The Presence of Nucleated Red Cells in the Blood of Critical Care Patients is Associated with an Increased Mortality Risk

Duțu Mădălina¹, Negoiță S¹, Manolescu Rely ¹, Calu V³, Corneci D¹, Georgescu Anca⁵, Togănel Cornelia⁴, Azamfirei L²

1 Anesthesiology Clinic, Elias Emergency University Hospital, Bucharest, Romania
2 Anesthesiology Clinic I, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Surgical Clinic, Elias Emergency University Hospital, Bucharest, Romania
4 Department of Oncology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
5 Clinic of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The occurrence of nucleated red blood cells (NRBCs) in critically ill patients is a consequence of either hypoxic or inflammatory injuries. Therefore erythroblasts’ detection may be used as an early indicator of high mortality risk.
Material and methods: In a prospective study the detection of NRBCs was used for daily monitoring of 90 patients for a 3-months term. The prognostic significance of the NRBCs presence was compared with two risk scores: APACHE II and SAPS II.
Results: The incidence of erythroblasts’ presence was 20% (18/90). The mortality of NRBC-positive patients was 88.8% (16/18) and was significantly higher (p <0.05) than the mortality of NRBC-negative patients: 30.5% (22/72). The incidence of the erythroblasts in peripheral blood has increased simultaneously with APACHE II and SAPS II scores. On average, NRBCs were detected for the first time 6.5 days before death. The occurrence of NRBCs was not associated with a specific cause of death; however septic patients who died had the highest incidence of NRBCs’ presence.
Conclusion: The daily screening of the presence of NRBCs seems to be a useful tool to estimate the mortality risk in critically ill patients, the parameter being of high prognostic strength regarding the mortality risk.