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Schmidt G, Martens A, Koch C, Markmann M, Schneck E, Matt U, Hecker M, Tello K, Wolff M, Sander M, Vadász I. Nucleated red blood cells are a late biomarker in predicting intensive care unit mortality in patients with COVID-19 acute respiratory distress syndrome: an observational cohort study. Front Immunol 2024; 15:1313977. [PMID: 38304431 PMCID: PMC10830722 DOI: 10.3389/fimmu.2024.1313977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Abstract
Background Nucleated red blood cells (nRBC) are precursor cells of the erythropoiesis that are absent from the peripheral blood under physiological conditions. Their presence is associated with adverse outcomes in critically ill patients. This study aimed to evaluate the predictive value of nRBC on mortality in intensive care unit (ICU) patients with COVID-19 acute respiratory distress syndrome (ARDS). Material and methods This retrospective, observational cohort study analyzed data on 206 ICU patients diagnosed with COVID-19 ARDS between March 2020 and March 2022. The primary endpoint was ICU mortality, and secondary endpoints included ICU and hospital stay lengths, ventilation hours, and the time courses of disease severity scores and clinical and laboratory parameters. Results Among the included patients, 68.9% tested positive for nRBC at least once during their ICU stay. A maximum nRBC of 105 µl-1 had the highest accuracy in predicting ICU mortality (area under the curve of the receiver operating characteristic [AUCROC] 0.780, p < 0.001, sensitivity 69.0%, specificity 75.5%). Mortality was significantly higher among patients with nRBC >105 µl-1 than ≤105 µl-1 (86.5% vs. 51.3%, p = 0.008). Compared to patients negative for nRBC in their peripheral blood, those positive for nRBC required longer mechanical ventilation (127 [44 - 289] h vs. 517 [255 - 950] h, p < 0.001), ICU stays (12 [8 - 19] vs. 27 [13 - 51] d, p < 0.001), and hospital stays (19 [12 - 29] d vs. 31 [16 - 58] d, p < 0.001). Peak Sepsis-related Organ Failure Assessment (SOFA), Simplified Acute Physiology Score, PaO2/FiO2, interleukin-6, and procalcitonin values were reached before the peak nRBC level. However, the predictive performance of the SOFA (AUCROC 0.842, p < 0.001) was considerably improved when a maximum SOFA score >8 and nRBC >105 µl-1 were combined. Discussion nRBC predict ICU mortality and indicate disease severity among patients with COVID-19 ARDS, and they should be considered a clinical alarm signal for a worse outcome. nRBC are a late predictor of ICU mortality compared to other established clinical scoring systems and laboratory parameters but improve the prediction accuracy when combined with the SOFA score.
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Affiliation(s)
- Götz Schmidt
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - Arnd Martens
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - Melanie Markmann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - Ulrich Matt
- Department of Internal Medicine V, Universities of Giessen and Marburg Lung Center (UGMLC), Excellence Cluster Cardiopulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Matthias Hecker
- Department of Internal Medicine II, Universities of Giessen and Marburg Lung Center (UGMLC), Excellence Cluster Cardiopulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Khodr Tello
- Department of Internal Medicine II, Universities of Giessen and Marburg Lung Center (UGMLC), Excellence Cluster Cardiopulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
| | - Matthias Wolff
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany
| | - István Vadász
- Department of Internal Medicine II, Universities of Giessen and Marburg Lung Center (UGMLC), Excellence Cluster Cardiopulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus-Liebig University, Giessen, Germany
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Gearhart A, Esteso P, Sperotto F, Elia EG, Michelson KA, Lipsitz S, Sun M, Knoll C, Vanderpluym C. Nucleated Red Blood Cells Are Predictive of In-Hospital Mortality for Pediatric Patients. Pediatr Emerg Care 2023; 39:907-912. [PMID: 37246140 PMCID: PMC10981975 DOI: 10.1097/pec.0000000000002980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE We sought to establish whether nucleated red blood cells (NRBCs) are predictive of disposition, morbidity, and mortality for pediatric patients presenting to the emergency department (ED). METHODS A single-center retrospective cohort study examining all ED encounters from patients aged younger than 19 years between January 2016 and March 2020, during which a complete blood count was obtained. Univariate analysis and multivariable logistic regression were used to test the presence of NRBCs as an independent predictor of patient-related outcomes. RESULTS The prevalence of NRBCs was 8.9% (4195/46,991 patient encounters). Patient with NRBCs were younger (median age 4.58 vs 8.23 years; P < 0.001). Those with NRBCs had higher rates of in-hospital mortality (30/2465 [1.22%] vs 65/21,741 [0.30%]; P < 0.001), sepsis (19% vs 12%; P < 0.001), shock (7% vs 4%; P < 0.001), and cardiopulmonary resuscitation (CPR) (0.62% vs 0.09%; P < 0.001). They were more likely to be admitted (59% vs 51%; P < 0.001), have longer median hospital length of stay {1.3 (interquartile range [IQR], 0.22-4.14) vs 0.8 days (IQR, 0.23-2.64); P < 0.001}, and median intensive care unit (ICU) length of stay (3.9 [IQR, 1.87-8.72] vs 2.6 days [IQR, 1.27-5.83]; P < 0.001). Multivariable regression revealed presence of NRBCs as an independent predictor for in-hospital mortality (adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.38-3.53; P < 0.001), ICU admission (aOR, 1.30; 95% CI, 1.11-1.51; P < 0.001), CPR (aOR, 3.83; 95% CI, 2.33-6.30; P < 0.001), and 30-day return to the ED (aOR, 1.15; 95% CI, 1.15-1.26; P < 0.001). CONCLUSIONS The presence of NRBCs is an independent predictor for mortality, including in-hospital mortality, ICU admission, CPR, and readmission within 30 days for children presenting to the ED.
