Ofori Kenneth, Chen Diane, Sepulveda Jorge, Bhagat Govind, Alobeid Bachir
Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center New York, NY, USA.
Department of Pathology, George Washington University Washington, DC, USA.
Int J Clin Exp Pathol. 2023 Sep 15;16(9):235-242. eCollection 2023.
The clinical, pathological, and laboratory correlates of normoblastemia in COVID-19 patients have not been adequately explored. We sought to assess the frequency of normoblastemia in COVID-19, its association with other markers of disease, as well as other clinical outcomes.
All COVID-19 patients seen at our institution with at least one automated complete blood count (aCBC) evaluation from March to May 2020 were included in this retrospective cohort analysis. Results of aCBC and tests for markers of the acute phase response performed within 5 days before the first COVID-19 positive test and 14 days after the last positive test were reviewed. We also evaluated histologic features of the reticuloendothelial system of COVID-19 decedents.
Among a total of 2501 COVID-19 patients, 715 (28.6%) were found to have normoblastemia. Patients with this abnormality had significantly higher (median, (1 quartile, 3 quartile) WBC (15.7 (11.2, 23.1) u/L vs. 8.3 (6.2, 11.5) u/L), absolute neutrophil count (7.0 (5.1, 10.1) u/L vs. 5.1 (3.7, 7.3) u/L), immature granulocyte percentage (0.8 (0.5, 1.3)% vs. 0.5 (0.3, 0.8)%), ESR (76.0 (60.5, 100.0) mm/hr vs. 66.0 (45.0, 87.0) mm/hr), ferritin (1404.5 (645.0, 2871.0) ng/mL vs. 672.7 (313.4, 1348.0) ng/mL), INR (1.4 (1.2, 1.7) vs. 1.2 (1.1, 1.3)), D-dimer (8.2 (2.8, 20.0) ug/mL FEU vs. 1.5 (0.8, 3.7) µg/mL FEU), and IL-6 (216.6 (77.7, 315.0) pg/mL vs. 54.3 (23.2, 127.8) pg/mL) levels, and lower hemoglobin (12.5 (10.7, 14.2) g/dL vs. 13.2 (11.8, 14.6) g/dL) and absolute lymphocyte count (1.0 (0.7, 1.3) u/L vs. 1.1 (0.8, 1.5) u/L). The incidence of intubation and ventilation support (61.3% (65/106) vs. 10.5% (31/263)) and mortality rates (37.9%, 271/715 vs. 11.8%, 210/1786), were higher in normoblastemic patients. Multivariable logistic regression revealed normoblastemia to be an independent predictive biomarker of short-term mortality in COVID-19.
Normoblastemia in COVID-19 is associated with markers of severe disease, extramedullary erythropoiesis, and adverse clinical outcome.
新冠病毒病（COVID-19）患者中幼红细胞血症的临床、病理及实验室相关因素尚未得到充分研究。我们旨在评估COVID-19患者中幼红细胞血症的发生率、其与其他疾病标志物的关联以及其他临床结局。
本回顾性队列分析纳入了2020年3月至5月在我院就诊且至少进行过一次自动全血细胞计数（aCBC）评估的所有COVID-19患者。回顾了首次COVID-19阳性检测前5天内及最后一次阳性检测后14天内的aCBC结果和急性期反应标志物检测结果。我们还评估了COVID-19死亡患者网状内皮系统的组织学特征。
在总共2501例COVID-19患者中，发现715例（28.6%）有幼红细胞血症。有此异常的患者白细胞计数（中位数，（第1四分位数，第3四分位数）15.7（11.2，23.1）×10⁹/L对8.3（6.2，11.5）×10⁹/L）、绝对中性粒细胞计数（7.0（5.1，10.1）×10⁹/L对5.1（3.7，7.3）×10⁹/L）、未成熟粒细胞百分比（0.8（0.5，1.3）%对0.5（0.3，0.8）%）、红细胞沉降率（ESR）（76.0（60.5，100.0）mm/h对66.0（45.0，87.0）mm/h）、铁蛋白（1404.5（645.0，2871.0）ng/mL对672.7（313.4，1348.0）ng/mL）、国际标准化比值（INR）（1.4（1.2，1.7）对1.2（1.1，1.3））、D-二聚体（8.2（2.8，20.0）μg/mL FEU对1.5（0.8，3.7）μg/mL FEU）和白细胞介素-6（IL-6）（216.6（77.7，315.0）pg/mL对54.3（23.2，127.8）pg/mL）水平显著更高，而血红蛋白（12.5（10.7，14.2）g/dL对13.2（11.8，14.6）g/dL）和绝对淋巴细胞计数（1.0（0.7，1.3）×10⁹/L对1.1（0.8，1.5）×10⁹/L）更低。幼红细胞血症患者的插管和通气支持发生率（61.3%（65/106）对10.5%（31/263））和死亡率（37.9%，271/715对11.8%，210/1786）更高。多变量逻辑回归显示，幼红细胞血症是COVID-19短期死亡率的独立预测生物标志物。
COVID-19患者中的幼红细胞血症与严重疾病标志物、髓外造血及不良临床结局相关。
