Impact of the seventh day Nucleated Red Blood Cell count on mortality in Covid-19 Intensive Care Unit patients: A retrospective case-control study

Nucleated RBCs in COVID-19

  • Muhammed Emin DÜZ Amasya University
  • Mustafa ARSLAN Amasya University
  • Elif MENEKŞE Amasya University
  • Burak Yasin AVCI Amasya University
Keywords: Nucleated erythrocytes, COVID-19, COVID-19 Pandemic, Mortality, Survival

Abstract


Objective

COVID-19 covers a broad clinical spectrum, threatening global health. Although several studies have investigated various prognostic biochemical and hematological parameters, they generally lack specificity and are insufficient for decision-making. Beyond the neonatal period, NRBCs (nucleated red blood cells) in peripheral blood is rare and often associated with malignant neoplasms, bone marrow diseases, and other severe disorders such as sepsis and hypoxia. In addition, NRBCs can predict mortality in hypoxic ICU patients like COVID-19, similar to other diseases.

Materials and Methods

Seventy-one unvaccinated RT-PCR confirmed COVID-19 ICU patients was divided into those who survived (n=35, mean age=58) and died (n=36, mean age=75). NRBC numbers and percentages of the patients were compared on the first and seventh days of admission to the ICU. Results are reported as a proportion of NRBCs per 100 WBCs [NRBCs/ 100 WBC (NRBC%) and as absolute NRBC count (NRBC #, × 109 /L).

Results

NRBC 7th-day count and % values were statistically higher in non-survival ones. The sensitivity for 7th day NRBC value <0.01 (negative) was 86.11%, the specificity was 48.57%, for <0.02; 75.00%, and 77.14%, for <0.03; 61.11%, and 94.60%.

Conclusion

In conclusion, we indicate that NRBC elevation (>0.01) significantly predicts mortality in ICU hospitalized patients due to COVID-19. Worse, a high mortality rate is expected, especially with NRBC values of >0.03.

