The appearance of NRBCs have been described in:
(1) ICU patients
(2) following cardiothoracic surgery
(3) with significant burn injury
NRBCs appear after several days of critical illness (1-2 weeks) and so tends to be a finding seen in patients who are more seriously ill. For patients who died they appeared about 1 week prior to death.
Implications:
(1) The appeareance of NRBCs may precede clinical deterioration.
(2) The in-hospital mortality is higher, especially if the number of NRBCs continues to increases.
(3) A critically-ill patient with NRBCs in the peripheral blood should be monitored closely and should not be transferred to a general ward.
Stachon et al (2004) reported that each increase in 1 absolute NRBC per µL (10^6/L) increased the odds ratio of in-hospital mortality by 1.01. Stachon (2006) reported
|
Absolute NRBC
|
Odds Ratio for Mortality
|
|
0
|
1
|
|
1 to 40 per µL
|
1.8
|
|
41 to 80 per µL
|
3.2
|
|
81 to 240 per µL
|
5.8
|
|
> 240 per µL
|
10.5
|
Stachon et al (2007) correlated the absolute NRBC count with increases in the APACHE II score.
|
Absolute NRBC
|
Increase to APACHE II
|
|
0
|
+0
|
|
1 to 100 per µL
|
+4
|
|
101 to 200 per µL
|
+8
|
|
> 200 per µL
|
+12
|
Differential diagnosis: presence of NRBCs for another cause
