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Zhong L, Zhang Z, Ji X, Wang H, Xie B, Yang X. Relationship between initial red cell distribution width and ΔRDW and mortality in cardiac arrest patients. ESC Heart Fail 2024; 11:433-443. [PMID: 38030411 PMCID: PMC10804170 DOI: 10.1002/ehf2.14602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS There has been a lack of research examining the relationship between red cell distribution width (RDW) and the prognosis of cardiac arrest (CA) patients. The prognostic value of the changes in RDW during intensive care unit (ICU) hospitalization for CA patients has not been investigated. This study aims to investigate the correlation between RDW measures at ICU admission and RDW changes during ICU hospitalization and the prognosis of CA patients and then develop a nomogram that predicts the risk of mortality of these patients. METHODS AND RESULTS A retrospective cohort study is used to collect clinical characteristics of CA patients (>18 years) that are on their first admission to ICU with RDW data measured from the Medical Information Mart for Intensive Care IV Version 2.0 database. Patients are randomly divided into a development cohort (75%) and a validation cohort (25%). The primary outcome is 30 and 360 day all-cause mortality. ΔRDW is defined as the RDW on ICU discharge minus RDW on ICU admission. A multivariate Cox regression model is applied to test whether the RDW represents an independent risk factor that affects the all-cause mortality of these patients. Meanwhile, the dose-response relationship between the RDW and the mortality is described by restricted cubic spine (RCS). A prediction model is constructed using a nomogram, which is then assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). A total of 1278 adult CA patients are included in this study. We found that non-survivors have a higher level of RDW and ΔRDW compared with survivors, and the mortality rate is higher in the high RDW group than in the normal RDW group. The Kaplan-Meier survival curve indicates that patients in the normal RDW group had a higher cumulative survival rate at 30 and 360 days than those in the high RDW group (log-rank test, χ2 = 36.710, χ2 = 54.960, both P values <0.05). The multivariate Cox regression analysis shows that elevated RDW at ICU admission (>15.50%) is an independent predictor of 30 [hazard ratio = 1.451, 95% confidence interval (CI) = 1.181-1.782, P < 0.001] and 360 day (hazard ratio = 1.393, 95% CI = 1.160-1.671, P < 0.001) all-cause mortality among CA patients, and an increase in RDW during ICU hospitalization (ΔRDW ≥ 0.4%) can serve as an independent predictor of mortality among these patients. A non-linear relationship between the RDW measured at ICU admission and the increased risk of mortality rate of these patients is shown by the RCS. This study established and validated a nomogram based on six variables, anion gap, first-day Sequential Organ Failure Assessment score, cerebrovascular disease, malignant tumour, norepinephrine use, and RDW, to predict mortality risk in CA patients. The consistency indices of 30 and 360 day mortality of CA patients in the validation cohort are 0.721 and 0.725, respectively. The nomogram proved to be well calibrated in the validation cohort. DCA curves indicated that the nomogram provided a higher net benefit over a wide, reasonable range of threshold probabilities for predicting mortality in CA patients and could be adapted for clinical decision-making. CONCLUSIONS Elevated RDW levels on ICU admission and rising RDW during ICU hospitalization are powerful predictors of all-cause mortality for CA patients at 30 and 360 days, and they can be used as potential clinical biomarkers to predict the bad prognosis of these patients. The newly developed nomogram, which includes RDW, demonstrates high efficacy in predicting the mortality of CA patients.