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Affiliation(s)
- Addison Gearhart
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul Esteso
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Francesca Sperotto
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Eleni G. Elia
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Kenneth A. Michelson
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Stu Lipsitz
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Mingwei Sun
- Clinical Research Informatics Team, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Christopher Knoll
- Department of Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, 85016, USA
| | - Christina Vanderpluym
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
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Hashmi SA, Khowaja R, Ali M, Mangi AR, Khowaja A, Riaz G, Hashmi SMM, Haider AR, Hussain SDA, Agha S. Prognostic Significance of Nucleated RBCs in Predicting Mortality Among ST-Elevation Myocardial Infarction Patients Admitted to the ICU. Cureus 2023; 15:e45445. [PMID: 37859905 PMCID: PMC10583491 DOI: 10.7759/cureus.45445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background The nucleated red blood cells (NRBCs) are a readily available hematological parameter with potential for risk stratification for mortality. Therefore, our objective was to assess the predictive significance of NRBCs for ICU mortality among ST-elevation myocardial infarction (STEMI) patients admitted to an ICU. Additionally, we aimed to compare the predictive capacity of NRBCs with that of the acute physiology and chronic health evaluation (APACHE) II score and the sequential organ failure assessment (SOFA) score. Methodology This descriptive cross-sectional study was conducted in the ICU of the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from the 1st of February to the 30th of June, 2023. We included adult patients (≥18 years) diagnosed with STEMI who were subsequently admitted to the ICU. NRBCs were assessed in all patients over up to five days at 24-hour intervals, and the highest NRBC levels were used for the final analysis. Furthermore, the APACHE II score and the SOFA score were also documented. Patients were monitored throughout their ICU stay, and any adverse events or complications, such as re-intubation, bleeding necessitating transfusion, requirement for renal replacement therapy, arrhythmias, re-infarction, and mortality, were recorded. Results This study included 151 patients, of whom 97 (64.2%) were male, with an average age of 61.1 ± 10.7 years. Patients with positive NRBCs had higher mean SOFA scores (7.4 ± 2.9 vs. 5.4 ± 2.6; p < 0.001) and APACHE II scores (14.6 ± 6.3 vs. 12.6 ± 5.5; p = 0.037) compared to those with negative NRBCs. The culprit vessel showed greater mean stenosis (%) in patients with positive NRBCs (98.8 ± 3.0% vs. 96.8 ± 5.7%; p = 0.004). Post-procedure thrombolysis in myocardial infarction (TIMI) flow grade III was lower in patients with positive NRBCs (77.8% vs. 91.8% for positive vs. negative NRBCs, respectively). Moreover, patients with positive NRBCs experienced significantly higher mortality rates (63% vs. 8.2%; p < 0.001), a higher occurrence of arrhythmias (35.2% vs. 19.6%; p = 0.034), and an increased requirement for vasopressors/inotropic support (96.3% vs. 71.1%; p < 0.001) compared to those with negative NRBCs. NRBCs demonstrated superior discriminatory ability compared to the SOFA and APACHE II scores, with an area under the curve of 0.818 (95% CI: 0.738-0.899) for NRBCs, 0.774 (95% CI: 0.692-0.857) for SOFA, and 0.707 (95% CI: 0.613-0.801) for APACHE II. Positive NRBCs exhibited a sensitivity of 81.0% and a specificity of 81.7% in predicting ICU mortality. Conclusion In conclusion, positive NRBCs emerge as a robust and reliable prognostic indicator, strongly associated with an elevated risk of ICU mortality in STEMI patients. Moreover, the predictive power of positive NRBCs surpasses that of both SOFA and APACHE II scoring systems.
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Affiliation(s)
- Syeda Akefah Hashmi
- Critical Care Medicine, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Raheela Khowaja
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Maria Ali
- Transfusion Medicine, Regional Blood Centre Karachi, Karachi, PAK
| | - Ali R Mangi
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Aamir Khowaja
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Gohar Riaz
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Ali Raza Haider
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Sidrah Agha
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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Pikora K, Krętowska-Grunwald A, Krawczuk-Rybak M, Sawicka-Żukowska M. Diagnostic Value and Prognostic Significance of Nucleated Red Blood Cells (NRBCs) in Selected Medical Conditions. Cells 2023; 12:1817. [PMID: 37508482 PMCID: PMC10378384 DOI: 10.3390/cells12141817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Nucleated red blood cells (NRBCs) are premature erythrocyte precursors that reside in the bone marrow of humans of all ages as an element of erythropoiesis. They rarely present in healthy adults' circulatory systems but can be found circulating in fetuses and neonates. An NRBC count is a cost-effective laboratory test that is currently rarely used in everyday clinical practice; it is mostly used in the diagnosis of hematological diseases/disorders relating to erythropoiesis, anemia, or hemolysis. However, according to several studies, it may be used as a biomarker in the diagnosis and clinical outcome prognosis of preterm infants or severely ill adult patients. This would allow for a quick diagnosis of life-threatening conditions and the prediction of a possible change in a patient's condition, especially in relation to patients in the intensive care unit. In this review, we sought to summarize the possible use of NRBCs as a prognostic marker in various disease entities. Research into the evaluation of the NRBCs in the pediatric population most often concerns neonatal hypoxia, the occurrence and consequences of asphyxia, and overall neonatal mortality. Among adults, NRBCs can be used to predict changes in clinical condition and mortality in critically ill patients, including those with sepsis, trauma, ARDS, acute pancreatitis, or severe cardiovascular disease.
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Affiliation(s)
- Katarzyna Pikora
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
| | - Anna Krętowska-Grunwald
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
| | - Małgorzata Sawicka-Żukowska
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Jerzego Waszyngtona 17, 15-274 Bialystok, Poland
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Piggott KD, Norlin C, Laviolette C, Turner J, Lewis L, Soliman A, Hebert D, Pettitt T. Nucleated red blood cells as a biomarker for mortality in infants and neonates requiring veno-arterial extracorporeal membrane oxygenation for cardiac disease. Perfusion 2023; 38:299-304. [PMID: 34636269 DOI: 10.1177/02676591211050607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Nucleated red blood cells (NRBC) are rare in the peripheral circulation of healthy individuals and their presence have been associated with mortality in adults and very low birth weight newborns, however, its value as a biomarker for mortality in infants requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has yet to be studied. We sought to determine if NRBC can serve as a biomarker for ECMO mortality and inpatient mortality in infants requiring V-A ECMO. METHODS A single-center retrospective chart review analyzing infants <1 year of age requiring VA ECMO due to myocardial dysfunction or post-cardiotomy between January 1, 2011 to June 30, 2020. RESULTS One hundred two patients required VA ECMO. Sixty-five patients required ECMO post-cardiotomy, 19 for perioperative deterioration, and 18 for myocardial dysfunction. Fifty-one patients (50%) died (21 died on ECMO, 30 died post-ECMO decannulation). Multivariable analysis found Age <60 days (OR 13.0, 95% CI 1.9-89.6, p = 0.009), NRBC increase by >50% post-ECMO decannulation (OR 17.1, 95% CI 3.1-95.1, p = 0.001), Single Ventricle (OR 9.0, 95% CI 1.7-47.7, p = 0.01), and lactate at ECMO decannulation (OR 3.0, 95% CI 1.3-7.1, p = 0.011) to be independently associated with inpatient mortality. ROC curves evaluating NRBC pre-ECMO decannulation as a biomarker for mortality on ECMO (AUC 0.80, 95% CI 0.68-0.92, p ⩽ 0.001) and post-ECMO decannulation (AUC 0.75, 95% CI 0.65-0.84, p ⩽ 0.001) show NRBC to be an accurate biomarker for mortality. CONCLUSIONS Greater than 50% increase in NRBC post-ECMO decannulation is associated with inpatient mortality. NRBC value pre-ECMO decannulation may be a useful biomarker for mortality while on ECMO and post-decannulation.
