Peripheral monocytosis as a predictive factor for adverse outcome in the emergency department: Survey based on a register study.

Monocytosis is associated with chronic infections such as tuberculosis or endocarditis as well as rheumatic and myeloproliferative disorders. Monocytes are also involved in the pathogenesis of atherosclerosis, coronary artery disease, and stroke. The value of monocytosis as a prognostic marker in different diagnostic groups in the emergency setting, however, has not been investigated so far.The aim of the article is to study monocytosis as an outcome factor in the emergency setting.In a Swiss register study, we analyzed monocyte counts in 4238 patients aged >18 years who were admitted to the emergency department of a regional tertiary care hospital. Monocytosis was defined as 0.8×10 cells/L. Diagnoses were grouped into infection, cardiovascular, neurological, metabolic, gastrointestinal, pulmonary, or other. Thirty-day mortality was defined as the primary endpointA total of 1217 patients with monocytosis were identified. Patients with monocytosis at admission suffered more frequently from respiratory symptoms (17.7% vs 8.9%, P <.001) and infection as the final diagnosis (20.8% vs 10.3%, P <.001) while neurological diagnoses were significantly lower in the monocytosis group (15.3% vs 30.9%, P <.001). Patients with monocytosis suffered from more comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, tumor, diabetes, or renal failure but not dementia. When adjusted for age, gender, comorbidities, and main diagnosis, the 30-day mortality (P = .002) and length of stay (P = .001) were significantly higher in patients with monocytosis. The 30-day mortality in patients with monocytosis was most notably influenced by a cardiological diagnosis (odds ratio 3.91).An increased monocyte count predicts adverse outcome in patients admitted to the emergency department. Mechanistic studies will be necessary to specify the potentially detrimental role of monocytosis in critical illness.

Screening and Treatment of Vitamin D Deficiency on Hospital Admission: Is There a Benefit for Medical Inpatients?

BACKGROUND: Whether screening and treatment of vitamin D deficiency improves clinical outcomes in medical inpatients remains unclear. We performed a systematic search and summarized the evidence from observational and randomized, controlled studies (RCTs) on the influence of vitamin D deficiency and its treatment on patient outcomes. METHODS: The MEDLINE and EMBASE databases were searched in January 2015 using the terms "vitamin D deficiency," "vitamin D," "mortality," "inpatient," "length of stay," "hospitalization," "accidental falls," "quality of life," "activities of daily living," and "intensive care units." RESULTS: Of 239 potential studies, 29 observational studies and 5 RCTs were included. Observational studies revealed an association between vitamin D deficiency and adverse patient outcomes, such as mortality, higher incidence and severity of infections, and increased duration of hospital stay, in the inpatient and geriatric patient population. The RCT data, however, are inconclusive regarding beneficial effects of vitamin D supplementation for reduction of mortality and length of hospital stay, as well as fall prevention. CONCLUSIONS: Despite evidence of associations in observational studies, high-quality evidence from interventional trials on the benefits of vitamin D supplementation in inpatients is currently lacking. On the basis of the available evidence, general vitamin D screening and supplementation for the medical inpatient population in an acute care setting cannot be recommended.