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Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study.
Crit Care. 2017 06 21; 21(1):154.CC

Abstract

BACKGROUND

Little is known about risk factors associated with out-of-hospital outcomes in survivors of critical illness. We hypothesized that the presence of nucleated red blood cells in patients who survived critical care would be associated with adverse outcomes following hospital discharge.

METHODS

We performed a two-center observational cohort study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. All data were obtained from the Research Patient Data Registry at Partners HealthCare. We studied 2878 patients, age ≥ 18 years, who received critical care between 2011 and 2015 and survived hospitalization. The exposure of interest was nucleated red blood cells occurring from 2 days prior to 7 days after critical care initiation. The primary outcome was mortality in the 90 days following hospital discharge. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both nucleated red blood cells and outcome. Adjustment included age, race (white versus nonwhite), gender, Deyo-Charlson Index, patient type (medical versus surgical), sepsis and acute organ failure.

RESULTS

In patients who received critical care and survived hospitalization, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8% and 21.9% in patients with 0/μl, 1-100/μl, 101-200/μl and more than 200/μl nucleated red blood cells respectively. Nucleated red blood cells were a robust predictor of postdischarge mortality and remained so following multivariable adjustment. The fully adjusted odds of 90-day postdischarge mortality in patients with 1-100/μl, 101-200/μl and more than 200/μl nucleated red blood cells were 1.77 (95% CI, 1.23-2.54), 2.51 (95% CI, 1.36-4.62) and 3.72 (95% CI, 2.16-6.39) respectively, relative to patients without nucleated red blood cells. Further, the presence of nucleated red blood cells is a significant predictor of the odds of unplanned 30-day hospital readmission.

CONCLUSION

In critically ill patients who survive hospitalization, the presence of nucleated red blood cells is a robust predictor of postdischarge mortality and unplanned hospital readmission.

Authors+Show Affiliations

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Boulder, CO, USA.Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.Renal and Rheumatology Division, Internal Medicine Department, Okinawa Southern Medical Center and Children's Hospital, Haebaru, Okinawa, Japan.Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.The Nathan E. Hellman Memorial Laboratory, Renal Division, Channing Division of Network Medicine, Brigham and Women's Hospital, MRB 418, 75 Francis Street, Boston, MA, 02115, USA. kbchristopher@partners.org.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28633658

Citation

Purtle, Steven W., et al. "Nucleated Red Blood Cells, Critical Illness Survivors and Postdischarge Outcomes: a Cohort Study." Critical Care (London, England), vol. 21, no. 1, 2017, p. 154.
Purtle SW, Horkan CM, Moromizato T, et al. Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. Crit Care. 2017;21(1):154.
Purtle, S. W., Horkan, C. M., Moromizato, T., Gibbons, F. K., & Christopher, K. B. (2017). Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. Critical Care (London, England), 21(1), 154. https://doi.org/10.1186/s13054-017-1724-z
Purtle SW, et al. Nucleated Red Blood Cells, Critical Illness Survivors and Postdischarge Outcomes: a Cohort Study. Crit Care. 2017 06 21;21(1):154. PubMed PMID: 28633658.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study. AU - Purtle,Steven W, AU - Horkan,Clare M, AU - Moromizato,Takuhiro, AU - Gibbons,Fiona K, AU - Christopher,Kenneth B, Y1 - 2017/06/21/ PY - 2016/09/05/received PY - 2017/05/22/accepted PY - 2017/6/22/entrez PY - 2017/6/22/pubmed PY - 2018/9/18/medline KW - Critical care KW - Hospital readmission KW - Mortality KW - Nucleated red blood cells KW - Outcomes SP - 154 EP - 154 JF - Critical care (London, England) JO - Crit Care VL - 21 IS - 1 N2 - BACKGROUND: Little is known about risk factors associated with out-of-hospital outcomes in survivors of critical illness. We hypothesized that the presence of nucleated red blood cells in patients who survived critical care would be associated with adverse outcomes following hospital discharge. METHODS: We performed a two-center observational cohort study of patients treated in medical and surgical intensive care units in Boston, Massachusetts. All data were obtained from the Research Patient Data Registry at Partners HealthCare. We studied 2878 patients, age ≥ 18 years, who received critical care between 2011 and 2015 and survived hospitalization. The exposure of interest was nucleated red blood cells occurring from 2 days prior to 7 days after critical care initiation. The primary outcome was mortality in the 90 days following hospital discharge. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both nucleated red blood cells and outcome. Adjustment included age, race (white versus nonwhite), gender, Deyo-Charlson Index, patient type (medical versus surgical), sepsis and acute organ failure. RESULTS: In patients who received critical care and survived hospitalization, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8% and 21.9% in patients with 0/μl, 1-100/μl, 101-200/μl and more than 200/μl nucleated red blood cells respectively. Nucleated red blood cells were a robust predictor of postdischarge mortality and remained so following multivariable adjustment. The fully adjusted odds of 90-day postdischarge mortality in patients with 1-100/μl, 101-200/μl and more than 200/μl nucleated red blood cells were 1.77 (95% CI, 1.23-2.54), 2.51 (95% CI, 1.36-4.62) and 3.72 (95% CI, 2.16-6.39) respectively, relative to patients without nucleated red blood cells. Further, the presence of nucleated red blood cells is a significant predictor of the odds of unplanned 30-day hospital readmission. CONCLUSION: In critically ill patients who survive hospitalization, the presence of nucleated red blood cells is a robust predictor of postdischarge mortality and unplanned hospital readmission. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/28633658/Nucleated_red_blood_cells_critical_illness_survivors_and_postdischarge_outcomes:_a_cohort_study_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1724-z DB - PRIME DP - Unbound Medicine ER -