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Affiliation(s)
- Kurt D Piggott
- Division of Pediatric Cardiac Intensive Care, Louisiana State University Health Sciences, New Orleans, LA, USA
| | - Casey Norlin
- Lousiana State University Health Sciences, New Orleans, LA, USA
| | - Cynthia Laviolette
- Division of Pediatric Cardiac Intensive Care, Louisiana State University Health Sciences, New Orleans, LA, USA
| | - Jason Turner
- Division of Pediatric Cardiac Intensive Care, Louisiana State University Health Sciences, New Orleans, LA, USA
| | - LaTasha Lewis
- Division of Pediatric Cardiac Intensive Care, Louisiana State University Health Sciences, New Orleans, LA, USA
| | - Amira Soliman
- Division of Pediatric Cardiac Intensive Care, Louisiana State University Health Sciences, New Orleans, LA, USA
| | - David Hebert
- Lousiana State University Health Sciences, New Orleans, LA, USA
| | - Tim Pettitt
- Lousiana State University Health Sciences, New Orleans, LA, USA
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Düz ME, Arslan M, Menek EE, Avci BY. Impact of the seventh day nucleated red blood cell count on mortality in COVID-19 intensive care unit patients: A retrospective case-control study. J Med Biochem 2023; 42:138-144. [PMID: 36819135 PMCID: PMC9920868 DOI: 10.5937/jomb0-39839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background COVID-19 covers a broad clinical spectrum, threatening global health. Although several studies have investigated various prognostic biochemical and hematological parameters, they generally lack specificity and are insufficient for decision-making. Beyond the neonatal period, NRBCs (nucleated red blood cells) in peripheral blood is rare and often associated with malignant neoplasms, bone marrow diseases, and other severe disorders such as sepsis and hypoxia. Therefore, we investigated if NRBCs can predict mortality in hypoxic ICU (Intensive Care Unit) patients of COVID-19. Methods Seventy-one unvaccinated RT-PCR confirmed COVID-19 ICU patients was divided into those who survived (n=35, mean age=58) and died (n=36, mean age=75). Venous blood samples were collected in K3 EDTA tubes and analyzed on a Sysmex XN-1000 hematology analyzer with semiconductor laser flow cytometry and nucleic acid fluorescence staining method for NRBC analysis. NRBC numbers and percentages of the patients were compared on the first and seventh days of admission to the ICU. Results are reported as a proportion of NRBCs per 100 WBCs NRBCs/100 WBC (NRBC% and as absolute NRBC count (NRBC #, × 109/L). Results NRBC 7th-day count and % values were statistically higher in non-survival ones. The sensitivity for 7th day NRBC value <0.01 (negative) was 86.11%, the specificity was 48.57%, for <0.02; 75.00%, and 77.14%, for <0.03; 61.11%, and 94.60%. Conclusions In conclusion, our results indicate that NRBC elevation (>0.01) significantly predicts mortality in ICU hospitalized patients due to COVID-19. Worse, a high mortality rate is expected, especially with NRBC values of >0.03.
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Affiliation(s)
- Muhammed Emin Düz
- Amasya University, Sabuncuoğlu Şerefeddin Training, and Research Hospital, Medical Biochemistry, Amasya, Turkey
| | - Mustafa Arslan
- Amasya University, Sabuncuoğlu Şerefeddin Training, and Research Hospital, Infectious Diseases, Amasya, Turkey
| | - Elif E. Menek
- Amasya University, Sabuncuoğlu Şerefeddin Training, and Research Hospital, Medical Biochemistry, Amasya, Turkey
| | - Burak Yasin Avci
- Amasya University, Sabuncuoğlu Şerefeddin Training, and Research Hospital, Infectious Diseases, Amasya, Turkey
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Abstract
INTRODUCTION Nucleated red blood cells (NRBCs) are immature red cells that under normal conditions are not present in the peripheral circulation. Several studies have suggested an association between elevated NRBC and poor outcome in critically ill adults and neonates. We sought to determine if elevations in NRBC value following cardiac surgery and following clinical events during the hospital stay can be used as a biomarker to monitor for mortality risk in neonates post-cardiac surgery. MATERIALS AND METHODS We constructed a retrospective study of 264 neonates who underwent cardiac surgery at Children's Hospital, New Orleans between 2011 and 2020. Variables included mortality and NRBC value were recorded following cardiac surgery and following peri-operative clinical events. The study was approved by LSU Health IRB. Sensitivity, specificity, receiver operating characteristic (ROC) curves with area under the curve (AUC) and logistic regression analysis were performed. RESULTS Thirty-six patients (13.6%) died, of which 32 had an NRBC value ≥10/100 white blood cell (WBC) during hospitalisation. Multi-variable analysis found extracorporeal membrane oxygenation use (OR 10, 95% CI 2.9-33, p=<0.001), NRBC ≥10/100 WBC (OR 16.1, CI 4.1-62.5, p ≤ 0.001) and peak NRBC in the 14-day period post-cardiac surgery (continuous variable, OR 1.05, 95% CI 1.0-1.09, p = 0.03), to be independently associated with mortality. Using a cut-off NRBC value of 10/100 WBC, there was an 88.9% sensitivity and a 90.8% specificity, with ROC curve showing an AUC of 0.9 and 0.914 for peak NRBC value in 14 days post-surgery and entire hospitalisation, respectively. CONCLUSIONS NRBC ≥10/100 WBC post-cardiac surgery is strongly associated with mortality. Additionally, NRBC trend appears to show promise as an accurate biomarker for mortality.
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Neutrophil-to-Lymphocyte Ratio Is Not Associated with Severity of Coronary Artery Disease and Is Not Correlated with Vitamin D Level in Patients with a History of an Acute Coronary Syndrome. BIOLOGY 2022; 11:biology11071001. [PMID: 36101382 PMCID: PMC9311593 DOI: 10.3390/biology11071001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022]
Abstract
Coronary artery disease (CAD), the leading cause of death worldwide, has an underlying cause in atherosclerosis. The activity of this inflammatory process can be measured with neutrophil-to-lymphocyte ratio (NLR). The anti-inflammatory and anti-atherogenic properties of vitamin D affect many mechanisms involved in CAD. In this study, we investigated the association between NLR, vitamin D concentration, and severity of CAD in a group of patients with a history of myocardial infarction (MI). NLR was higher in patients with acute coronary syndrome (ACS) in comparison to those with stable CAD (median: 2.8, range: 0.96−24.3 vs. median: 2.3, range: 0.03−31.6; p < 0.05). No associations between NLR and severity of CAD (p = 0.14) in the cohort and in the subgroups with stable CAD (p = 0.40) and ACS (p = 0.34) were observed. We found no correlation between vitamin D level and NLR neither in the whole study group (p = 0.29) nor in subgroups of patients with stable CAD (p = 0.84) and ACS (p = 0.30). NLR could be used as prognostic biomarker of consecutive MI in patients with CAD and a history of MI.
