Hensel Mathias, Grädel Lena, Kutz Alexander, Haubitz Sebastian, Huber Andreas, Mueller Beat, Schuetz Philipp, Hügle Thomas
Department of Rheumatology, University Hospital Basel, Basel Department Internal Medicine, Kantonsspital Aarau, Aarau Department of Rheumatology, University Hospital Lausann (CHUV), Lausann, Switzerland.
Medicine (Baltimore). 2017 Jul;96(28):e7404. doi: 10.1097/MD.0000000000007404.
Monocytosis is associated with chronic infections such as tuberculosis or endocarditis as well as rheumatic and myeloproliferative disorders. Monocytes are also involved in the pathogenesis of atherosclerosis, coronary artery disease, and stroke. The value of monocytosis as a prognostic marker in different diagnostic groups in the emergency setting, however, has not been investigated so far.The aim of the article is to study monocytosis as an outcome factor in the emergency setting.In a Swiss register study, we analyzed monocyte counts in 4238 patients aged >18 years who were admitted to the emergency department of a regional tertiary care hospital. Monocytosis was defined as 0.8×10 cells/L. Diagnoses were grouped into infection, cardiovascular, neurological, metabolic, gastrointestinal, pulmonary, or other. Thirty-day mortality was defined as the primary endpointA total of 1217 patients with monocytosis were identified. Patients with monocytosis at admission suffered more frequently from respiratory symptoms (17.7% vs 8.9%, P <.001) and infection as the final diagnosis (20.8% vs 10.3%, P <.001) while neurological diagnoses were significantly lower in the monocytosis group (15.3% vs 30.9%, P <.001). Patients with monocytosis suffered from more comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, tumor, diabetes, or renal failure but not dementia. When adjusted for age, gender, comorbidities, and main diagnosis, the 30-day mortality (P = .002) and length of stay (P = .001) were significantly higher in patients with monocytosis. The 30-day mortality in patients with monocytosis was most notably influenced by a cardiological diagnosis (odds ratio 3.91).An increased monocyte count predicts adverse outcome in patients admitted to the emergency department. Mechanistic studies will be necessary to specify the potentially detrimental role of monocytosis in critical illness.
单核细胞增多症与慢性感染（如结核病或心内膜炎）以及风湿性和骨髓增殖性疾病有关。单核细胞也参与动脉粥样硬化、冠状动脉疾病和中风的发病机制。然而，到目前为止，单核细胞增多症作为急诊不同诊断组中预后标志物的价值尚未得到研究。本文的目的是研究单核细胞增多症作为急诊环境中的一个结局因素。在一项瑞士登记研究中，我们分析了4238名年龄大于18岁且入住地区三级护理医院急诊科患者的单核细胞计数。单核细胞增多症定义为单核细胞计数>0.8×10⁹细胞/L。诊断分为感染、心血管、神经、代谢、胃肠道、肺部或其他类别。30天死亡率被定义为主要终点。共识别出1217例单核细胞增多症患者。入院时患有单核细胞增多症的患者更频繁地出现呼吸道症状（17.7%对8.9%，P<0.001），且最终诊断为感染的比例更高（20.8%对10.3%，P<0.001），而单核细胞增多症组的神经诊断显著更低（15.3%对30.9%，P<0.001）。患有单核细胞增多症的患者有更多的合并症，如充血性心力衰竭、慢性阻塞性肺疾病、肿瘤、糖尿病或肾衰竭，但不包括痴呆。在调整年龄、性别、合并症和主要诊断后，单核细胞增多症患者的30天死亡率（P = 0.002）和住院时间（P = 0.001）显著更高。单核细胞增多症患者的30天死亡率最显著地受到心脏病诊断的影响（比值比3.91）。单核细胞计数增加预示着入住急诊科患者的不良结局。有必要进行机制研究以明确单核细胞增多症在危重病中潜在的有害作用。
