Prognostic significance of nucleated red blood cells in trauma patients

Position du problème et objectif(s) de l’étude

Introduction: Nucleated red blood cells (NRBCs), normally absent in adults, appear in response to severe hypoxia or inflammation. Their prognostic value in trauma ICU patients is unclear. This study assessed associations between NRBCs and outcomes in critically injured patients.

Matériel et méthodes

Methods: Retrospective cohort study of trauma patients admitted to the Reims Level-1 Trauma ICU between Jan 2019 and Mar 2025, also included in the Traumabase® registry. NRBCs were quantified in the first 10 ICU days. Associations with complications and mortality were analyzed using multivariate models. The TraumaBase registry is approved by the Advisory Committee for Information Processing in Health Research (11.305bis) and the National Commission for Data Protection agency (CNIL 911461 and 2211878).

Résultats & Discussion

Results: Among 1,636 patients, 221 (13.5%) had at least one NRBC-positive count. They had higher Injury Severity Scores (median 25 vs 16, p<0.001) and more frequent complications: ARDS (27.6% vs 11.5%), septic shock (18.1% vs 5.1%), and infections (50.2% vs 34.1%). They were also more often mechanically ventilated (63.8% vs 50.9%, p=0.004) and had longer ICU stays. Surprisingly, ICU and 30-day mortality rates were slightly lower in the NRBC group (p=0.04), possibly reflecting survival bias. Four NRBC kinetic profiles were identified: early transient (28%), delayed single peak (63%), multiple peaks (5%), and persistent (4%). Persistent NRBCs were associated with the highest mortality (66.6%). In multivariate analysis, NRBC presence was independently associated with ARDS (aOR 2.6, 95% CI [1.8–3.6]), septic shock (aOR 3.5, 95% CI [2.3–5.5]), and thromboembolic events (aOR 3.0, 95% CI [1.5–6.2]), but not with 30-day mortality. Discussion: NRBCs reflect the severity of systemic inflammation and are associated with major ICU complications. However, their presence does not independently predict mortality. Their dynamic patterns—particularly persistence—may provide additional prognostic insight.

Conclusion

Conclusion: NRBCs are common in trauma ICU patients and associated with increased morbidity. Their temporal evolution could support risk stratification in critical care settings.

Auteurs

Jeanne SERVAIS (1) , Carinne LECOQ-LAFON (2), Thierry FLOCH (1), Marion LECLERCQ-ROUGET (1), Lukshe KANAGARATNAM (3), Pierre-Antoine SEUBE-REMY (1), Vincent LEGROS (1) - (1)Service D’anesthésie-Réanimation Et Médecine Périopératoire,, Reims, France, (2)Laboratoire D'hematologie, Reims, France, (3)Unité D'aide Methodologique, Reims, France

Orateur(s)

Jeanne SERVAIS (Reims)