References

1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr;382(18):1708–20.
2. Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province. Ann Intensive Care. 2020;10(1):33. Published 2020 Mar 18. https://doi.org/10.1186/s13613-020-00650-2.
3. Galloway JB, Norton S, Barker RD, Brookes A, Carey I, Clarke BD, et al. A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: an observational cohort study. J Infect. 2020 Aug;81(2):282–8.
4. Ji D, Zhang D, Xu J, Chen Z, Yang T, Zhao P, et al. Prediction for Progression Risk in Patients With COVID-19 Pneumonia: the CALL Score. Clin Infect Dis. 2020 Sep;71(6):1393–9.
5. Lu J, Hu S, Fan R, Liu Z, Yin X, Wang Q, et al. (2020). ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of the outbreak in Wuhan, China.
6. Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. Published 2020 Mar 18. https://doi.org/10.1186/s13054-020-2833-7.
7. Sun Y, Dong Y, Wang L, Xie H, Li B, Chang C, et al. Characteristics and prognostic factors of disease severity in patients with COVID-19: the Beijing experience. J Autoimmun. 2020 Aug;112:102473.
8. Chen R, Liang W, Jiang M, Guan W, Zhan C, Wang T, et al.; Medical Treatment Expert Group for COVID-19. Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. Chest. 2020 Jul;158(1):97–105.
9. Hermansen MC. Nucleated red blood cells in the fetus and newbornArchives of Disease in Childhood - Fetal and Neonatal Edition 2001;84:F211-F215.
10. Schwartz SO, Stansbury F. Significance of nucleated red blood cells in peripheral blood; analysis of 1,496 cases. J Am Med Assoc. 1954 Apr;154(16):1339–40.
11. Desai S, Jones SL, Turner KL, Hall J, Moore LJ. Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis. Surg Infect (Larchmt). 2012 Dec;13(6):360–5.
12. Danise P, Maconi M, Barrella F, Di Palma A, Avino D, Rovetti A, et al. Evaluation of nucleated red blood cells in the peripheral blood of hematological diseases. Clin Chem Lab Med. 2011 Oct;50(2):357–60.
13. Dennison D, Al Khabori M, Al Mamari S, Aurelio A, Al Hinai H, Al Maamari K, et al. Circulating activated neutrophils in COVID-19: an independent predictor for mechanical ventilation and death. Int J Infect Dis. 2021 May;106:155–9.
14. Menk M, Giebelhäuser L, Vorderwülbecke G, et al. Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study. Ann Intensive Care. 2018;8(1):42. Published 2018 Mar 27. https://doi.org/10.1186/s13613-018-0387-5.
15. Monteiro Júnior JG, Torres DO, da Silva MC, Ramos TM, Alves ML, Nunes Filho WJ, et al. Nucleated red blood cells as predictors of all-cause mortality in cardiac intensive care unit patients: a prospective cohort study. PLoS One. 2015 Dec;10(12):e0144259.
16. Desai S, Jones SL, Turner KL, Hall J, Moore LJ. Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis. Surg Infect (Larchmt). 2012 Dec;13(6):360–5.
17. Danise P, Maconi M, Barrella F, Di Palma A, Avino D, Rovetti A, et al. Evaluation of nucleated red blood cells in the peripheral blood of hematological diseases. Clin Chem Lab Med. 2011 Oct;50(2):357–60.
18. Stachon A, Segbers E, Holland-Letz T, Kempf R, Hering S, Krieg M. Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study. Crit Care. 2007;11(3): R62.
19. Stachon A, Becker A, Holland-Letz T, Friese J, Kempf R, Krieg M. Estimation of the mortality risk of surgical intensive care patients based on routine laboratory parameters. Eur Surg Res. 2008;40(3):263–72.
20. Kuert S, Holland-Letz T, Friese J, Stachon A. Association of nucleated red blood cells in the blood and arterial oxygen partial tension. Clin Chem Lab Med. 2011 Feb;49(2):257–63.
21. Stachon A, Kempf R, Holland-Letz T, Friese J, Becker A, Krieg M. Daily monitoring of nucleated red blood cells in the blood of surgical intensive care patients. Clin Chim Acta. 2006;366(1–2):329–35
22. de Júnior JGMM, de Torres DOC, da Silva MCFC, de Brito Ramos TM, Alves ML, Nunes Filho WJ, et al. Nucleated red blood cells as predictors of all-cause mortality in cardiac intensive care unit patients: a prospective cohort study. PLoS ONE. 2015;10(12):e0144259.
23. Ouyang, SM., Zhu, HQ., Xie, YN. Temporal changes in laboratory markers of survivors and non-survivors of adult inpatients with COVID-19. BMC Infect Dis 20, 952 (2020). https://doi.org/10.1186/s12879-020-05678-0
24. Pozdnyakova O, Connell NT, Battinelli EM, Connors JM, Fell G, Kim AS. Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection. Am J Clin Pathol. 2021;155(3):364-375. doi:10.1093/ajcp/aqaa231
25. Chandler CM, Reid MC, Cherian S, Sabath DE, Edlefsen KL. Comparison of Blood Counts and Markers of Inflammation and Coagulation in Patients With and Without COVID-19 Presenting to the Emergency Department in Seattle, WA. Am J Clin Pathol. 2021;156(2):185-197. doi:10.1093/ajcp/aqab052
26. Stachon A, Bolulu O, Holland-Letz T, Krieg M. Association between nucleated red blood cells in the blood and the levels of erythropoietin, interleukin 3, interleukin 6, and interleukin 12p70. Shock. 2005;24(1):34–9.
27. Kuert S, Holland-Letz T, Friese J, Stachon A. Association of nucleated red blood cells in the blood and arterial oxygen partial tension. Clin Chem Lab Med. 2011;49(2):257–63.
28. Ward HP, Holman J. The association of nucleated red cells in the peripheral smear with hypoxemia. Ann Intern Med. 1967;67(6):1190–4.
29. Burkett LL, Cox ML, Fields ML. Leukoerythroblastosis in the adult. Am J Clin Pathol. 1965;44(5):494–8
30. Purtle SW, Horkan CM, Moromizato T, Gibbons FK, Christopher KB. Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. Crit Care. 2017;21(1):154.
Published
2022/11/06
Section
Original paper