Elevated red blood cell distribution width at ICU discharge is associated with readmission to the intensive care unit

Tonietto, Tiago Antônio; Boniatti, Márcio Manozzo; Lisboa, Thiago; Viana, Marina Verçoza; Santos, Moreno Calcagnotto dos; Lincho, Carla S.; Pellegrini, José Augusto Santos; Vidart, Josi; Neyeloff, Jeruza Lavanholi; Faulhaber, Gustavo Adolpho Moreira

doi:10.1016/j.clinbiochem.2018.03.010

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…Similarly, Ueda et al demonstrated that an elevated MCV is associated with mortality among patients with acute HF [6]. Prior studies have shown associations between elevated MCV with mortality and ICU readmission in other ICU populations [14,16]. Bazick et al previously demonstrated a higher MCV to be associated with increased hospital mortality in a cohort of 51,143 mixed ICU patients (including 15% with MI and 22% with HF), after performing multivariable adjustment [16].…”

Section: Discussionmentioning

confidence: 95%

“…In addition, abnormal values of hematological indices, including red cell distribution width (RDW) and mean corpuscular volume (MCV) have also been associated with worse outcome in patients with acute cardiac disease [6][7][8][9][10][11][12]. In general intensive care unit (ICU) populations, the presence of anemia has been associated with demand myocardial ischemia, ICU readmission, and increased mortality [13][14][15]. As in patients with cardiac disease, elevated RDW and MCV are also associated with worse outcomes in general ICU patients [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

et al. 2019

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Background Anemia and elevated red cell distribution width (RDW) or mean corpuscular volume (MCV) are associated with an adverse prognosis in patients with cardiovascular disease and critical illness. Limited data exist regarding these associations in unselected cardiac intensive care unit (CICU) patients. Methods Retrospective cohort study of CICU patients between January 1, 2007, and December 31, 2015, with a hemoglobin (Hb) level measured at admission. Multivariable regression was performed to determine predictors of hospital mortality, and Kaplan-Meier analysis was used to determine post-discharge survival. Results We included 9644 patients with a mean age of 67.5 ± 15.1 years, including 3604 (37.4%) females. The median (IQR) values of Hb, MCV and RDW were 12.2 g/dL (10.6, 13.7), 90.7 fL (87.3, 94.2) fL, and 14.1% (13.3, 15.8), respectively. Anemia (admission Hb < 12 g/dL) was present in 4434 (46%) patients. A total of 845 (8.8%) patients died in the hospital. Patients with anemia had higher hospital mortality (11.3% vs. 6.6%, unadjusted OR 1.82, 95% CI 1.58-2.10, p < 0.001). After multivariable regression, admission Hb and MCV were not significantly associated with hospital mortality (both p > 0.1), while admission RDW (adjusted OR 1.12 per 1%, 95% CI 1.07-1.18, p < 0.001) was significantly associated with hospital mortality. Hospital survivors with lower Hb, higher MCV, or higher RDW had lower post-discharge survival. Conclusion Elevated RDW on admission was independently associated with higher hospital mortality in CICU patients. These data emphasize the importance of hematologic abnormalities for mortality risk stratification in CICU populations. Hamza A. Rayes and Jacob C. Jentzer contributed equally to this work.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

et al. 2019

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“…Studies have shown that RDW is associated with blood inflammation markers such as interleukin-6 and C-reactive protein (CRP). In addition, oxidative stress disrupts erythropoiesis and increases anisocytosis and it has been shown that it causes membrane damage leading to RDW increase and reduces circulating red blood cell half-life [14][15]. High RDW has been associated with poor prognosis in various diseases such as pneumonia, cardiovascular diseases, pulmonary embolism, cancer and cerebral infarction [16].…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Hematological Parameters and Mortality in Cardiovascular Patients With Postcardiac Arrest Syndrome

Erol¹,

Kankılıç²,

Kaya³

et al. 2019

Cureus

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Background: Post-cardiac arrest syndrome is the insufficiency of cardiac and cerebral functions caused by ischemia after sudden cardiac arrest. We aimed to determine the hematological parameters associated with mortality in the intensive care follow-up of patients with postcardiac arrest syndrome. Methods: The hematological parameters of 285 cardiovascular patients who were admitted to the emergency department of Harran University Medical Faculty between 2013 and 2018 and followed up in the intensive care unit with post-cardiac arrest syndrome were examined. A total of 85 patients were included in the study. These parameters were recorded as the time of arrival to the emergency department (0 hour) and hematological parameters at the 24 th and 48 th hours of intensive care follow-up. Results: In the mortality group, albumin (P:0.030), hemoglobin (Hg) (P: 0.049), and hematocrit (HCT) (P: 0.020) values in the blood parameters, at the time of admission to the emergency department, were significantly lower than those in the survival group. Red blood cell distribution width (RDW) (P: 0.009) and urea (P <0.001) values at the time of arrival were higher than the survival group. In the 24 th and 48 th hours, mean hemoglobin (MCHC) (P <0.05) values were lower and RDW (P <0.05) values were higher in the mortality group compared to the survival group. Conclusions: In this retrospective validation, low albumin, Hg, HCT, MCHC, and high RDW and urea levels may increase mortality in cardiovascular patients who develop post-cardiac arrest syndrome within the first 48 hours. Correcting these values early may reduce mortality.

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“…In the past, RDW has been used for differentiating thalassemia and iron deficiency anemia [5]. However, recent studies have revealed that RDW is also a useful test for estimating the prognosis or disease activity of various cancers [6,7], thyroiditis [8], gastrointestinal disorders [9], cardiovascular diseases [10][11][12][13], critical illness [14][15][16], and autoimmune diseases [17,18]. This may be due to the fact that RDW is an inflammatory parameter [17], and inflammatory response is involved in the progression of various disorders.…”

Section: Introductionmentioning

confidence: 99%

Red Blood Cell Distribution Width, Neutrophil-to-Lymphocyte Ratio, and In-Hospital Mortality in Dyspneic Patients Admitted to the Emergency Department

2020

Disease Markers

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Red blood cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) have shown a prognostic value in various clinical settings. We aimed to investigate the association between RDW, NLR, and in-hospital mortality in patients with dyspnea. In this retrospective study with the Medical Information Mart for Intensive Care III database (version 1.4), adult patients who came to the emergency department with dyspnea were included. Patients’ comorbidities, hematological parameters within the first 48 hours after admission to the emergency department, and in-hospital mortality were extracted. The relationships between RDW, NLR, and in-hospital mortality were analyzed with the receiver operating characteristic (ROC) curve analysis and multivariate logistic regression model. We found that hospital survivors had significantly lower NLR than those who died. However, RDW was not significantly increased in patients who died during the hospitalization. The area under the ROC curve of NLR for predicting in-hospital mortality was 0.62. On multivariate analysis, NLR was not independently associated with in-hospital mortality. On further analysis, lymphocyte percentage was independently associated with in-hospital mortality, with an odds ratio of 0.56. Therefore, we concluded that RDW and NLR are not reliable parameters to predict in-hospital mortality in critically ill patients admitted to the emergency department with dyspnea.

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Elevated red blood cell distribution width at ICU discharge is associated with readmission to the intensive care unit

Cited by 12 publications

References 32 publications

Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

Association between anemia and hematological indices with mortality among cardiac intensive care unit patients

The Relationship Between Hematological Parameters and Mortality in Cardiovascular Patients With Postcardiac Arrest Syndrome

Red Blood Cell Distribution Width, Neutrophil-to-Lymphocyte Ratio, and In-Hospital Mortality in Dyspneic Patients Admitted to the Emergency Department

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