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Abstract
Finding a reliable marker for mortality and morbidity in the intensive care will always remain a challenge in our daily ICU practice. Intensivists are always concerned with the appropriate time to stop treatment and when to relocate patients to ward. Depending on signs and symptoms may be conflicting, especially in the early course of the disease. Causes of re-admission to ICU are not always evident and sometimes appear to be due to early triaging from ICU. This mandates further research to find a reliable marker for morbidity and mortality that can guide the course of treatment in ICU.
Being nearly a daily cheap routine investigation in all ICUs, CBC took the first priority in many researches seeking mortality markers. Beside hemoglobin level, hematocrit, WBCs, and platelets, other CBC parameters began to attract physicians’ attention. Among all, NRBCs and eosinopenia were the most interesting. Under normal conditions, the peripheral blood of healthy adults is free of NRBCs, which tend to be found in patients with severe pathology. Also, eosinopenia showed a strong correlation with infection, which is considered a leading cause of morbidity and mortality in ICU. Thus, in our study, we were interested in investigating the impact of these two available cheap parameters on mortality among intensive care patients.
The current study was conducted on 230 patients admitted to ICU over a six month period. Patients below the age of 18, trauma patients and surgical patients were excluded from this study. On the day of admission, informed consents were obtained and APACHE II and SAPS II scores were calculated for all patients. Laboratory investigations in the form of CBC, CRP, creatinine and alanine aminotransferase were measured every three days. NRBCs and eosinophils were measured using the automated blood analyzer Sysmex XE 2100 and results were confirmed with a peripheral blood smear. Mortality was monitored during the ICU stay period. For statistical simplicity, a patient was defined as NRBC-positive when NRBCs were detected in blood at least once. Eosinopenia was considered present if eosinophils were less than 1% of the total leukocytic count on the day of admission.
Our results revealed that 27.39% of ICU patients were NRBC-positive, and nearly 31% of them showed NRBCs in their blood on the day of admission. The total mortality of NRBC-positive patients was 50.8%. When compared to the total mortality of the NRBC-negative patients (8.4%), we realize the high prognostic power of the mechanized NRBCs detection in blood as regards mortality, revealing sensitivity of 69.6 % and specificity of 83.2 %, thus, increasing the mortality risk by eleven folds. Furthermore, mortality risk was found to increase with increasing NRBC concentration. NRBCs appeared around seven days before mortality, thus, could be considered an early marker. And in comparison with other laboratory parameters, NRBCs showed no correlation with hemoglobin, but a significant correlation with leukocytosis, eosinopenia, increased CRP, higher APACHE II .