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. 2015 Dec 29;10(12):e0144259.
doi: 10.1371/journal.pone.0144259. eCollection 2015.

Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study

José Gildo de Moura Monteiro Júnior  1 , Dilênia de Oliveira Cipriano Torres  2 , Maria Cleide Freire Clementino da Silva  2 , Tadzia Maria de Brito Ramos  2 , Marilene Leite Alves  2 , Wellington Jorge Nunes Filho  1 , Edgar Paulo Damasceno  1 , Antônio Fernandes Brunet  1 , Márcio Sommer Bittencourt  3 , Rodrigo Pinto Pedrosa  1 , Dário Celestino Sobral Filho  1
Affiliations

Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study

José Gildo de Moura Monteiro Júnior et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of patients.
Fig 2
Fig 2. Mortality of ICU patients in relation to concentrations of nucleated red blood cells (NRBCs) P<0.001.
Fig 3
Fig 3. Mortality among coronary and non-coronary patients.
Fig 4
Fig 4. Comparison of ROC curves, p = 0.01.
See this image and copyright information in PMC

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