Department of Medicine, Christiana Care Health System, Newark, DE 4755, USA.
Am J Med. 2012 Nov;125(11):1124.e9-1124.e15. doi: 10.1016/j.amjmed.2012.04.039. Epub 2012 Aug 28.
Measuring immature white blood cell forms ("bands") has been considered clinically unnecessary. We performed this study to determine whether elevated band counts, with normal total white blood cells on admission, were associated with infection or in-hospital death.
We performed a retrospective cohort study including all patients admitted to the Christiana Care Health System 2-hospital, 1100-bed community-based academic health system in 2009 with normal white blood cells (3800-10,800 per mm(3)) on admission who had manual differentials performed. We defined our band groups as normal (≤10% bands and other immature cells), moderate (11%-19%), or high (≥20%). Via chart review, we ascertained vital signs and culture results for all patients with elevated bands and 407 randomly sampled patients with normal bands. Cultures likely to be contaminants were excluded. We used multivariable logistic regression to determine whether bandemia was predictive of significant positive cultures or death.
Of 2342 patients, 167 (7.1%) had high bands and 205 (8.6%) had moderate bands. The mean white blood cell count was 7.5 cells/mm(3), with no difference among groups. Bandemia was associated with increased odds of having any significant positive culture (adjusted odds ratio [OR], 2.0, 95% confidence interval [CI], 1.3-3.1 for moderate bands; adjusted OR, 2.8, 95% CI, 1.7-4.3 for high bands) and having positive blood cultures (adjusted OR, 3.8, 95% CI, 2.0-7.2 for moderate bands; adjusted OR, 6.2, 95% CI, 3.2-11.8 for high bands). Patients with moderate or high bands also had increased odds of in-hospital death (adjusted OR, 3.2, 95% CI, 1.7-6.1; adjusted OR, 4.7, 95% CI, 2.4-9.0, respectively).
Even with normal total white blood cells, patients with moderate and high bandemia on admission had significantly increased odds of having positive cultures, including blood cultures, and of in-hospital mortality.
检测未成熟白细胞形态（“带状细胞”）在临床上已被认为无必要。我们进行此项研究，旨在确定入院时白细胞总数正常但带状细胞计数升高是否与感染或院内死亡相关。
我们进行了一项回顾性队列研究，纳入了 2009 年在一家拥有 1100 张床位的社区型学术医疗中心的 Christiana Care 医疗系统的所有患者。这些患者入院时白细胞总数正常（3800-10800 个/立方毫米），且进行了人工白细胞分类。我们将带状细胞组定义为正常（带状细胞和其他未成熟细胞占比≤10%）、中度（11%-19%）或高度（≥20%）。通过病历回顾，我们确定了所有带状细胞升高患者和 407 例随机抽取的白细胞正常患者的生命体征和培养结果。我们排除了可能为污染菌的培养物。我们使用多变量逻辑回归来确定带状细胞血症是否可预测阳性显著培养结果或死亡。
在 2342 例患者中，167 例（7.1%）存在高度带状细胞血症，205 例（8.6%）存在中度带状细胞血症。平均白细胞计数为 7.5 个/立方毫米，各组间无差异。带状细胞血症与阳性显著培养结果（中度带状细胞血症的校正比值比[OR]，2.0；95%置信区间[CI]，1.3-3.1；高度带状细胞血症的校正 OR，2.8；95%CI，1.7-4.3）和阳性血培养（中度带状细胞血症的校正 OR，3.8；95%CI，2.0-7.2；高度带状细胞血症的校正 OR，6.2；95%CI，3.2-11.8）的可能性增加相关。中度或高度带状细胞血症的患者也有更高的院内死亡风险（中度带状细胞血症的校正 OR，3.2；95%CI，1.7-6.1；高度带状细胞血症的校正 OR，4.7；95%CI，2.4-9.0）。
即使白细胞总数正常，入院时中度和高度带状细胞血症的患者发生阳性培养（包括血培养）和院内死亡的可能性显著增加。
