Prognostic significance of marked leukocytosis in hospitalized patients.
OBJECTIVE
To identify the prognostic significance of marked neutrophilic leukocytosis (MNL), defined as white blood cell (WBC) count of greater than or equal to 25,000/microL and greater than or equal to 80% mature neutrophils by differential count, in hospitalized patients.


METHODS
A central laboratory computer identified all consecutive patients with MNL in a one-month period. After exclusion of outpatients, neonates, and patients with hematologic malignancies or incomplete records, the remaining patients were studied and followed until discharge or death.


METHODS
Inpatient services of a 988-bed tertiary care teaching hospital.


METHODS
72 inpatients with MNL.


METHODS
None.


RESULTS
Associated conditions and hospital mortality were recorded. Potentially confounding or contributing variables, including age, sex, intensive care unit stay, infection, acidosis, uremia, malignancy, hemorrhage, surgery or invasive procedure, peak WBC count, and duration of MNL, were examined by multivariate analysis with mortality as the outcome variable. Overall hospital mortality was 29% in study patients. A higher peak WBC count (p = 0.0046), increasing age (p = 0.0058), MNL duration of greater than one day (p = 0.025), and lack of associated invasive procedures (p = 0.04) were jointly significant in the prediction of mortality in MNL patients.


CONCLUSIONS
The results confirm the impression of poor outcome associated with MNL and validate the use of MNL data in indices of severity of illness and as a prognostic marker for hospitalized patients regardless of underlying disease.
Chang
R
R
Department of Medicine, New York Hospital, Cornell Medical Center, New York.
Wong
G Y
GY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006760:Hospitalization; D006801:Humans; D007964:Leukocytosis / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012720:Severity of Illness Index