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Peripheral Nucleated Red Blood Cells and Mortality in Critically Ill Children. J Pediatr Hematol Oncol 2022; 44:79-83. [PMID: 34486569 DOI: 10.1097/mph.0000000000002294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
The present retrospective cohort study examines whether there is an association between circulating nucleated red blood cells (nRBCs) and mortality in critically ill children. nRBCs are erythropoietic progenitor cells not found in peripheral blood of healthy adults and children beyond the neonatal period. The presence of circulating nRBCs is associated with poor prognosis in adults and neonates, though little is known about their significance in children. Admissions to both the general and cardiac pediatric intensive care unit at the Stollery Children's Hospital in Edmonton, Alberta between January 1, 2015 and December 31, 2017 were examined, and logistic regression was performed to ascertain the association between the peak absolute nRBC counts and in-hospital mortality in critically ill children. A total of 2065 admissions were included. The number of admissions with detectable nRBCs was 386 (prevalence: 13.9%), and the number of deaths was 93 (mortality: 4.5%). A statistically significant association was found between the absolute value of nRBC peak and intensive care unit mortality (odds ratio=1.37; 95% confidence interval: 1.13-1.67; P=0.002) as well as hospital mortality (odds ratio=1.38; 95% confidence interval: 1.12-1.70; P=0.003) independent of the Pediatric Index of Mortality 3 score (PIM3). This result warrants more attention to nRBC values and their potential clinical use.
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Kanemasa H, Ishimura M, Eguchi K, Tanaka T, Nanishi E, Shiraishi A, Goto M, Motomura Y, Ohga S. The immunoregulatory function of peripheral blood CD71 + erythroid cells in systemic-onset juvenile idiopathic arthritis. Sci Rep 2021; 11:14396. [PMID: 34257378 PMCID: PMC8277864 DOI: 10.1038/s41598-021-93831-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/30/2021] [Indexed: 12/18/2022] Open
Abstract
CD71+ erythroid cells (CECs) are recognized to have an immunoregulatory function via direct cell–cell interaction and soluble mediators. Circulating CECs appear in newborns or patients with hemolytic and cardiopulmonary disorders. To assess the biological role of CECs in systemic inflammation, we studied the gene expression and function in systemic-onset juvenile idiopathic arthritis (SoJIA). Peripheral blood mononuclear cells of SoJIA patients expressed upregulated erythropoiesis-related genes. It represented the largest expansion of CECs during active phase SoJIA among other inflammatory diseases. Despite the opposing roles of erythropoietin and hepcidin in erythropoiesis, both serum levels were in concert with the amounts of SoJIA-driven CECs. Circulating CECs counts in inflammatory diseases were positively correlated with the levels of C-reactive protein, IL-6, IL-18, or soluble TNF receptors. Co-culture with active SoJIA-driven CECs suppressed secretions of IL-1β, IL-6, and IL-8 from healthy donor monocytes. The top upregulated gene in SoJIA-driven CECs was ARG2 compared with CECs from cord blood controls, although cytokine production from monocytes was suppressed by co-culture, even with an arginase inhibitor. CECs are driven to the periphery during the acute phase of SoJIA at higher levels than other inflammatory diseases. Circulating CECs may control excessive inflammation via the immunoregulatory pathways, partly involving arginase-2.
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Affiliation(s)
- Hikaru Kanemasa
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masataka Ishimura
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Katsuhide Eguchi
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tamami Tanaka
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Etsuro Nanishi
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akira Shiraishi
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Motohiro Goto
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshitomo Motomura
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shouichi Ohga
- Departments of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Chinudomwong P, Khongjaroensakun N, Chatachote B, Chaothai N, Paisooksantivatana K. Improving the efficiency of the autoverification workflow for nucleated red blood cell reporting in the hematology laboratory. Int J Lab Hematol 2021; 43:1373-1378. [PMID: 34237189 DOI: 10.1111/ijlh.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although the microscopic manual count is considered the standard method for NRBC enumeration, modern hematology analyzers can perform this task automatically with reliable accuracy and efficiency. This study aims to evaluate the diagnostic performance of the Sysmex XN hematology analyzer and to construct the optimal workflow for accurate and efficient NRBC reporting. METHODS Specimens containing different levels of NRBC were included. Analytical performance was evaluated via method comparison with flow cytometry (FCM) and manual count (MC). Clinical sensitivity was analyzed by ROC analysis using manual count as the standard method. RESULTS Correlation study of %NRBC with FCM and MC demonstrated an r value of 0.925 (95% CI 0.905 to 0.942) and 0.990 (95% CI 0.987 to 0.992) with a mean difference of -0.8 (95%CI: -6.7 to +5.0) and +0.50 (95% CI: -6.7 to +7.7), respectively. When the automated NRBC count was equal to zero and >0.07 × 109 /L, the false-negative rate and false-positive rate were 100%, respectively; hence, manual slide review could be omitted. A false-positive rate of 72.7% was noted in specimens containing NRBC count less than 0.07 × 109 /L. CONCLUSION The Sysmex XN can help improve the efficiency of NRBC enumeration owing to its accuracy, rapidity, and automation. However, further studies are required to improve the accuracy of detection in specimens containing a very low level of NRBC.
