Red cell distribution width and all-cause mortality in critically ill patients*

Abstract

Red Cell Distribution Width (RDW) is a predictor of mortality in the general population. The prevalence of increased RDW and its significance in the intensive care unit are unknown. Objective To investigate the association between RDW at the initiation of critical care and all cause mortality Design Multicenter observational study Setting Two tertiary academic hospitals in Boston, Massachusetts Patients 51,413 patients, age ≥ 18 years, who received critical care between 1997 and 2007 Measurements The exposure of interest was RDW and categorized a priori in quintiles as ≤13.3%, 13.3–14.0%, 14.0–14.7%, 14.7–15.8%, and >15.8%. Logistic regression examined death by days 30, 90 and 365 post-critical care initiation, in-hospital mortality and bloodstream infection. Adjusted odds ratios were estimated by multivariable logistic regression models. Adjustment included age, sex, race, Deyo-Charlson index, CABG, MI, CHF, hematocrit, WBC, MCV, BUN, red blood cell transfusion, sepsis and creatinine. Interventions None Key Results RDW was a particularly strong predictor of all cause mortality 30 days following critical care initiation with a significant risk gradient across RDW quintiles following multivariable adjustment: RDW 13.3–14.0% OR 1.19 (95% CI, 1.08–1.30; P<0.001); RDW 14.0–14.7% OR 1.28 (95% CI, 1.16–1.42; P<0.001); RDW 14.7–15.8% OR 1.69 (95% CI, 1.52–1.86; P<0.001); RDW > 15.8% OR 2.61 (95% CI, 2.37–2.86; P<0.001); all relative to patients with RDW ≤13.3%. Similar significant robust associations post multivariable adjustments are seen with death by days 90 and 365 post-critical care initiation as well as in-hospital mortality. In a sub-analysis of patients with blood cultures drawn (n= 18,525), RDW at critical care initiation was associated with the risk of bloodstream infection and remained significant following multivariable adjustment. The adjusted risk of bloodstream infection was 1.40- and 1.44-fold higher in patients with RDW values in the 14.7–15.8% and >15.8% quintiles, respectively, compared with those with RDW ≤13.3%. Estimating the ROC AUC shows that RDW has moderate discriminative power for 30-day mortality (AUC = 0.67). Conclusion RDW is a robust predictor of the risk of all cause patient mortality and bloodstream infection in the critically ill. RDW is commonly measured, inexpensive and widely available and may reflect overall inflammation, oxidative stress, or arterial underfilling in the critically ill.

Impact of Intravenous Ascorbic Acid Infusion on Novel Biomarkers in Patients with Severe Sepsis

“…Although the CBC remains among the most frequently ordered diagnostic tests in medicine, the use of this highly mechanized, relatively inexpensive evaluation of the cellular components of peripheral blood remains severely under-utilized as a prognosticating tool. Bazick et al found that the rate of sepsis was higher based on RDW levels, and that RDW was associated with significant risk for blood stream infection [36]. Jo et al recently showed that RDW of non-survivors was higher than that of survivors in severe sepsis and septic shock [37].…”

Raised red cell distribution width as a prognostic marker in aortic valve replacement surgery

“…Previous studies have indicated higher values of RDW as an applicable parameter in reserves are lowered. Some authors suggest that RDW is an indicator of a patient's physiologic reserve -the ability of cells to defend against the strong stress of hypoxia [25][26][27].…”

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

“…RDW quartiles based on previously published a priori cutpoints (RDW < 13.4, 13.4-14.3, 14.4-15.7 and >15.7) [8,9].…”

“…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].…”