Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T11:34:58.763Z Has data issue: false hasContentIssue false
  • English
  • Français

Nucleated red blood cells as a biomarker for mortality in neonates following cardiac surgery

Part of: Surgery

Published online by Cambridge University Press:  31 August 2021

Kurt D. Piggott Open the ORCID record for Kurt D. Piggott [Opens in a new window] ,
Syeda Maqsood ,
Cynthia L. Warner ,
Timothy Pettitt ,
Shengping Yang ,
Jason Turner ,
Amira Soliman ,
Casey Norlin ,
LaTasha Lewis  and
Ajay Bhatia
Kurt D. Piggott*
Affiliation:
Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Syeda Maqsood
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Cynthia L. Warner
Affiliation:
Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Timothy Pettitt
Affiliation:
Division of Pediatric Cardiothoracic Surgery, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Shengping Yang
Affiliation:
Department of Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
Jason Turner
Affiliation:
Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Amira Soliman
Affiliation:
Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Casey Norlin
Affiliation:
Louisiana State University Health Sciences, New Orleans, LA 70112, USA
LaTasha Lewis
Affiliation:
Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
Ajay Bhatia
Affiliation:
Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, New Orleans, LA 70118, USA
*
Author for correspondence: K. D. Piggott, MD, Division of Pediatric Cardiac Intensive Care, Children’s Hospital, LSUHSC, 200 Henry Clay Avenue, New Orleans, LA 70118, USA. Tel: +1 504-894-5445. E-mail: kurt.piggott@lcmchealth.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Nucleated red blood cells (NRBCs) are immature red cells that under normal conditions are not present in the peripheral circulation. Several studies have suggested an association between elevated NRBC and poor outcome in critically ill adults and neonates. We sought to determine if elevations in NRBC value following cardiac surgery and following clinical events during the hospital stay can be used as a biomarker to monitor for mortality risk in neonates post-cardiac surgery.

Materials and methods:

We constructed a retrospective study of 264 neonates who underwent cardiac surgery at Children’s Hospital, New Orleans between 2011 and 2020. Variables included mortality and NRBC value were recorded following cardiac surgery and following peri-operative clinical events. The study was approved by LSU Health IRB. Sensitivity, specificity, receiver operating characteristic (ROC) curves with area under the curve (AUC) and logistic regression analysis were performed.

Results:

Thirty-six patients (13.6%) died, of which 32 had an NRBC value ≥10/100 white blood cell (WBC) during hospitalisation. Multi-variable analysis found extracorporeal membrane oxygenation use (OR 10, 95% CI 2.9–33, p=<0.001), NRBC ≥10/100 WBC (OR 16.1, CI 4.1–62.5, p ≤ 0.001) and peak NRBC in the 14-day period post-cardiac surgery (continuous variable, OR 1.05, 95% CI 1.0–1.09, p = 0.03), to be independently associated with mortality. Using a cut-off NRBC value of 10/100 WBC, there was an 88.9% sensitivity and a 90.8% specificity, with ROC curve showing an AUC of 0.9 and 0.914 for peak NRBC value in 14 days post-surgery and entire hospitalisation, respectively.

Conclusions:

NRBC ≥10/100 WBC post-cardiac surgery is strongly associated with mortality. Additionally, NRBC trend appears to show promise as an accurate biomarker for mortality.