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Affiliation(s)
- Lei Zhong
- Department of Intensive Care UnitHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
- Emergency and Critical Care Center, Intensive Care UnitZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Zeng‐Yu Zhang
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| | - Xiao‐Wei Ji
- Department of Intensive Care UnitHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
| | - Hai‐Li Wang
- Department of Obstetrics and GynecologyHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
| | - Bo Xie
- Department of Intensive Care UnitHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
| | - Xiang‐Hong Yang
- Emergency and Critical Care Center, Intensive Care UnitZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouZhejiangChina
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Tang X, Qiu L, Wang F, Liu S, Lü X, Chen X. Diagnostic value of procalcitonin and red blood cell distribution width at admission on the prognosis of patients with severe burns: A retrospective analysis. Int Wound J 2023; 20:3708-3716. [PMID: 37381890 PMCID: PMC10588303 DOI: 10.1111/iwj.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/20/2023] [Indexed: 06/30/2023] Open
Abstract
The plasma procalcitonin (PCT) concentration and red blood cell distribution (RDW) value after severe burns can be used as prognostic indicators, but at present, it is difficult to give consideration to sensitivity and specificity in diagnosing the prognosis of severe burns with a single indicator. This study analysed the diagnostic value of plasma PCT concentration and RDW value at admission on the prognosis of severe burn patients to improve its sensitivity and specificity. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. The optimal cut-off values of plasma PCT concentration and RDW were analysed and counted through the subject curve (ROC curve). According to the cut-off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. The independent risk factors of severe burns were analysed by single-factor and multiple-factor COX regression. Kaplan-Meier survival was used to analyse the mortality of high PCT group and low PCT group, high RDW group and low RDW group. The area under the curve of plasma PCT concentration and RDW value at admission was 0.761 (95% CI, 0.662-0.860, P < .001), 0.687 (95% CI, 0.554-0.820, P = .003) respectively, and the optimal cut-off values of serum PCT concentration and RDW were 2.775 ng/mL and 14.55% respectively. Cox regression analysis found that age, TBSA, and RDW were independent risk factors for mortality within 90 days after severe burns. Kaplan-Meier survival analysis showed that there was a significant difference in the 90-day mortality rate of severe burns between the PCT ≥ 2.775 ng/mL group and the PCT < 2.775 ng/mL group (log-rank: 24.162; P < .001), with the mortality rate of 36.84% versus 5.49%, respectively. The 90-day mortality rate of severe burns was significantly different between the RDW ≥ 14.55% group and the RDW < 14.55% group (log-rank: 14.404; P < .001), with the mortality rate of 44% versus 12.2% respectively. The plasma PCT concentration and RDW value at admission are both of diagnostic value for the 90-day mortality of severe burns, but the plasma PCT concentration has higher sensitivity and the RDW value has higher specificity. Age, TBSA, and RDW were independent risk factors for severe burns, and then plasma PCT concentration was not independent risk factors.
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Affiliation(s)
- Xu‐Dong Tang
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Le Qiu
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Fei Wang
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Sheng Liu
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Xiong‐Wen Lü
- School of PharmacyAnhui Medical UniversityHefeiAnhui ProvinceChina
- Institute for Liver Disease of Anhui Medical UniversityAnhui Medical UniversityHefeiAnhui ProvinceChina
| | - Xu‐Lin Chen
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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Weihs V, Frenzel S, Dedeyan M, Heinz T, Hajdu S, Frossard M. Red blood cell distribution width and Charlson comorbidity index help to identify frail polytraumatized patients : Experiences from a level I trauma center. Wien Klin Wochenschr 2023; 135:538-544. [PMID: 35943632 PMCID: PMC10558364 DOI: 10.1007/s00508-022-02063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/10/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Little is known about the potential impact of the red blood cell distribution width (RDW) and pre-existing comorbidities on the late-phase survival of polytraumatized patients. METHODS A total of 173 polytraumatized patients were included retrospectively in this cohort study in a level I trauma center from January 2012 to December 2015. The Charlson comorbidity index (CCI) scores and RDW values were evaluated. RESULTS Out of all polytraumatized patients (n = 173), 72.8% (n = 126) were male, the mean ISS was 31.7 points (range 17-75) and the mean age was 45.1 years (range 18-93 years). Significantly higher RDW values (13.90 vs. 13.37; p = 0.006) and higher CCI scores (3.38 vs. 0.49; p < 0.001) were seen in elderly polytraumatized patients (age > 55 years). RDW values > 13.75% (p = 0.033) and CCI scores > 2 points (p = 0.001) were found to have a significant influence on the late-phase survival of polytraumatized patients. Age > 55 years (p = 0.009, HR 0.312; 95% confidence interval (CI) 0.130-0.749) and the presence of severe traumatic brain injury (TBI) (p = 0.007; HR 0.185; 95% CI 0.054-0.635) remained as independent prognostic factors on the late-phase survival after multivariate analysis. CONCLUSION Even younger elderly polytraumatized patients (> 55 years of age) showed significant higher RDW values and higher CCI scores. In addition to the presence of severe TBI and age > 55 years, RDW value > 13.75% on admission and CCI score > 2 might help to identify the "younger" frail polytraumatized patient at risk.
