Nucleated red blood cell and its specific fluctuations are risk factors of 28-day and 90-day all-cause mortality in ICU patients: an observational cohort study

Background Little was known about the first occurrence time of Nucleated red blood cell (NRBC)and the persistent duration of the positive results in ICU patients, nor the dynamic changes of NRBC count and quantified predictive value of NRBC for mortality in ICU patients. We hypothesized that the persistent presence of NRBC in ICU patients would be associated with all-cause mortality and death patients would have specific NRBC fluctuations compared to survival ones.Methods A total of 224 newly admitted ICU patients in our hospital were collected and were followed up to 90 days after admission to ICU. Biological information, clinical characteristics and laboratory indicators and dynamic changes of NRBC count was compared between survival group and death group. Factors plausibly interact with both NRBC and outcome were included in logistic regression analysis to explore the risk factors of 28-day and 90-day mortality,ROC curve were drawn to determine the predictive value of NRBC for 28-day and 90-day all-cause mortality for ICU patients.Results NRBC was positively correlated with NRBC-positive duration days, APACHE II score, SOFA score, CCI, CRP, PCT and RDW. The 28-day mortality and 90-day were 15.0%,31.3%, 41.2%, 56.7% and 32.7%,52.9%, 59.4%, 80.0% in patients with 0/μL, 1–100/μL, 101–200/μL and more than 200/μL NRBC,respectively.NRBC in the death group had a rapid upward trend before death, while those in the survival group were stable at low levels.NRBC was a robust predictor of 28-day and 90-day all-cause mortality following multivariable adjustment. The adjusted odds of 28-day and 90-day all-cause mortality in patients with more than 200/μL NRBC were 5.087(95% CI, 1.960-13.202) and 4.922(95% CI, 1.369-17.703), relative to patients without NRBC. Area under the curve(AUC) of predicting 28-day all-cause mortality and 90-day all-cause mortality by NRBC were 0.685 and 0.670, and NRBC had high predictive values for sepsis patients and non-respiratory failure patients.Conclusion In ICU patients especially sepsis patients and non-respiratory failure patients, the presence of NRBC is a robust predictor of 28-day all-cause mortality and 90-day all-cause mortality. Specific NRBC fluctuations were found in death patients compared to survival ones.

[1]  K. Wernecke,et al.  Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study , 2018, Annals of Intensive Care.

[2]  J. Damås,et al.  SOFA criteria predict infection-related in-hospital mortality in ICU patients better than SIRS criteria and the qSOFA score , 2017, Evidence-Based Medicine.

[3]  A. Caraffa,et al.  Use of Common Inflammatory Markers in the Long-Term Screening of Total Hip Arthroprosthesis Infections: Our Experience , 2017, Advances in orthopedics.

[4]  C. Horkan,et al.  Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study , 2017, Critical Care.

[5]  D. Yong,et al.  The impact of production of extended-spectrum β-lactamases on the 28-day mortality rate of patients with Proteus mirabilis bacteremia in Korea , 2017, BMC Infectious Diseases.

[6]  M. Divon,et al.  Nucleated Red Blood Cells as a Marker of Acute and Chronic Fetal Hypoxia in a Rat Model , 2017, Rambam Maimonides medical journal.

[7]  G. Logroscino,et al.  Hospitalizations due to respiratory failure in patients with Amyotrophic Lateral Sclerosis and their impact on survival: a population-based cohort study , 2016, BMC Pulmonary Medicine.

[8]  M. Aarabi,et al.  COMPARISON OF PATIENTS’ ADMISSION, MEAN AND HIGHEST SOFA SCORES IN PREDICTION OF ICU MORTALITY: A PROSPECTIVE OBSERVATIONAL STUDY , 2016, Materia socio-medica.

[9]  H. Simmen,et al.  Fresh frozen plasma is permissive for systemic inflammatory response syndrome, infection, and sepsis in multiple-injured patients. , 2016, The American journal of emergency medicine.

[10]  N. Nonaka,et al.  The expression of embryonic globin mRNA in a severely anemic mouse model induced by treatment with nitrogen-containing bisphosphonate , 2016, BMC Hematology.

[11]  Li Li,et al.  Nucleated Red Blood Cell Count in Maternal Peripheral Blood and Hypertensive Disorders in Pregnant Women , 2016, The American journal of the medical sciences.

[12]  G. Ioannidis,et al.  Implementation of EuroSCORE II as an adjunct to APACHE II model and SOFA score, for refining the prognostic accuracy in cardiac surgical patients. , 2015, The Journal of cardiovascular surgery.

[13]  V. Avery,et al.  Mechanical clearance of red blood cells by the human spleen: Potential therapeutic applications of a biomimetic RBC filtration method. , 2015, Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine.

[14]  Marta C. Cohen,et al.  Measurement of nucleated red blood cells in the peripheral blood as a marker of hypoxia in sudden unexpected death in infancy , 2015, Journal of Clinical Pathology.

