Red Blood Cell Distribution Width Is an Independent Predictor of Mortality in Patients With Gram-Negative Bacteremia

Abstract

Red blood cell distribution width (RDW) is known to be a predictor of severe morbidity and mortality in some chronic diseases such as congestive heart failure. However, to our knowledge, little is known about RDW as a predictor of mortality in patients with Gram-negative bacteremia, a major nosocomial cause of intra-abdominal infections, urinary tract infections, and primary bacteremia. Therefore, we investigated whether RDW is an independent predictor of mortality in patients with Gram-negative bacteremia. Clinical characteristics, laboratory parameters, and outcomes of 161 patients with Gram-negative bacteremia from November 2010 to March 2011 diagnosed at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, were retrospectively analyzed. The main outcome measure was 28-day all-cause mortality. The 28-day mortality rate was significantly higher in the increased RDW group compared with the normal RDW group (P < 0.001). According to multivariate Cox proportional hazard analysis, RDW levels at the onset of bacteremia (per 1% increase, P = 0.036), the Charlson index (per 1-point increase, P < 0.001), and the Sequential Organ Failure Assessment score (per 1-point increase, P = 0.001) were independent risk factors for 28-day mortality. Moreover, the nonsurvivor group had significantly higher RDW levels 72 h after the onset of bacteremia than did the survivor group (P = 0.001). In addition, the area under the curve of RDW at the onset of bacteremia, the 72-h RDW, and the Sequential Organ Failure Assessment score for 28-day mortality were 0.764 (P = 0.001), 0.802 (P < 0.001), and 0.703 (P = 0.008), respectively. Red blood cell distribution width at the onset of bacteremia was an independent predictor of mortality in patients with Gram-negative bacteremia. Also, 72-h RDW could be a predictor for all-cause mortality in patients with Gram-negative bacteremia.

Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis

“…A study by Guclu et al (21) found that the AUC of PDW was 0.733 (95% CI: 0.678-0.783) with a sensitivity of 59.31% and a specificity of 76.22%. An investigation by Ku et al (4) observed that the AUC of RDW was 0.764 (95% CI: 0.650-0.879). Therefore, the two indices PDW and RDW have diagnostic power in the discrimination of bacteremia.…”

“…PDW is measure of variation in platelet size, which may be an indicator of active platelet release (3). A number of previous investigations have shown that RDW and PDW are significantly associated diseases including chronic spontaneous urticaria and gram-negative bacteremia (3)(4)(5). Furthermore, RDW has also been regarded as a prognostic marker for certain diseases, such as stable angina pectoris (6,7).…”

Correlation between red blood cell distrubition width and glycated hemoglobin in diabetic and nondiabetic patients

“…It was used in the distinctive diagnosis of anaemia for years [13]. Studies investigating the relationship between RDW and cardiovascular diseases, inflammatory diseases and DM were made recently.…”

The Association between Red Cell Distribution Width and Mortality in Pediatric Acute Lymphoblastic Leukemia

“…Elevated RDW on complete blood count reflects impairment in erythropoiesis and abnormal red blood cell survival which can be caused by any disease involving red blood cell destruction or production [1]. In recent years, several studies have demonstrated that elevation of this simple parameter is associated with increased risk of mortality in different contexts including sepsis, cardiovascular disease, cancer, and chronic lower respiratory tract disease [2][3][4][5][6][7][8][9][10]. It is established that inflammation and oxidative stress affect RDW and it has been shown that RDW elevation is associated with raise in the cytokines such as IL6, TNF-α [11,12].…”