Nucleated Red Blood Cells Are Predictive of In-Hospital Mortality for Pediatric Patients

Abstract

Purpose We sought to establish whether nucleated red blood cells (NRBCs) are predictive of disposition, morbidity, and mortality for pediatric patients presenting to the emergency department (ED). Methods A single-center retrospective cohort study examining all ED encounters from patients aged younger than 19 years between January 2016 and March 2020, during which a complete blood count was obtained. Univariate analysis and multivariable logistic regression were used to test the presence of NRBCs as an independent predictor of patient-related outcomes. Results The prevalence of NRBCs was 8.9% (4195/46,991 patient encounters). Patient with NRBCs were younger (median age 4.58 vs 8.23 years; P < 0.001). Those with NRBCs had higher rates of in-hospital mortality (30/2465 [1.22%] vs 65/21,741 [0.30%]; P < 0.001), sepsis (19% vs 12%; P < 0.001), shock (7% vs 4%; P < 0.001), and cardiopulmonary resuscitation (CPR) (0.62% vs 0.09%; P < 0.001). They were more likely to be admitted (59% vs 51%; P < 0.001), have longer median hospital length of stay {1.3 (interquartile range [IQR], 0.22–4.14) vs 0.8 days (IQR, 0.23–2.64); P < 0.001}, and median intensive care unit (ICU) length of stay (3.9 [IQR, 1.87–8.72] vs 2.6 days [IQR, 1.27–5.83]; P < 0.001). Multivariable regression revealed presence of NRBCs as an independent predictor for in-hospital mortality (adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.38–3.53; P < 0.001), ICU admission (aOR, 1.30; 95% CI, 1.11–1.51; P < 0.001), CPR (aOR, 3.83; 95% CI, 2.33–6.30; P < 0.001), and 30-day return to the ED (aOR, 1.15; 95% CI, 1.15–1.26; P < 0.001). Conclusions The presence of NRBCs is an independent predictor for mortality, including in-hospital mortality, ICU admission, CPR, and readmission within 30 days for children presenting to the ED.