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Affiliation(s)
- Pawadee Chinudomwong
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narin Khongjaroensakun
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Benjarat Chatachote
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nutdanai Chaothai
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Karan Paisooksantivatana
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kaito Y, Konuma T, Monna-Oiwa M, Kato S, Isobe M, Okabe M, Imai Y, Takahashi S, Tojo A. Prognostic impacts of peripheral blood erythroblasts after single-unit cord blood transplantation. Int J Lab Hematol 2021; 43:1437-1442. [PMID: 34118105 DOI: 10.1111/ijlh.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/28/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The appearance of erythroblasts (EBLs) in peripheral blood occurs in a variety of serious conditions and has been associated with mortality in critically ill patients. However, the incidence, risk factor, and outcomes of EBLs after cord blood transplantation (CBT) remain unclear. METHODS We have investigated the impact of EBLs on transplant outcomes on 225 adult patients who underwent single-unit CBT at our single institute. RESULTS The cumulative incidences of EBL ≥200 × 106 /L and EBL ≥1000 × 106 /L at 60 days after CBT were 17% and 4%, respectively, detected after a median of 35 days and 36.5 days. Multivariate analysis using erythroblastosis as time-dependent covariates demonstrated the significant association of EBL ≥1000 × 106 /L, but not EBL ≥200 × 106 /L, with the development of grade III-IV acute graft-versus-host disease (GVHD, hazard ratio [HR]: 18.56; P < .001), higher nonrelapse mortality (HR: 13.38; P < .001), and overall mortality (HR: 4.97; P = .001). CONCLUSION These data suggested that higher levels of EBLs were recognized as a significant risk factor for severe acute GVHD and mortality after single-unit CBT. Higher levels of EBLs may serve as a surrogate marker for poor single CBT outcomes.
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Affiliation(s)
- Yuta Kaito
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Maki Monna-Oiwa
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seiko Kato
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masamichi Isobe
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Motohito Okabe
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoichi Imai
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Li Y, Cui Z, Yu J, Bao X, Wang S. Do we need to conduct full-thickness closure after endoscopic full-thickness resection of gastric submucosal tumors? TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:942-947. [PMID: 33626009 DOI: 10.5152/tjg.2020.19685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Successful closure of gastric wall defects is a pivotal step for endoscopic full-thickness resection (EFTR). Our study indicates that for submucosal tumors (SMTs) smaller than 2.5 cm, closing the mucosal layer is safe and feasible when the modified method, ZIP, is used. MATERIALS AND METHODS We retrospectively analyzed 37 patients with gastric SMTs arising from the muscularis propria (MP) who underwent EFTR with defect closure of the mucosal layer. The main procedure involved: (1) making a longitudinal incision of the mucosal and submucosal layers above the lesion, (2) fully exposing the lesion and symmetrically punching holes on both sides of the incision into the submucosal layer, (3) en bloc resection of the lesion using an electrosurgical snare or knife, (4) hooking of metallic clips into the holes and clipping of the mucosal layer successively to close the gastric wall defect. This modified method was named ZIP. RESULTS Successful complete resection by EFTR was achieved in 37 cases (100%). The median procedure time was 60 min (range: 30-120 min), whereas the closure procedure took a median of 8 min (range: 5-20 min). The median lesion size was 1.0 cm (range: 0.5-2.5 cm). No patients had severe complications. No residual lesions or tumor recurrence were found during the follow-up period. CONCLUSION Closing the mucosal layer of gastric wall defects after EFTR by ZIP is feasible and effective.
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Affiliation(s)
- Yandong Li
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Zhao Cui
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jiangping Yu
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaoyan Bao
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Shi Wang
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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Xu C, Wang J, Jin X, Yuan Y, Lu G. Establishment of a predictive model for outcomes in patients with severe acute pancreatitis by nucleated red blood cells combined with Charlson complication index and APACHE II score. TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:936-941. [PMID: 33626008 DOI: 10.5152/tjg.2020.19954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Nucleated red blood cell (NRBC) is an immature red blood cell, which can appear in the peripheral blood of newborns but not in normal adults. However, in the presence of hemorrhage, severe hypoxia, or severe infection, NRBCs may exist in adult blood and are associated with prognosis. The aims of this study were to establish a predictive model for the outcome of patients with severe acute pancreatitis (SAP) based on NRBCs. MATERIALS AND METHODS Data from 92 patients with SAP were retrospectively collected for the study. We used chi-square automatic interaction detection (CHAID) to explore a prediction model of mortality in patients with SAP by NRBCs. RESULTS During the 90-day follow-up, 11 participants (12.0%) died. The NRBC-positive rate of nonsurvivors was much higher than survivors (90.9% vs. 23.5%). Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation II (APACHE II), Ranson score, and serum C-reactive protein were higher in nonsurvivors (5.0, 29.0, 6.0, and 140.0 g/L) than survivors (3.0, 13.0, 4.0, and 54.7 g/L). A CHAID model including NRBC, CCI, APACHE II score, and Ranson score showed that NRBCs differentiated well between nonsurvivors and survivors. All patients with SAP survived when they had a negative test result for NRBCs and CCI was below 7. All patients died when they had a positive test result for NRBCs and APACHE II score exceeded 30. Among patients whose NRBC test result was positive and APACHE II score was below 30, if the Ranson score was less than 5, the mortality rate was only 5.6%, whereas the mortality rate was 66.7% if the Ranson score exceeded 5. A validated population of 32 patients showed that the accuracy of the prediction model was 100%. CONCLUSION NRBC combined with CCI, APACHE II, and Ranson score can predict 90-day mortality of patients with SAP.
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Affiliation(s)
- Chengxin Xu
- Department of Clinical Laboratory, Shanghai Jiading District Jiangqiao hospital, 800 Huang Jia Hua Yuan Road, Jiading District, Shanghai
| | - Jing Wang
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Taizhou Enze Medical Center (Group), 150 Ximen Road, Linhai, Zhejiang Province, China
| | - Xiaxia Jin
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Taizhou Enze Medical Center (Group), 150 Ximen Road, Linhai, Zhejiang Province, China
| | - Yuan Yuan
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Taizhou Enze Medical Center (Group), 150 Ximen Road, Linhai, Zhejiang Province, China
| | - Guoguang Lu
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Taizhou Enze Medical Center (Group), 150 Ximen Road, Linhai, Zhejiang Province, China
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15
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Jenkins PM, Al Daoud F, Mercer L, Scholten D, Wong K, Perinjelil V, Majeski K, Cranford J, Elian G, Nigam T, Carto CA, Sachwani-Daswani GR. The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients. J Burn Care Res 2021; 42:1210-1214. [PMID: 33608722 PMCID: PMC8633085 DOI: 10.1093/jbcr/irab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in older patients (P < .001); and was associated with increased hospital length of stay (P < .001), injury severity scores (P < .001), and complications. The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death that the presence of NRBCs portends.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ghaith Elian
- Michigan State University College of Human Medicine
| | - Tina Nigam
- Michigan State University College of Human Medicine
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Morton SU, Brettin K, Feldman HA, Leeman KT. Association of nucleated red blood cell count with mortality among neonatal intensive care unit patients. Pediatr Neonatol 2020; 61:592-597. [PMID: 32771363 DOI: 10.1016/j.pedneo.2020.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/05/2020] [Accepted: 07/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nucleated red blood cells (nRBCs) are associated with adverse outcomes for pediatric and adult intensive care patients. METHODS The association between nRBC count and mortality was examined in an observational cohort of patients admitted to the neonatal intensive care unit from December 2015-December 2018. RESULTS Among the 1059 patients with at least one nRBC count obtained, 45 infants (4.2%) experienced in-hospital mortality prior to NICU discharge, the primary outcome measured in this study. Infants with any nRBC count >0 had a significantly higher risk of mortality (5.3% [45/849] vs. 0% [0/351], p < 0.001 by Fisher exact), and time to mortality decreased with higher nRBC counts (Spearman correlation -0.59, p < 0.001). The association between nRBC count and mortality remained significant even when restricting only to infants who were older than 7 days at time of nRBC count. CONCLUSION Among neonatal intensive care unit patients, including those >7 days old, nRBCs are associated with significantly elevated mortality risk. A prospective study to better characterize clinical co-variants is necessary to better establish the use of nRBCs as a predictor of mortality.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA.
