Which observation from the complete blood cell count predict mortality for hospitalized patients?

Abel N. Kho, Siu Hui, Joe G. Kesterson, Clement J. Mcdonald

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Information on the prognostic utility of the admission complete blood count (CBC) and differential count is lacking. Objective: To identify independent predictors of mortality from the varied number and morphology of cells in the complete blood count defined as a hemogram, automated five cell differential count and manual differential count. Design: Retrospective cohort study and chart review. Setting: Wishard Memorial Hospital, a large urban primary care hospital. Patients: A total of 46,522 adult inpatients admitted over 10 years to Wishard Memorial Hospital - from January 1993 through December 2002.w Intervention: None. Measurements: Thirty-day mortality measured from day of admission as determined by electronic medical records and Indiana State death records. Results: Controlling for age and sex, the multivariable regression model identified 3 strong independent predictors of 30-day mortality-nucleated red blood cells (NRBCs), burr cells, and absolute lymphocytosis - each of which was associated with a 3-fold increase in the risk of death within 30 days. The presence of nucleated RBCs was associated with a 30-day mortality rate of 25.5% across a range of diagnoses, excluding patients with sickle-cell disease and obstetric patients, for whom NRBCs were not associated with increased mortality. Having burr cells was associated with a mortality rate of 27.3% and was found most commonly in patients with renal or liver failure. Absolute lymphocytosis predicted poor outcome in patients with trauma and CNS injury. Conclusions: Among patients admitted to Wishard Memorial Hospital, the presence of nucleated RBCs, burr cells, or absolute lymphocytosis at admission was each independently associated with a 3-fold increase in risk of death within 30 days of admission.

Original languageEnglish (US)
Pages (from-to)5-12
Number of pages8
JournalJournal of hospital medicine
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2007

Keywords

  • Diagnostic decision making
  • Electronic medical record
  • Laboratory testing

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management
  • Medicine(all)

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