Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock

Abstract

Background:The normal range of red cell distribution width (RDW) level is <15%. Several studies have indicated that a high RDW level was associated with mortality in critically ill patients, and the patients with a high RDW level need increased focus in clinical practice. In view of the difficulty in defining the specific value of high RDW level, the key is to focus on the patient with the level beyond the normal upper limit. This study aimed to determine whether dynamic change of RDW levels, rather than the level itself, is predictive of death in elderly patients with septic shock when RDW level is beyond 15%.Methods:Between September 2013 and September 2015, the elderly septic shock patients with RDW level beyond 15% were enrolled in this study. The RDW levels were measured at enrollment (day 1), and days 4 and 7 after enrollment. Sequential Organ Failure Assessment (SOFA) scores were recorded simultaneously.Results:A total of 45 patients, including 32 males and 13 females, were included in the final analysis. Based on their hospital outcomes, these patients were divided into the survivor group (n = 26) and the nonsurvivor group (n = 19). There were no significant differences in age, gender, body mass index, initial level of RDW, Acute Physiology and Chronic Health Evaluation II scores, and SOFA scores between survivors and nonsurvivors. At days 4 and 7 measurement, both RDW level (median [interquartile range]: day 4: 15.8 [2.0]% vs. 16.7 [2.0]%, P = 0.011; and day 7: 15.6 [1.8]% vs. 17.7 [2.5]%, P = 0.001) and SOFA scores (day 4: 7.0 [4.0] vs. 16.0 [5.0], P < 0.001, day 7: 5.5 [4.0] vs. 17.0 [5.0], P < 0.001) were significantly lower in survivors than those in nonsurvivors. Dynamic changes of RDW and SOFA scores in survivor group were significantly different from those in nonsurvivor group (all P < 0.05). Continuous increase in RDW level was observed in 10 of the 13 nonsurvivors, but only in 3 of the 26 survivors. The level of RDW7 and dynamic changes significantly correlated with their counterparts of SOFA scores (all P < 0.05), whereas the levels of RDW1 and RDW4 had no significant correlation with their counterparts of SOFA scores (all P > 0.05).Conclusions:Continuous increase in RDW level, rather than the level of RDW itself, was more useful in predicting hospital death in elderly patients with septic shock when the level of RDW was >15%. The dynamic changes of RDW were highly correlated with the SOFA score in the patients.

Comparative study between complete blood picture indices and presepsin as early prognostic markers in septic shock patients

“…In survivors, RDW was higher on admission than day 3, while it was higher on day 3 than admission in non-survivors. In agreement, Ju et al [14] reported that survivors had higher RDW on day 1 than day 4, whereas non-survivors had higher RDW on day 4 than day 1.…”

“…It has been used with mean corpuscular volume (MCV) to distinguish causes of anaemias, following that, its relation with several medical conditions was assessed in literatures [12]. Recently, RDW showed significant value in sepsis diagnosis [13], course monitoring, and predicting outcome [11,14].…”

Dynamic Increase of Red Cell Distribution Width Predicts Increased Risk of 30-Day Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“… 13 Similarly, Ju et al showed that a dynamic increase in the RDW was more useful in predicting prognosis among elderly patients with septic shock. 33 Yoon et al proved that a dynamic increase in the RDW predicts the occurrence of adverse events in patients with end-stage renal disease. 15 The study conducted by Yazıcı on pulmonary embolism also confirmed the importance of the dynamic measurement of the RDW.…”

Dynamic APACHE II Score to Predict Outcome Among Intensive Care Unit Patients

“…Just as the accuracy of dynamic SOFA score in predicting sepsis is higher than that of SOFA score [7,20,21]. Some scholars suggest that the APACHE II score should be proposed during the initial 7 days of ICU stay to reduce the error to the greatest extent [22].…”