Abstract
Objective: To clarify if leucocyte count progression can predict one-week mortality in unselected medical patients admitted to the emergency department. Additionally, we investigated the importance of leucocyte count progression for admission to the intensive care unit and length of stay.
Method: This retrospective cohort study uses data collected in two phases from patients admitted through the emergency department at Hospital of South West Jutland. Upon admission, a nurse recorded the primary complaint and vital signs and registered these along with demographic information. Blood test results were subsequently extracted from the hospital’s computer systems. Patients were separated into three groups according to the development in their leucocyte count from the day of admission to the day after.
Results: The total cohort was 5894 patients; 30.5% remained after exclusion. Median age was 71, and 50.3% were female. Using logistic regression, we found significantly lower one-week mortality with falling leucocyte count progression, even when controlling for confounders.
A decreasing leucocyte count had a sensitivity for one-week mortality of 65%, specificity of 62%, positive predictive value of 4%, and negative predictive value of 99%.
Difference in admission to the intensive care unit was non-significant between the three groups. Difference in length of stay was significant, but with one day difference, the clinical significance is questionable.
Conclusion: Leucocyte count progression is not sensitive enough to predict one-week mortality, nor specific enough to discount it. It is important for physicians to be aware of this to avoid faulty assessments based on imprecise assumptions.
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]
References
- Abramson N, Melton B. Leukocytosis: Basics of clinical assessment. Am Fam Physician 2000; 62(9): 2053-2060.
- Hotchkiss R, Kinsley K, Swanson P, Schmieg R, Hui J, Chang K, et al. Sepsis-induced apoptosis causes progressive profound depletion of B and CD4 + T hymphocytes in humans. J Immunol 2001; 166: 6952-6963.
- M. Brabrand, T. Knudsen, J. Halas. Identifying admitted patients at risk of dying: a prospective observational validation of four biochemical scoring systems. BMJ Open 2013; 3: e002890.
- L. Frank. When an entire country is a cohort. Science 2000.287(5462): 2398-2399.
- R. W. Duckitt, R. Buxton-Thomas, J. Walker, E. Cheek, V. Bewick, R. Venn, L. G. Forni. Worthington Physiological Scoring System: derivation and validation of a physiological early-warning system for medical admissions. An observational, populationbased single-centre study. British journal of anaesthesia 2007; 98(6):
769-774. - M. E. Charlson, P. Pompei, K. L. Ales, C. R. Mackensie. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Diseases 1987; 40(5):373-383.
- Manitoba Centre for Health Policy. Available at: http://mchpappserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1098 Accessed: 10-06-16.
- C. B. Pedersen. The Danish Civil Registration System. Scandinavian Journal of Public Health 2011; 39(7): 22-25.
- C. Kung, C. Su, H. Chang, H. Cheng, S. Hsiao, T. Tsai, N. Tsai. The prognostic value of leucocyte apoptosis in patients with severe sepsis at the emergency department. Clinica Chimica Acta 2015; 438: 364-369
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
