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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: [email protected]
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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
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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