title: Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study.
abstract: BACKGROUND
  In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood, the prognosis is poor.
  
  
  METHODS
  In a prospective study, the detection of NRBCs was used for a daily monitoring of 383 medical intensive care patients.
  
  
  RESULTS
  The incidence of NRBCs in medical intensive care patients was 17.5% (67/383). The mortality of NRBC-positive patients was 50.7% (34/67); this was significantly higher (p < 0.001) than the mortality of NRBC-negative patients (9.8%, 31/316). Mortality increased with increasing NRBC concentration. Seventy-eight point six percent of the patients with NRBCs of more than 200/microl died. The detection of NRBCs is highly predictive of death, the odds ratio after adjustment for other laboratory and clinical prognostic indicators being 1.987 (p < 0.01) for each increase in the NRBC category (0/microl, 1 to 100/microl, 101 to 200/microl, and more than 200/microl). Each step-up in the NRBC category increased the mortality risk as much as an increase in APACHE II (Acute Physiology and Chronic Health Evaluation II) score of approximately 4 points. The mortality of patients who were NRBC-positive on the day of relocation from the intensive care unit to a peripheral ward was 27.6% (8/27). This was significantly higher than the mortality of patients who were NRBC-negative on the relocation day (8.6%, 28/325; p < 0.01). On average, NRBCs were detected for the first time 14 days (median, 3 days) before death.
  
  
  CONCLUSIONS
  The routine analysis of NRBCs in blood is of high prognostic power with regard to mortality of critically ill patients. Therefore, this parameter may serve as a daily indicator of patients at high mortality risk. Furthermore, NRBC-positive intensive care patients should not be relocated to a normal ward but should obtain ongoing intensive care treatment.
authors.affiliation: Institute of Clinical Chemistry, Transfusion and Laboratory Medicine, BG-University Hospital Bergmannsheil, Buerkle de la Camp-Platz 1, Ruhr-University Bochum, 44789 Bochum, Germany. axel.stachon@ruhr-uni-bochum.de
authors.forename: Axel
authors.initials: A
authors.lastname: Stachon
authors.forename: Elmar
authors.initials: E
authors.lastname: Segbers
authors.forename: Tim
authors.initials: T
authors.lastname: Holland-Letz
authors.forename: Reiner
authors.initials: R
authors.lastname: Kempf
authors.forename: Steffen
authors.initials: S
authors.lastname: Hering
authors.forename: Michael
authors.initials: M
authors.lastname: Krieg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality*; D004900:Erythroblasts / Q000378:metabolism*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis
chemical_list: D015415:Biomarkers