有核红细胞(nRBC)是在生理条件下外周血中不存在的红细胞生成的前体细胞。它们的存在与危重患者的不良结局有关。本研究旨在评估nRBC对重症监护病房(ICU)COVID-19急性呼吸窘迫综合征(ARDS)患者死亡率的预测价值。
■这次回顾展,观察性队列研究分析了2020年3月至2022年3月206例ICU诊断为COVID-19ARDS患者的数据.主要终点是ICU死亡率,次要终点包括ICU和住院时间,通风小时数,以及疾病严重程度评分和临床和实验室参数的时程。
■在纳入的患者中,68.9%的人在ICU逗留期间至少一次nRBC检测呈阳性。105µl-1的最大nRBC在预测ICU死亡率方面具有最高的准确性(受试者工作特性曲线下面积[AUCROC]0.780,p<0.001,灵敏度69.0%,特异性75.5%)。nRBC>105µl-1的患者死亡率明显高于≤105µl-1的患者(86.5%vs.51.3%,p=0.008)。与外周血nRBC阴性的患者相比,nRBC阳性的患者需要更长的机械通气时间(127[44-289]hvs.517[255–950]h,p<0.001),ICU停留(12[8-19]vs.27[13-51]d,p<0.001),和住院时间(19[12-29]dvs.31[16–58]d,p<0.001)。脓毒症相关器官衰竭峰值评估(SOFA),简化急性生理学评分,在峰值nRBC水平之前达到PaO2/FiO2,白介素6和降钙素原值。然而,当最大SOFA评分>8和nRBC>105µl-1时,SOFA的预测性能(AUCROC0.842,p<0.001)显著提高.
■nRBC可预测ICU死亡率并显示COVID-19ARDS患者的疾病严重程度,它们应该被视为更坏结果的临床警报信号。与其他已建立的临床评分系统和实验室参数相比,nRBC是ICU死亡率的晚期预测因子,但与SOFA评分相结合可提高预测准确性。
Nucleated red blood cells (nRBC) are precursor cells of the erythropoiesis that are absent from the peripheral blood under physiological conditions. Their presence is associated with adverse outcomes in critically ill patients. This study aimed to evaluate the predictive value of nRBC on mortality in intensive care unit (ICU) patients with COVID-19 acute respiratory distress syndrome (ARDS).
This retrospective, observational cohort study analyzed data on 206 ICU patients diagnosed with COVID-19 ARDS between March 2020 and March 2022. The primary endpoint was ICU mortality, and secondary endpoints included ICU and hospital stay lengths, ventilation hours, and the time courses of disease severity scores and clinical and laboratory parameters.
Among the included patients, 68.9% tested positive for nRBC at least once during their ICU stay. A maximum nRBC of 105 µl-1 had the highest accuracy in predicting ICU mortality (area under the curve of the receiver operating characteristic [AUCROC] 0.780, p < 0.001, sensitivity 69.0%, specificity 75.5%). Mortality was significantly higher among patients with nRBC >105 µl-1 than ≤105 µl-1 (86.5% vs. 51.3%, p = 0.008). Compared to patients negative for nRBC in their peripheral blood, those positive for nRBC required longer mechanical ventilation (127 [44 - 289] h vs. 517 [255 - 950] h, p < 0.001), ICU stays (12 [8 - 19] vs. 27 [13 - 51] d, p < 0.001), and hospital stays (19 [12 - 29] d vs. 31 [16 - 58] d, p < 0.001). Peak Sepsis-related Organ Failure Assessment (SOFA), Simplified Acute Physiology Score, PaO2/FiO2, interleukin-6, and procalcitonin values were reached before the peak nRBC level. However, the predictive performance of the SOFA (AUCROC 0.842, p < 0.001) was considerably improved when a maximum SOFA score >8 and nRBC >105 µl-1 were combined.
nRBC predict ICU mortality and indicate disease severity among patients with COVID-19 ARDS, and they should be considered a clinical alarm signal for a worse outcome. nRBC are a late predictor of ICU mortality compared to other established clinical scoring systems and laboratory parameters but improve the prediction accuracy when combined with the SOFA score.