title: Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study.
abstract: BACKGROUND
  The presence of nucleated red blood cells (NRBCs) in the peripheral blood of critically ill patients is associated with a poorer prognosis, though data on cardiovascular critical care patients is lacking. The aim of the present study was to assess the role of NRBCs as a predictor of intensive care unit (ICU) and in hospital all-cause mortality among cardiologic patients.
  
  
  METHODS
  NRBCs were measured daily in consecutive cardiac ICU patients, including individuals with both coronary and non-coronary acute cardiac care. We excluded patients younger than 18 years, with cancer or hematological disease, on glucocorticoid therapy, those that were readmitted after hospital discharge and patients who died in the first 24 hours after admission. We performed a multiple logistic analysis to identify independent predictors of mortality.
  
  
  RESULTS
  We included 152 patients (60.6 ± 16.8 years, 51.8% female, median ICU stay of 7 [4-11] days). The prevalence of NRBCs was 54.6% (83/152). The presence of NRBC was associated with a higher ICU mortality (49.4% vs 21.7%, P<0.001) as well as in-hospital mortality (61.4% vs 33.3%, p = 0.001). NRBC were equally associated with mortality among coronary disease (64.71% vs 32.5% [OR 3.80; 95%CI: 1.45-10.0; p = 0.007]) and non-coronary disease patients (61.45% vs 33.3% [OR 3.19; 95%CI: 1.63-6.21; p<0.001]). In a multivariable model, the inclusion of NRBC to the APACHE II score resulted in a significant improvement in the discrimination (p = 0.01).
  
  
  CONCLUSIONS
  NRBC are predictors of all-cause in-hospital mortality in patients admitted to a cardiac ICU. This predictive value is independent and complementary to the well validated APACHE II score.
authors.affiliation: Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
authors.forename: José Gildo de Moura
authors.initials: JG
authors.lastname: Monteiro Júnior
authors.affiliation: Laboratory of PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Dilênia de Oliveira Cipriano
authors.initials: Dde O
authors.lastname: Torres
authors.affiliation: Laboratory of PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Maria Cleide Freire Clementino
authors.initials: MC
authors.lastname: da Silva
authors.affiliation: Laboratory of PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Tadzia Maria de Brito
authors.initials: TM
authors.lastname: Ramos
authors.affiliation: Laboratory of PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Marilene Leite
authors.initials: ML
authors.lastname: Alves
authors.affiliation: Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
authors.forename: Wellington Jorge
authors.initials: WJ
authors.lastname: Nunes Filho
authors.affiliation: Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
authors.forename: Edgar Paulo
authors.initials: EP
authors.lastname: Damasceno
authors.affiliation: Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
authors.forename: Antônio Fernandes
authors.initials: AF
authors.lastname: Brunet
authors.affiliation: Center for Clinical and Epidemiological Research, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Márcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
authors.forename: Rodrigo Pinto
authors.initials: RP
authors.lastname: Pedrosa
authors.affiliation: Coronary Care Unit of PROCAPE (Pernambuco Cardiac Emergency Hospital), University of Pernambuco (UPE), Recife, Pernambuco, Brazil.
authors.forename: Dário Celestino
authors.initials: DC
authors.lastname: Sobral Filho
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D016638:Critical Illness; D004900:Erythroblasts / Q000473:pathology; D004906:Erythrocyte Count; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D016019:Survival Analysis