Prognostic Significance of Red Blood Cell Distribution width (RDW) in Critically ill Paediatric Patients at Sohag University Hospital

Abstract

Background: RDW has been recently reported as a strong prognostic factor in several diseases of various organ systems , In critically ill children, it is crucial to assess the severity of illness and organ dysfunction.Aim: this study aimed to evaluate RDW as a marker for illness severity in critically ill paediatric patients Patients and methods: One hundred and eleven children, 55 males (49.5 %). were included in this cross-sectional hospital-based study. All critically ill paediatric patients, 1 month to 12 years of age, which were admitted to the Paediatric intermediate & Intensive Care Unit (PICU), at Sohag University Hospital, over six months period were included in the study, Investigations performed ; Complete Blood Count, Serum electrolytes, Blood gases, Coagulation profile , Liver and kidney functions, CRP, Serum lactate, serum fibrinogen, Blood urea nitrogen (BUN) and b-type natriuretic peptide. Observation for the patient if a mechanical ventilation and or inotropes were needed, and for the duration of hospital stay and for the outcome of the case. Calculation of critical illness scores including pediatric multiple organ dysfunction syndrome (PMODS), the pediatric risk of mortality (PRISM), pediatric sequential organ failure assessment (PSOFA) and pediatric logistic organ dysfunction-2 (PELOD-2). Results: Mortality among critically ill children was significantly associated with high RDW >16.9 with p-value <0.001.Critically ill children with low RDW <16.9 had significantly longer duration of PICU admission with p-value =0.015.Critically ill children with high RDW >16.9 had significantly lower GCS during their PICU admission with p-value<0.001. There was a statistically significant positive correlation between R DW level, PRISM III, SOFA, PLEOD II, and PMODS scores with pvalue <0.001. High RDW > 16.9 had a statistically significant predictor for survival of critically ill children with p-value <0.001.Univariate regression analysis shows that PRISM III, PSOFA, PLEOD II, PMODS and RDW% had statistically significant effect on PICU survival among critically ill children with p-value <0.001. Conclusion: Red blood cell distribution width ( RDW) is a good predictor of critical illness severity in pediatrics being significantly correlated with severity scores including SOFA, PLEOD II, and PRISM scores