Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study

Christen Bertel L Andersen; D. Tesfa; Volkert Dirk Siersma; Håkon Sandholdt; H Hasselbalch; O.W. Bjerrum; P Felding; B. Lind; Niels de Fine Olivarius; J. Palmblad

doi:10.1111/joim.12467

Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study

Christen Bertel L Andersen, D. Tesfa, Volkert Dirk Siersma, Håkon Sandholdt, H Hasselbalch, O.W. Bjerrum, P Felding, B. Lind, Niels de Fine Olivarius, J. Palmblad

17 Citationer (Scopus)

Abstract

Background: Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L^-1, may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. Methods: Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed. Results: Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L^-1), mild (≥1.0-1.5 G L^-1) and moderate-severe (≥0.0-1.0 G L^-1) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively. Conclusions: Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.

Originalsprog	Engelsk
Tidsskrift	Journal of Internal Medicine
Vol/bind	279
Udgave nummer	6
Sider (fra-til)	566-575
ISSN	0954-6820
DOI	https://doi.org/10.1111/joim.12467
Status	Udgivet - 1 jun. 2016

FN’s Verdensmål

Dette resultat bidrager til følgende verdensmål

Adgang til dokumentet

10.1111/joim.12467

joim.12467Forlagets udgivne version, 203 KB

Citationsformater

@article{a5ec85b0edca4946a88c7f8f1532b732,

title = "Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study",

abstract = "Background: Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L-1, may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. Methods: Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed. Results: Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L-1), mild (≥1.0-1.5 G L-1) and moderate-severe (≥0.0-1.0 G L-1) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively. Conclusions: Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.",

author = "Andersen, {Christen Bertel L} and D. Tesfa and Siersma, {Volkert Dirk} and H{\aa}kon Sandholdt and H Hasselbalch and O.W. Bjerrum and P Felding and B. Lind and Olivarius, {Niels de Fine} and J. Palmblad",

year = "2016",

month = jun,

day = "1",

doi = "10.1111/joim.12467",

language = "English",

volume = "279",

pages = "566--575",

journal = "Acta Medica Scandinavica",

issn = "0955-7873",

publisher = "Wiley-Blackwell",

number = "6",

}

TY - JOUR

T1 - Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study

AU - Andersen, Christen Bertel L

AU - Tesfa, D.

AU - Siersma, Volkert Dirk

AU - Sandholdt, Håkon

AU - Hasselbalch, H

AU - Bjerrum, O.W.

AU - Felding, P

AU - Lind, B.

AU - Olivarius, Niels de Fine

AU - Palmblad, J.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background: Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L-1, may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. Methods: Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed. Results: Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L-1), mild (≥1.0-1.5 G L-1) and moderate-severe (≥0.0-1.0 G L-1) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively. Conclusions: Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.

AB - Background: Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L-1, may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. Methods: Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed. Results: Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L-1), mild (≥1.0-1.5 G L-1) and moderate-severe (≥0.0-1.0 G L-1) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively. Conclusions: Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.

U2 - 10.1111/joim.12467

DO - 10.1111/joim.12467

M3 - Journal article

C2 - 26791682

SN - 0955-7873

VL - 279

SP - 566

EP - 575

JO - Acta Medica Scandinavica

JF - Acta Medica Scandinavica

IS - 6

ER -

Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study

Abstract

FN’s Verdensmål

Adgang til dokumentet

Fingeraftryk

Citationsformater