[15]  V. Laux,et al.  Effects of Rivaroxaban on Platelet Activation and Platelet–Coagulation Pathway Interaction , 2015, Journal of cardiovascular pharmacology and therapeutics.

[16]  G. Mitić,et al.  Prognostic value of hemostasis-related parameters for prediction of organ dysfunction and mortality in sepsis. , 2015, Turkish journal of medical sciences.

[17]  L. Feldman,et al.  Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery , 2015, The journal of trauma and acute care surgery.

[18]  A. Moritz,et al.  A Retrospective Study of 1,098 Blood Samples with Anemia from Adult Cats: Frequency, Classification, and Association with Serum Creatinine Concentration , 2014, Journal of veterinary internal medicine.

[19]  A. Balbi,et al.  Dialysis Complications in AKI Patients Treated with Extended Daily Dialysis: Is the Duration of Therapy Important? , 2014, BioMed research international.

[20]  A. Garland,et al.  Distinct determinants of long-term and short-term survival in critical illness , 2014, Intensive Care Medicine.

[21]  Yali Zhou,et al.  Splenectomy improves anaemia but does not reduce iron burden in patients with haemoglobin H Constant Spring disease. , 2014, Blood transfusion = Trasfusione del sangue.

[22]  Yudong D. He,et al.  Dose-related Differences in the Pharmacodynamic and Toxicologic Response to a Novel Hyperglycosylated Analog of Recombinant Human Erythropoietin in Sprague-Dawley Rats with Similarly High Hematocrit , 2014, Toxicologic pathology.

[23]  A. Bedrick.  Nucleated red blood cells and fetal hypoxia: a biologic marker whose ‘timing’ has come? , 2014, Journal of Perinatology.

[24]  Marta C. Cohen,et al.  Increased Number of Fetal Nucleated Red Blood Cells in the Placentas of Term or Near-Term Stillborn and Neonates Correlates with the Presence of Diffuse Intradural Hemorrhage in the Perinatal Period , 2014, Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society.

[25]  M. Graefen,et al.  Re-assessment of 30-, 60- and 90-day mortality rates in non-metastatic prostate cancer patients treated either with radical prostatectomy or radiation therapy. , 2013, Canadian Urological Association journal = Journal de l'Association des urologues du Canada.

[26]  S. Villani,et al.  Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996–2010). A population cross-sectional survey study , 2013, Langenbeck's Archives of Surgery.

[27]  Stephen L. Jones,et al.  Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis. , 2012, Surgical infections.

[28]  N. A. N. Raj,et al.  Dielectric Behavior of Calcium Oxalate Monohydrate Urinary Stone , 2012 .

[29]  Huifang Zhao,et al.  Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. , 2011, JAMA.

[30]  T. Holland-Letz,et al.  Association of nucleated red blood cells in blood and arterial oxygen partial tension , 2011, Clinical chemistry and laboratory medicine.

[31]  S. Bagshaw,et al.  Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study , 2010, BMC Cancer.

[32]  Annemarije Braber,et al.  Unravelling post-ICU mortality: predictors and causes of death , 2010, European journal of anaesthesiology.

[33]  T. Drake,et al.  Chronic Microcytic Anemia and Jaundice in a 36-Year-Old Male of Burmese Descent , 2010 .

[34]  A. Abu-Hanna,et al.  Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review , 2008, Critical care.

[35]  Ruopeng Sun,et al.  The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy. , 2008, Journal of perinatal medicine.

[36]  L. Korst,et al.  Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment , 2007, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[37]  Jan O Friedrich,et al.  Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study , 2006, Critical care.

[38]  G. Gursel,et al.  Value of APACHE II, SOFA and CPIS Scores in Predicting Prognosis in Patients with Ventilator-Associated Pneumonia , 2006, Respiration.

[39]  T. Holland-Letz,et al.  Daily monitoring of nucleated red blood cells in the blood of surgical intensive care patients. , 2006, Clinica chimica acta; international journal of clinical chemistry.

[40]  T. Holland-Letz,et al.  ASSOCIATION BETWEEN NUCLEATED RED BLOOD CELLS IN BLOOD AND THE LEVELS OF ERYTHROPOIETIN, INTERLEUKIN 3, INTERLEUKIN 6, AND INTERLEUKIN 12p70 , 2005, Shock.

[41]  M. Krieg,et al.  Nucleated red blood cells indicate high risk of in-hospital mortality. , 2002, The Journal of laboratory and clinical medicine.

[42]  R. Moreno,et al.  Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge , 2001, Intensive Care Medicine.

[43]  L S Wong,et al.  A comparison of ICU mortality prediction using the APACHE II scoring system and artificial neural networks , 1998, Anaesthesia.

[44]  A. Gatta,et al.  Splenic haemodynamics and portal hypertension in patients with liver cirrhosis and spleen enlargement. , 1985, Clinical physiology.

[45]  D. Danon,et al.  Phagocytosis of nucleated and mature beta thalassaemic red blood cells by mouse macrophages in vitro. , 1979, British journal of haematology.