| | | | - Henry A Feldman
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, 02115, USA; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Kristen T Leeman
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
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Xiao Y, Li J, Zhang Y, Zhang X, Liu H, Qin Z, Chen B. Transcriptome analysis identifies genes involved in the somatic embryogenesis of Eucalyptus. BMC Genomics 2020; 21:803. [PMID: 33208105 PMCID: PMC7672952 DOI: 10.1186/s12864-020-07214-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/08/2020] [Indexed: 01/11/2023] Open
Abstract
Background Eucalyptus, a highly diverse genus of the Myrtaceae family, is the most widely planted hardwood in the world due to its increasing importance for fiber and energy. Somatic embryogenesis (SE) is one large-scale method to provide commercial use of the vegetative propagation of Eucalyptus and dedifferentiation is a key step for plant cells to become meristematic. However, little is known about the molecular changes during the Eucalyptus SE. Results We compared the transcriptome profiles of the differentiated and dedifferentiated tissues of two Eucalyptus species – E. camaldulensis (high embryogenetic potential) and E. grandis x urophylla (low embryogenetic potential). Initially, we identified 18,777 to 20,240 genes in all samples. Compared to the differentiated tissues, we identified 9229 and 8989 differentially expressed genes (DEGs) in the dedifferentiated tissues of E. camaldulensis and E. grandis x urophylla, respectively, and 2687 up-regulated and 2581 down-regulated genes shared. Next, we identified 2003 up-regulated and 1958 down-regulated genes only in E. camaldulensis, including 6 somatic embryogenesis receptor kinase, 17 ethylene, 12 auxin, 83 ribosomal protein, 28 zinc finger protein, 10 heat shock protein, 9 histone, 122 cell wall related and 98 transcription factor genes. Genes from other families like ABA, arabinogalactan protein and late embryogenesis abundant protein were also found to be specifically dysregulated in the dedifferentiation process of E. camaldulensis. Further, we identified 48,447 variants (SNPs and small indels) specific to E. camaldulensis, including 13,434 exonic variants from 4723 genes (e.g., annexin, GN, ARF and AP2-like ethylene-responsive transcription factor). qRT-PCR was used to confirm the gene expression patterns in both E. camaldulensis and E. grandis x urophylla. Conclusions This is the first time to study the somatic embryogenesis of Eucalyptus using transcriptome sequencing. It will improve our understanding of the molecular mechanisms of somatic embryogenesis and dedifferentiation in Eucalyptus. Our results provide a valuable resource for future studies in the field of Eucalyptus and will benefit the Eucalyptus breeding program. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-020-07214-5.
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Affiliation(s)
- Yufei Xiao
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China
| | - Junji Li
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China
| | - Ye Zhang
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China
| | - Xiaoning Zhang
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China
| | - Hailong Liu
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China
| | - Zihai Qin
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China
| | - Bowen Chen
- Guangxi Key Laboratory of Superior Timber Trees Resource Cultivation, Guangxi Forestry Research Institute, 23 Yongwu Road, Nanning, 530002, Guangxi, China.
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Macichová M, Grochová M, Rácz O, Firment J, Mitníková M, Rosenberger J, Šimonová J, Hudák V. Improvement of mortality prediction accuracy in critically ill patients through combination of SOFA and APACHE II score with markers of stress haematopoiesis. Int J Lab Hematol 2020; 42:796-800. [PMID: 32803866 DOI: 10.1111/ijlh.13308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In critically ill patients nucleated red blood cells (NRBC) and immature granulocytes (IG) appear in the peripheral blood as the consequence of stress haematopoesis. The aim of this retrospective study was to evaluate the diagnostic value of NRBC and IG and to propose a model of improved mortality prediction including these parameters in the assessment of critically ill patients. METHODS The study included 338 critically ill adult patients hospitalized at Department of Anaesthesiology and Intensive Medicine, Louis Pasteur University Hospital in Kosice. As NRBC positive patients were considered patients with peripheral NRBC > 0.01 × 109 /L and IG positivity as >0.03 × 109 /L. Apache II index was calculated 24 hours after admission and Systemic Organ Failure Assessment (SOFA) on the day with the worst clinical condition. RESULTS NRBC positivity was found in 27.6% of patients. The mortality of NRBC positive patients was 48.38%, significantly higher than 23.7% of NRBC negative patients. IG positivity was 79.0% and their mortality was also higher as compared with that of IG negative patients (69.3% vs 33.8%). Three regression models predicting mortality including stress haematopoiesis markers, APACHE II, SOFA scores and age had sufficient level of sensitivity and specificity. CONCLUSION The presence of NRBC in the peripheral blood and the IG increase are available early risk predictors of mortality in critically ill patients. Regression models designed by combination of SOFA, APACHE II, and the new haematological parameters increase the accuracy and effectivity of diagnostic process in predicting prognosis and risk of mortality with high sensitivity and specificity.
