Viner Esther, Berger Judith, Bengualid Victoria
Internal Medicine, City University of New York (CUNY) School of Medicine, New York City, USA.
Infectious Diseases, St. Barnabas Hospital (SBH) Health System, New York City, USA.
Cureus. 2023 Apr 24;15(4):e38062. doi: 10.7759/cureus.38062. eCollection 2023 Apr.
The objective of this study was to determine the etiologies and co-morbidities associated with extreme leukocytosis, which is characterized by a white blood cell (WBC) count ≥ 35 × 10 leukocytes/L. Method: Retrospective chart review was conducted for all patients, aged 18 years and older, admitted to the internal medicine department between 2015 and 2021 with an elevated WBC count ≥ 35 × 10 leukocytes/L within the first 24 hours of admission. Results: Eighty patients were identified to have WBC count ≥ 35 × 10 leukocytes/L. The overall mortality was 16% and increased to 30% in those presenting with shock. Mortality increased from 2.8% in patients with WBC count in the range of 35-39.9 × 10 leukocytes/L to 33% in those with WBC count in the range of 40-50 × 10 leukocytes/L. There was no correlation with underlying co-morbidities or age. Pneumonia was the most common infection (38%), followed by UTI or pyelonephritis (28%) and abscesses (10%). There was no predominant organism responsible for these infections. The most common etiology for WBC count between 35-39.9 × 10 leukocytes/L and 40-50 × 10 leukocytes/L was infections, while malignancies (especially chronic lymphocytic leukemia) were more common with WBC count > 50 × 10 leukocytes/L. Conclusion: For WBC counts in the range of 35-50 × 10 leukocytes/L, infections were the main reason for admission to the internal medicine department. Mortality increased from 2.8% to 33% as WBC counts increased from 35-39.9 × 10 leukocytes/L to 40-50 × 10 leukocytes/L. Overall, mortality for all WBC counts ≥ 35 × 10 leukocytes/L was 16%. The most common infections were pneumonia, followed by UTI or pyelonephritis and abscesses. The underlying risk factors did not correlate with WBC counts or mortality.
本研究的目的是确定与极度白细胞增多症相关的病因和合并症，极度白细胞增多症的特征是白细胞（WBC）计数≥35×10⁹白细胞/L。方法：对2015年至2021年期间内科收治的所有18岁及以上患者进行回顾性病历审查，这些患者在入院后24小时内白细胞计数升高≥35×10⁹白细胞/L。结果：确定80例患者白细胞计数≥35×10⁹白细胞/L。总体死亡率为16%，休克患者死亡率增至30%。白细胞计数在35 - 39.9×10⁹白细胞/L范围内的患者死亡率为2.8%，白细胞计数在40 - 50×10⁹白细胞/L范围内的患者死亡率增至33%。与潜在合并症或年龄无关。肺炎是最常见的感染（38%），其次是尿路感染或肾盂肾炎（28%）和脓肿（10%）。这些感染没有主要的致病微生物。白细胞计数在35 - 39.9×10⁹白细胞/L和40 - 50×10⁹白细胞/L之间最常见的病因是感染，而白细胞计数>50×10⁹白细胞/L时恶性肿瘤（尤其是慢性淋巴细胞白血病）更常见。结论：对于白细胞计数在35 - 50×10⁹白细胞/L范围内的患者，感染是入住内科的主要原因。随着白细胞计数从35 - 39.9×10⁹白细胞/L增至40 - 50×10⁹白细胞/L，死亡率从2.8%增至33%。总体而言，所有白细胞计数≥35×10⁹白细胞/L的患者死亡率为16%。最常见的感染是肺炎，其次是尿路感染或肾盂肾炎和脓肿。潜在风险因素与白细胞计数或死亡率无关。
