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

11 Citations (Scopus)

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
Pages (from-to)5-12
Number of pages8
JournalJournal of Hospital Medicine
Volume2
Issue number1
DOIs
StatePublished - Jan 2007

Fingerprint

Blood Cell Count
Observation
Lymphocytosis
Mortality
Cell Count
Erythrocytes
Death Certificates
Electronic Health Records
Liver Failure
Wounds and Injuries
Sickle Cell Anemia
Obstetrics
Renal Insufficiency
Inpatients
Primary Health Care
Cohort Studies
Retrospective Studies

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)

Cite this

Which observation from the complete blood cell count predict mortality for hospitalized patients? / Kho, Abel N.; Hui, Siu; Kesterson, Joe G.; Mcdonald, Clement J.

In: Journal of Hospital Medicine, Vol. 2, No. 1, 01.2007, p. 5-12.

Research output: Contribution to journalArticle

Kho, Abel N. ; Hui, Siu ; Kesterson, Joe G. ; Mcdonald, Clement J. / Which observation from the complete blood cell count predict mortality for hospitalized patients?. In: Journal of Hospital Medicine. 2007 ; Vol. 2, No. 1. pp. 5-12.
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