Keywords

Nucleated red blood cellcongenital heart surgerymortalityneonatebiomarker
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1048 - 1052
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Constantino, B, Cogionis, B. Nucleated RBCs-significance in the peripheral blood film. Lab Med 2000; 31: 23–29.10.1309/D70F-HCC1-XX1T-4ETECrossRefGoogle Scholar
Cremer, M, Roll, S, Graf, C, Weimann, A, Buhrer, C, Dame, C. Nucleated red blood cells as marker for an increased risk of unfavorable outcome and mortality in very low birth weight infants. Early Hum Dev 2015; 91: 559–563. DOI 10.1016/j.earlhumdev.2015.06.004.10.1016/j.earlhumdev.2015.06.004CrossRefGoogle ScholarPubMed
Baschat, AA, Gungor, S, Kush, ML, Berg, C, Gembruch, U, Herman, CR. Nucleated red blood cell counts in the first of life: a critical appraisal of relationships with perinatal outcome in preterm growth restricted neonates. Am J Obstet Gynecol 2007; 197: el–8. DOI 10.1016/j.ajo.10.1016/j.ajog.2007.06.020CrossRefGoogle ScholarPubMed
Stachon, A, Bolulu, O, Holland-Letz, T, Krieg, M. Association between nucleated red blood cells in blood and the levels of erythropoietin, interleukin 3, interleukin 6, and interleukin 12p70. Int Congr Ser 2005; 24: 34–39.Google ScholarPubMed
Kurt, S, Holland-Letz, T, Friese, J, Stachon, A. Association of nucleated red blood cells in blood and arterial oxygen partial tension. Clin Chem Lab med 2011; 49: 257–263.10.1515/CCLM.2011.041CrossRefGoogle Scholar
Poryo, M, Wissing, A, Zemlin, M, et al. Nucleated red blood cells and serum lactate values on days 2 and 5 are associate with mortality and morbidity in VLBW infants. Wien Med Wochenschr 2019; 169: 87–92.10.1007/s10354-018-0649-8CrossRefGoogle ScholarPubMed
Li, J, Kobata, K, Kamei, Y, et al. Nucleated red blood cell counts: an early predictor of brain injury and 2- year outcome in neonates with hypoxic-ischemic encephalopathy in the era of cooling-based treatment. Brain Develop 2014; 36: 472–478.CrossRefGoogle ScholarPubMed
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: R62. DOI 10.1186/cc5932).CrossRefGoogle ScholarPubMed
Schaer, C, Schmugge, M, Frey, B. Prognostic value of nucleated red blood cells in critically ill children. Swiss Med Wkly 2014; 144: w13944.Google ScholarPubMed
JGdM, Monteiro Júnior, DdOC, Torres, da Silva, MCFC, 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: e0144259.Google Scholar
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. Clinical Chimica Acta 2006; 366: 329–335.10.1016/j.cca.2005.11.022CrossRefGoogle ScholarPubMed
Overman, D, Jacobs, J, Prager, R, et al. Report from the society of thoracic surgeons national database workforce: clarifying the definition of operative mortality. World J Pediatr Congenit Heart Surg 2013; 4: 10–12. DOI 10.1177/2150135112461924.CrossRefGoogle Scholar
Kellum, J, Lameire, N, for the KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17: 204. DOI 10.1186/cc11454.CrossRefGoogle ScholarPubMed
Gist, K, Kwiatkowski, D, Cooper, D. Acute kidney injury in congenital heart disease. Curr Opin Cardiol 2018; 33: 101–107. DOI 10.1097/HCO.00000000000000473.CrossRefGoogle ScholarPubMed
Piggott, K, Soni, M, DeCampli, W, et al. Acute kidney injury and fluid overload in neonates following surgery for congenital heart disease. World J PediatrCongenit Heart Surg 2015; 6: 401–406. DOI 10.1177/2150135115586814.CrossRefGoogle ScholarPubMed
Soni, M, Piggott, K, DeCampli, W, et al. Are we overdiagnosing acute kidney injury in pediatric patients following cardiac surgery? World J Pediatr Congenit Heart Surg 2015; 6: 496–501. DOI 10.1177/2150135115593129.10.1177/2150135115593129CrossRefGoogle ScholarPubMed
Gaies, M, Jeffries, H, Niebler, R, et al. Vasoactive-Inotropic score is associated with outcome after infant cardiac surgery: an analysis from the pediatric cardiac critical care consortium and virtual PICU system registries. Pediatr Crit Care Med 2014; 15: 529–537. DOI 10.1097/PCC.0000000000000153.10.1097/PCC.0000000000000153CrossRefGoogle ScholarPubMed