Leukemoid Reaction: Spectrum and Prognosis of 173 Adult Patients.
Clin Infect Dis. 2013 Aug 30;
Authors: Potasman I, Grupper M
Abstract
Objectives. The prognosis of patients with Leukemoid Reaction (LR) depends mainly on their underlying illness. Our aim was to investigate the etiologies and prognosis of a mixed group of patients with LR. Design/subjects. We identified 173 patients who had ≥30.0 X10(9) leukocytes/µL without hematologic malignancies. Causes LR and factors contributing to death were analyzed. Results. Patients with LR constituted 0.59% of all admitted adults. The median age was 75 years, but twenty were under 40. There was no difference in LR prevalence by gender (F/M=88/85). Average WBC count was 37.7 X10(9)/µL. Fourteen patients (8.0%) had a WBC count of >50.0 X10(9)/µL. The median duration of LR was 1 day, but 39 patients had prolonged LR (>1day). Infection was the most common cause of LR (n= 83, 47.9%; 95% CI=40.7-55.4), followed by ischemia/stress (27.7%), inflammation (6.9%) and obstetric diagnoses (6.9%). Higher WBC counts were significantly associated with positive blood cultures (p=0.017), or a positive C. difficile toxin (p=0.001). Antibiotics were prescribed to 140 patients (80.9%). Sixty six patients (38.1%) died during hospitalization. Those with prolonged LR had an in-hospital mortality rate of 61.5%. Factors found to be highly correlated with death were: age (OR=1.051, p<0.001), any infectious diagnosis (OR=2.574, p=0.014) and sepsis (OR=3.752, p=0.001). Conclusions. Leukemoid reaction carries a grave prognosis, especially among the elderly, and those with sepsis. LR was found to have multiple etiologies including infections, stress, inflammation and obstetric diagnoses.
PMID: 23994818 [PubMed - as supplied by publisher]