Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Am J Hematol. 2013 Aug;88(8):677-81. doi: 10.1002/ajh.23484. Epub 2013 Jun 20.
Although associated with adverse outcomes in other cardiovascular diseases, the prognostic value of an elevated white blood cell (WBC) count, a marker of inflammation and hypercoagulability, is uncertain in patients with pulmonary embolism (PE). We therefore sought to assess the prognostic impact of the WBC in a large, state-wide retrospective cohort of patients with PE. We evaluated 14,228 patient discharges with a primary diagnosis of PE from 186 hospitals in Pennsylvania. We used random-intercept logistic regression to assess the independent association between WBC count levels at the time of presentation and mortality and hospital readmission within 30 days, adjusting for patient and hospital characteristics. Patients with an admission WBC count <5.0, 5.0-7.8, 7.9-9.8, 9.9-12.6, and >12.6 × 10(9) /L had a cumulative 30-day mortality of 10.9%, 6.2%, 5.4%, 8.3%, and 16.3% (P < 0.001), and a readmission rate of 17.6%, 11.9%, 10.9%, 11.5%, and 15.0%, respectively (P < 0.001). Compared with patients with a WBC count 7.9-9.8 × 10(9) /L, adjusted odds of 30-day mortality were significantly greater for patients with a WBC count <5.0 × 10(9) /L (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14-2.03), 9.9-12.6 × 10(9) /L (OR 1.55, 95% CI 1.26-1.91), or >12.6 × 10(9) /L (OR 2.22, 95% CI 1.83-2.69), respectively. The adjusted odds of readmission were also significantly increased for patients with a WBC count <5.0 × 10(9) /L (OR 1.34, 95% CI 1.07-1.68) or >12.6 × 10(9) /L (OR 1.29, 95% CI 1.10-1.51). In patients presenting with PE, WBC count is an independent predictor of short-term mortality and hospital readmission.
虽然白细胞（WBC）计数升高与其他心血管疾病的不良预后相关，但在肺栓塞（PE）患者中，WBC 计数作为炎症和高凝状态的标志物，其预后价值尚不确定。因此，我们旨在评估在宾夕法尼亚州 186 家医院的 14228 例 PE 患者的大型、全州回顾性队列中，WBC 的预后影响。我们评估了来自宾夕法尼亚州 186 家医院的 14228 例以 PE 为主要诊断的患者的出院记录。我们使用随机截距逻辑回归来评估入院时 WBC 计数水平与 30 天内死亡率和再入院之间的独立关联，调整了患者和医院特征。入院 WBC 计数<5.0、5.0-7.8、7.9-9.8、9.9-12.6 和>12.6×109/L 的患者 30 天死亡率分别为 10.9%、6.2%、5.4%、8.3%和 16.3%（P<0.001），再入院率分别为 17.6%、11.9%、10.9%、11.5%和 15.0%（P<0.001）。与 WBC 计数 7.9-9.8×109/L 的患者相比，WBC 计数<5.0×109/L（比值比 [OR] 1.52，95%置信区间 [CI] 1.14-2.03）、9.9-12.6×109/L（OR 1.55，95% CI 1.26-1.91）或>12.6×109/L（OR 2.22，95% CI 1.83-2.69）的患者，30 天死亡率的调整比值比显著更高。入院时 WBC 计数<5.0×109/L（OR 1.34，95% CI 1.07-1.68）或>12.6×109/L（OR 1.29，95% CI 1.10-1.51）的患者，其再入院的调整比值比也显著增加。在出现 PE 的患者中，WBC 计数是短期死亡率和医院再入院的独立预测因子。