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Affiliation(s)
- Michaela Macichová
- Clinical Hematology Unit, Department of Laboratory Medicine, Louis Pasteur University Hospital, Košice, Slovakia
| | - Monika Grochová
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
| | - Oliver Rácz
- Medical School, Institute of Pathological Physiology, Šafárik University, Košice, Slovakia
| | - Jozef Firment
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
| | - Miriam Mitníková
- Clinical Hematology Unit, Department of Laboratory Medicine, Louis Pasteur University Hospital, Košice, Slovakia
| | | | - Jana Šimonová
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
| | - Vladimir Hudák
- 1st Department of Anesthesiology and Intensive Medicine, Medical School, Louis Pasteur University Hospital, Šafárik University, Košice, Slovakia
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Monteiro Júnior JGDM, de Oliveira Cipriano Torres D, Filho DCS. Hematological Parameters as Prognostic Biomarkers in Patients with Cardiovascular Diseases. Curr Cardiol Rev 2019; 15:274-282. [PMID: 30799790 PMCID: PMC6823671 DOI: 10.2174/1573403x15666190225123544] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases are the major causes of preventable health loss from disease in the world and lead to functional disturbances including hematological parameters. The inflammatory and hypoxemic nature of cardiovascular diseases causes a stimulus in the bone marrow and, depending on the intensity of this stimulus, there is a release of immature cells or increase of other cells in the bloodstream. Therefore, their presence in the circulation is an important variable used to diagnose, stratify and predict diseases. In the last five decades, with the advent of automated counting of immature cells in the peripheral blood, the hemogram was transformed into a clinical tool of great importance in hospital surveillance for demonstrating this daily variability in the hematopoietic response according to the existing injury in the patient. Studies have shown that the presence of nucleated red blood cells and increases in mean platelet volume, immature granulocytes and neutrophil to lymphocyte ratio in the systemic circulation are independent prognostic biomarkers. This review article has as main objective to demonstrate the association of these hematological parameters to cardiovascular diseases, emphasizing their importance in clinical decision making.
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Phan TT, Vy HT, Ho TT, Tran VT, Tran TT, Pho SP, Pham TTB, Le TT, Nguyen ST. Emergence role of nucleated red blood cells in molecular response evaluation for chronic myeloid leukemia. Int J Gen Med 2019; 12:333-341. [PMID: 31564956 PMCID: PMC6731972 DOI: 10.2147/ijgm.s219744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/12/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To investigate and evaluate the role of nucleated red blood cells (NRBCs) and other markers in predicting remission failure in chronic myeloid leukemia (CML) patients treated with imatinib. Methods Seventy-one CML patients with BCR-ABL(+) in bone marrow cells were selected for this study. Molecular response evaluations were done every three months according to the recommendations of European LeukemiaNet (ELN). Patients were defined as remission failure if BCR-ABL transcripts >10% after 6 months (T6), >1% after 12 months (T12), and >0.1% after 18 (T18) months of treatment. The logistic regression was used to determine the optimal cut-off point of each marker and test the association of marker level with remission failure. Results The median NRBC, white blood cells, blast cells, basophils, and platelets were declined parallel with the decreases of BCR-ABL transcripts in bone marrow cells after 6 months of treatment (P<0.001). In addition, NRBC was almost not found in the blood of patients who archived good response at T6, T12, and T18 time-points. Interestingly, patients with a high level of NRBC (cut-off: 0.003×109/L) have higher BCR-ABL transcripts compared to others. The elevated NRBC at T6 (OR=6.49, P=0.042), T12 (OR=6.73, P=0.007), and T18 (OR=5.96, P=0.009) time-points was identified as an independent factor for the remission failure. Conclusion The results of this study showed that a high number of NRBC in peripheral blood of CML patients is associated with higher BCR-ABL transcripts in bone marrow cells. The elevated NRBC might serve as an independent marker for molecular remission failure in CML.
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Affiliation(s)
- Thang Thanh Phan
- Biomolecular & Genetic Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam.,Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Ha The Vy
- Department of Hematology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Toan Trong Ho
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Vinh Thanh Tran
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Tung Thanh Tran
- Department of Hematology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Suong Phuoc Pho
- Biomolecular & Genetic Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Tuyen Thi Bich Pham
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Thao Thi Le
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Son Truong Nguyen
- Department of General Director, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam.,Department of the Vice Minister, Ministry of Health, Hanoi City 100000, Vietnam
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Poz D, De Falco E, Pisano C, Madonna R, Ferdinandy P, Balistreri CR. Diagnostic and Prognostic Relevance of Red Blood Cell Distribution Width for Vascular Aging and Cardiovascular Diseases. Rejuvenation Res 2018; 22:146-162. [PMID: 30132390 DOI: 10.1089/rej.2018.2094] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Evidence suggests association of red blood cell distribution width (RDW) with cardiovascular diseases (CVDs). On the contrary, we underline that the sole RDW values cannot represent a valid CVD biomarker. High RDW values are expression of biological effects of a lot of both endogenous and exogenous factors (i.e., age, sex, genetic background, inflammation, hormones, drugs, diet, exercise, hematological analyzers, and ranges of values), modulating the biology and physiology of erythrocytes. Thus, the singular monitoring of RDW cannot be used to predict cardiovascular disorders. Accordingly, we have reviewed the evidence for potential relationship of RDW values with alterations in the cardiovascular system (i.e., regenerative capacity, endothelial turnover, and senescence of cardiovascular cells), associated with vascular aging and disease. In addition, we highlight the inevitable impact of biases in clinical application of RDW related to CVDs. Based on our thorough review of literature, we suggest a combined evaluation of RDW with other emerging biomarkers related to vascular aging and the diagnosis and prognosis of CVDs, including telomere length of leukocytes, circulating nucleated red blood cells (nRBCs) and endothelial progenitor cells (EPCs) in future large scale studies.
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Affiliation(s)
- Donatella Poz
- 1 Department of Laboratory Medicine, Institute of Clinical Pathology, Azienda Sanitaria Universitaria Integrata (ASUI) di Udine, Udine, Italy
| | - Elena De Falco
- 2 Department of Medical-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Latina, Italy
| | - Calogera Pisano
- 3 Cardiac Surgery, Tor Vergata University, Cardiochirurgia Policlinico Tor Vergata, Rome, Italy
| | - Rosalinda Madonna
- 4 Heart Failure Research, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas.,5 Department of Internal Medicine, Cardiology, The University of Texas Health Science Center at Houston, Houston, Texas.,6 Department of Neurosciences, Center of Aging Sciences and Translational Medicine, CESI-Met and Institute of Cardiology, Imaging and Clinical Sciences "G. D'Annunzio" University, Chieti, Italy
| | - Peter Ferdinandy
- 7 Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary.,8 Pharmahungary Group, Szeged, Hungary
| | - Carmela Rita Balistreri
- 9 Department of Pathobiology and Medical and Forensic Biotechnologies, University of Palermo, Palermo, Italy
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22
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Prognostic value of hematological parameters in patients with acute myocardial infarction: Intrahospital outcomes. PLoS One 2018; 13:e0194897. [PMID: 29668734 PMCID: PMC5905886 DOI: 10.1371/journal.pone.0194897] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/12/2018] [Indexed: 01/16/2023] Open
Abstract
Background The intensity of the inflammatory response and hemodynamic repercussion in acute myocardial infarction causing the presence in the peripheral circulation of nucleated red blood cells (NRBCs), increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are associated with a poorer prognosis. The aim of this study was to assess the role of these hematological biomarkers as predictors of all causes of mortality during the hospitalization of patients with acute myocardial infarction. Methods Nucleated red blood cells, mean platelet volume and neutrophil to lymphocyte ratio were measured daily during the hospitalization of the patients with acute myocardial infarction. We excluded patients younger than 18 years, on glucocorticoid therapy, with cancer or hematological diseases and those that were readmitted after hospital discharge. We performed a multiple logistic analysis to identify independent predictors of mortality. Results We included 466 patients (mean age 64.2 ± 12.8 years, 61.6% male). The prevalence of NRBCs in the sample was 9.1% (42 patients), with levels > 200/μL in 27 patients (5.8%). The mean MPV value was 10.9 ±0,9 and the mean NLR value was 3.71 (2,38; 5,72). In a multivariate analysis of serum NRBCs (HR 2.42, 95% CI: 1.35–4.36, p = 0.003), MPV (HR 2.97, 95% CI: 1.15–7.67, p = 0.024) and NLR (HR 5.02, 95% CI: 1.68–15.0, p = 0.004). The presence in the peripheral blood of NRBCs, increased in mean platelet volume and neutrophil to lymphocyte ratio were associated with higher mortality. Conclusions Nucleated red blood cells, mean platelet volume and neutrophil to lymphocyte ratio are independent predictors of intrahospital mortality. Therefore, an important tool in intrahospital clinical surveillance.
