood
  11. Frequency of –163 C > A and 63 C > G single nucleotide polymorphism of cytochrome P450 1A2 in two African populations
  12. Long-term stability of endogenous B-type natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP) in frozen plasma samples
  13. Plasma or serum samples: measurements of cardiac troponin T and of other analytes compared
  14. Antioxidant capacity of the human pericardial fluid: does gender have a role?
  15. Comparison of serum digoxin concentration monitoring by fluorescence polarization immunoassay on the TDxFLx® and dry chemistry enzyme immunoassay on the Vitros 950
  16. Multicenter analytical performance evaluation of the Elecsys® proBNP assay
  17. Analytical evaluation and reference values of serum amyloid-A on the BN ProSpec
  18. Reference values of soluble interleukin-2 receptor on the IMMULITE
  19. Analysis of cystatin C, creatinine, albumin, lipids and lipoprotein concentrations in serum and acidified citrate plasma (Stabilyte™) tubes compared
  20. Analysis of γ-globulins consisting of hepatitis C-associated cryoglobulins in the blood
  21. Serum total glutathione-S-transferase in stroke, a preliminary report
  22. Santorini Biologie Prospective Conference 2004 “From Human Genetic Variations to Prediction of Risks and Responses to the Environment”, Santorini, Greece, September 30–October 4, 2004
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