SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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A Stachon, M Lehnhardt, Y Katzy, T Holland-Letz, HU Steinau, M Krieg

1Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany, 2Department for Plastic Surgery/Burn Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany, 3Department for Plastic Surgery/Burn Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany, 4Department for Biometry, Ruhr-University Bochum, Universitätsstrassse 150, D-44803 Bochum, Germany, 5Department for Plastic Surgery/Burn Center, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany, 6Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany

Objective: The detection of erythroblasts (EBL) in peripheral blood is generally associated with a poor prognosis. As yet the prognostic significance of EBL in the blood of burn patients in relation to the abbreviated burn severity index (ABSI) has not been assessed.
Methods: In a retrospective study we analyzed the database of 464 burn patients.
Results: 81 out of 464 patients died (17.4%). The incidence of EBL in burn patients was 11.4% (53/464). The mean ABSI for EBL-positive and EBL-negative patients were 9.1±0.3 (n=53) and 6.0±0.1 (n=411; P < 0.001), respectively. The total mortality of EBL-positive patients was 56.6% (30/53). The predictive value for death increased with the EBL concentration. All patients with more than 1000 EBL/µl died (n=10). The mortality of EBL-negative patients was 12.4% (51/411). The incidence of EBL increased with increasing ABSI. Patients with ABSI < 4 were generally EBL-negative. The highest incidence of EBL was found between ABSI 10 and 13: about 40-50% of those patients were EBL-positive.
Taking into account the detection of EBL in blood, the prognostic power of the ABSI became more significant if to the individual ABSI score the following score points were added (= ABSI-E): class 1 (EBL 0/µl): +0; class 2 (EBL 1-400/µl): +1; class 3 (EBL 400-1000/µl): +2; class 4 (EBL >1000/µl): +3.
In terms of mortality the odds ratios for each ABSI score point as well as each stepwise increase from one EBL class to the next were 2.4 (95% confidence interval 1.9-2.8) and 2.3 (95% confidence interval 1.4-3.7), respectively. The prognostic significance of the ABSI-E, calculated by the area under curve (C-statistic), was 0.96.
Summary and conclusion: Our data suggest that the detection of EBL in blood may improve the ABSI in identifying patients with rather poor prognosis. The prognostic power of EBL is independent of the respective power found for the ABSI. Thus, we propose a modified ABSI, i.e. ABSI-E.

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