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23
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Menk M, Giebelhäuser L, Vorderwülbecke G, Gassner M, Graw JA, Weiss B, Zimmermann M, Wernecke KD, Weber-Carstens S. Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study. Ann Intensive Care 2018; 8:42. [PMID: 29589209 PMCID: PMC5869325 DOI: 10.1186/s13613-018-0387-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Nucleated red blood cells (NRBCs) in critically ill patients are associated with increased mortality and poor outcome. The aim of the present study was to evaluate the predictive value of NRBCs in patients with acute respiratory distress syndrome (ARDS). Methods This observational study was conducted at an ARDS referral center and included patients from 2007 to 2014. Daily NRBC counts were assessed and the predictive validity of NRBCs on mortality was statistically evaluated. A cutoff for prediction of mortality based on NRBCs was evaluated using ROC analysis and specified according to Youden’s method. Multivariate nonparametric analysis for longitudinal data was applied to prove for differences between groups over the whole time course. Independent predictors of mortality were identified with multiple logistic and Cox’ regression analyses. Kaplan–Meier estimations visualized the survival; the corresponding curves were tested for differences with the log-rank test. Results A total of 404 critically ill ARDS patients were analyzed. NRBCs were found in 75.5% of the patients, which was associated with longer length of ICU stay [22 (11; 39) vs. 14 (7; 26) days; p < 0.05] and higher mortality rates (50.8 vs. 27.3%; p < 0.001). Logistic regression analysis with mortality as response showed NRBC positivity per se to be an independent risk factor for mortality in ARDS with a doubled risk for ICU death (OR 2.03; 95% CI 1.16–3.55; p < 0.05). Also, NRBC value at ICU admission was found to be an independent risk factor for mortality (OR 3.25; 95% CI 1.09–9.73, p = 0.035). A cutoff level of 220 NRBC/µl was associated with a more than tripled risk of ICU death (OR 3.2; 95% CI 1.93–5.35; p < 0.0001). ARDS patients below this threshold level had a significant survival advantage (median survival 85 days vs. 29 days; log rank p < 0.001). Presence of a severe ARDS was identified as independent risk factor for the occurrence of NRBCs > 220/µl (OR 1.81; 95% CI 1.1–2.97; p < 0.05). Conclusions NRBCs may predict mortality in ARDS with high prognostic power. The presence of NRBCs in the blood might be regarded as a marker of disease severity indicating a higher risk of ICU death.
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Affiliation(s)
- Mario Menk
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Lena Giebelhäuser
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gerald Vorderwülbecke
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martina Gassner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jan A Graw
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Björn Weiss
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mathias Zimmermann
- Central Institute of Laboratory Medicine, DRK Klinikum Berlin Westend, Spandauer Damm 130, 14050, Berlin, Germany
| | - Klaus-D Wernecke
- Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Sostana GmbH, Wildensteiner Straße 27, 10318, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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24
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Purtle SW, Horkan CM, Moromizato T, Gibbons FK, Christopher KB. Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017. [PMID: 28633658 PMCID: PMC5479031 DOI: 10.1186/s13054-017-1724-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Little is known about risk factors associated with out-of-hospital outcomes in survivors of critical illness. We hypothesized that the presence of nucleated red blood cells in patients who survived critical care would be associated with adverse outcomes following hospital discharge. Methods We performed a two-center observational cohort study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. All data were obtained from the Research Patient Data Registry at Partners HealthCare. We studied 2878 patients, age ≥ 18 years, who received critical care between 2011 and 2015 and survived hospitalization. The exposure of interest was nucleated red blood cells occurring from 2 days prior to 7 days after critical care initiation. The primary outcome was mortality in the 90 days following hospital discharge. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both nucleated red blood cells and outcome. Adjustment included age, race (white versus nonwhite), gender, Deyo–Charlson Index, patient type (medical versus surgical), sepsis and acute organ failure. Results In patients who received critical care and survived hospitalization, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8% and 21.9% in patients with 0/μl, 1–100/μl, 101–200/μl and more than 200/μl nucleated red blood cells respectively. Nucleated red blood cells were a robust predictor of postdischarge mortality and remained so following multivariable adjustment. The fully adjusted odds of 90-day postdischarge mortality in patients with 1–100/μl, 101–200/μl and more than 200/μl nucleated red blood cells were 1.77 (95% CI, 1.23–2.54), 2.51 (95% CI, 1.36–4.62) and 3.72 (95% CI, 2.16–6.39) respectively, relative to patients without nucleated red blood cells. Further, the presence of nucleated red blood cells is a significant predictor of the odds of unplanned 30-day hospital readmission. Conclusion In critically ill patients who survive hospitalization, the presence of nucleated red blood cells is a robust predictor of postdischarge mortality and unplanned hospital readmission. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1724-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven W Purtle
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Boulder, CO, USA
| | - Clare M Horkan
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Takuhiro Moromizato
- Renal and Rheumatology Division, Internal Medicine Department, Okinawa Southern Medical Center and Children's Hospital, Haebaru, Okinawa, Japan
| | - Fiona K Gibbons
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth B Christopher
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Channing Division of Network Medicine, Brigham and Women's Hospital, MRB 418, 75 Francis Street, Boston, MA, 02115, USA.
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