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

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A Stachon, T Holland-Letz, 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 of Biometry, Ruhr-University Bochum, Universitätsstrasse 150, D-44789 Bochum, Germany, 3Institute 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 nucleated red blood cells (NRBC) 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.
Methods: Using a Sysmex XE-2100, 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.
Results: 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±4x106/l (median 40x106/l; range 20 to 2930x106/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 NRBCs concentration of +1x106/l. NRBCs were detected for the first time, on average, 13 days (median 8 days) before death.
Summary and conclusion: 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.

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