{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:00:35Z","timestamp":1790946035295,"version":"4.1.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Nucleated red blood cells (NRBCs) have been reported to correlate to poor prognosis in critically ill patients. This study aimed to identify the role of NRBC count in early diagnosis of acute kidney injury (AKI) and prediction of poor prognosis in patients with acute pancreatitis (AP).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This retrospective cohort study enrolled AP patients who were admitted to our hospital from January 1, 2020 to January 1, 2024. Demographic data, NRBC count, laboratory indicators, and outcomes were recorded. Binary logistic regression analysis was used to identify independent biomarkers for AKI diagnosis and prognosis of AP. Receiver operating characteristic (ROC) curves, net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to evaluate the predictive value of NRBC count. Kaplan-Meier curves were generated to compare survival rate between different groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 486 patients with AP were included in this study. Patients with NRBCs in their peripheral blood were classified into the NRBC (+) group (n\u2009=\u2009190), and those without NRBCs in their peripheral blood were classified into the NRBC (-) group (n\u2009=\u2009296). Patients in the NRBC (+) group had a higher AKI incidence (29.5% vs 3.0%, p\u2009&lt;\u20090.001) and poor prognosis rate (12.7% vs 1.0%, p\u2009&lt;\u20090.001) than patients in the NRBC (-) group. Binary logistic regression analysis showed that NRBC count was significantly associated with AKI incidence (OR = 3601.361, p\u2009&lt;\u20090.05) and poor prognosis (OR = 204.434, p\u2009&lt;\u20090.05) in AP patients. Area under the ROC curve (AUC) was 0.830 for NRBC count predicting AKI (cutoff value: 0\/L) and 0.867 for NRBC count predicting poor prognosis in AP patients (cutoff value: 0.015\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L). Kaplan\u2013Meier survival analysis demonstrated that patients with NRBC count\u2009&gt;\u20090.015\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L (\u03c7\u00b2\u2009=\u200985.09, p\u2009&lt;\u20090.001) exhibited significantly lower survival rates during the 30-day follow-up period. NRBC count offered predictive performance comparable to procalcitonin (PCT) and outperformed C-reactive protein (CRP).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>NRBC count serves as a valuable predictive biomarker for both AKI incidence and poor prognosis in patients with AP.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0330611","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:23:49Z","timestamp":1755883429000},"page":"e0330611","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nucleated red blood cell count as a novel predictive biomarker for acute kidney injury and prognosis in patients with acute pancreatitis: A retrospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"given":"Qiang Yong","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi Ming","family":"Mo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen Wu","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4524-4977","authenticated-orcid":true,"given":"Hua Lan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"issue":"8","key":"pone.0330611.ref001","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1515\/CCLM.2006.183","article-title":"Poor prognosis indicated by nucleated red blood cells in peripheral blood is not associated 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Why is it important?","volume":"50","author":"BT Constantino","year":"2019","journal-title":"Lab Med"},{"issue":"9","key":"pone.0330611.ref028","first-page":"1289","article-title":"the importance of nucleated red blood cells in patients with beta thalassemia major and comparison of two automated systems with manual microscopy and flow cytometry","volume":"61","author":"M Karakukcu","year":"2015","journal-title":"Clin Lab"},{"key":"pone.0330611.ref029","doi-asserted-by":"crossref","first-page":"6328051","DOI":"10.1155\/2018\/6328051","article-title":"Impaired mitophagy of nucleated erythroid cells leads to anemia in patients with myelodysplastic syndromes","volume":"2018","author":"H Jiang","year":"2018","journal-title":"Oxid Med Cell Longev"},{"key":"pone.0330611.ref030","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2147\/IJGM.S219744","article-title":"Emergence role of nucleated red blood cells in molecular response evaluation for chronic myeloid leukemia","volume":"12","author":"TT Phan","year":"2019","journal-title":"Int J Gen Med"},{"issue":"10","key":"pone.0330611.ref031","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41581-019-0182-z","article-title":"Mechanisms of hypoxia signalling: new implications for nephrology","volume":"15","author":"J Sch\u00f6del","year":"2019","journal-title":"Nat Rev Nephrol"},{"issue":"5","key":"pone.0330611.ref032","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/j.ajog.2004.02.033","article-title":"Are elevated fetal nucleated red blood cell counts an indirect reflection of enhanced erythropoietin activity?","volume":"190","author":"A Ferber","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"pone.0330611.ref033","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1172\/JCI106911","article-title":"On the in vivo action of erythropoietin: a quantitative analysis","volume":"51","author":"T Papayannopoulou","year":"1972","journal-title":"J Clin Invest"},{"issue":"598","key":"pone.0330611.ref034","doi-asserted-by":"crossref","DOI":"10.1126\/scisignal.aap7336","article-title":"Inflammation induces stress erythropoiesis through heme-dependent activation of SPI-C","volume":"12","author":"LF Bennett","year":"2019","journal-title":"Sci Signal"},{"issue":"4","key":"pone.0330611.ref035","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2008.01.040","article-title":"Nucleated red blood cells are a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis","volume":"198","author":"AT Dulay","year":"2008","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"pone.0330611.ref036","article-title":"Role of the CCL20\/CCR6 axis in tubular epithelial cell injury: Kidney-specific translational insights from acute kidney injury to chronic kidney disease","volume":"38","author":"KD Yoo","year":"2024","journal-title":"FASEB 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