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Affiliation(s)
- Valerie Weihs
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Stephan Frenzel
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michél Dedeyan
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Heinz
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Frossard
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Urben T, Amacher SA, Becker C, Gross S, Arpagaus A, Tisljar K, Sutter R, Pargger H, Marsch S, Hunziker S. Red blood cell distribution width for the prediction of outcomes after cardiac arrest. Sci Rep 2023; 13:15081. [PMID: 37700019 PMCID: PMC10497505 DOI: 10.1038/s41598-023-41984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
The red blood cell distribution width (RDW) is a routinely available blood marker that measures the variation of the size/volume of red blood cells. The aim of our study was to investigate the prognostic value of RDW in cardiac arrest patients and to assess whether RDW improves the prognostic value of three cardiac arrest-specific risk scores. Consecutive adult cardiac arrest patients admitted to the ICU of a Swiss university hospital were included. The primary outcome was poor neurological outcome at hospital discharge assessed by Cerebral Performance Category. Of 702 patients admitted to the ICU after cardiac arrest, 400 patients (57.0%) survived, of which 323 (80.8%) had a good neurological outcome. Higher mean RDW values showed an independent association with poor neurological outcomes at hospital discharge (adjusted OR 1.27, 95% CI 1.14 to 1.41; p < 0.001). Adding the maximum RDW value to the OHCA- CAHP- and PROLOGUE cardiac arrest scores improved prognostic performance. Within this cohort of cardiac arrest patients, RDW was an independent outcome predictor and slightly improved three cardiac arrest-specific risk scores. RDW may therefore support clinical decision-making.
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Affiliation(s)
- Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Simon A Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Armon Arpagaus
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Kai Tisljar
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland.
- Medical Faculty, University of Basel, Basel, Switzerland.
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Lai H, Cai Z, Wu S, Zhang W, Chen J, Wu G. An Increase in Admission RDW Value Is Associated with Excess Short-Term Mortality Rates in Patients with Severe Burns. Appl Biochem Biotechnol 2022; 195:3217-3228. [PMID: 36576652 DOI: 10.1007/s12010-022-04302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
The predictive value of red blood cell distribution width (RDW) in severely burned patients remains unclear. This study aimed to investigate the potential association between admission RDW and outcomes in patients with severe burns. Data of severely burned patients in the burn center of Changhai Hospital were retrospectively evaluated. The relationship between admission RDW and mortality was analyzed and displayed using the receiver operating characteristic curve, Kaplan-Meier curve, Cox proportional hazards regression, and the nomogram method. A total of 342 patients were identified according to the filter criteria. The 30-day mortality was 12.9%, and the mortality rates in 7 days and 90 days were 2.9% and 16.7%, respectively. Patients with high admission RDW value were more likely to die than those with low RDW value. Multivariate analysis revealed that higher admission RDW, age, full-thickness burned area, and inhalation injury were independent risk factors with 30-day mortality. The nomogram based on these risk factors was established to predict survival probability in severe burn patients. The C-index of different follow-up times was computed between 0.867 and 0.904, and the nomogram model list fits the data well. Admission RDW played a valuable role in predicting short-term mortality in patients with severe burns. The nomogram containing admission RDW was established to predict mortality, which helps burn care providers identify the patients at higher risk of short-term mortality after severe burns. More attention should be paid to the application of these easy and inexpensive biochemical indicators in the early prediction of disease progression.
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Affiliation(s)
- Honghao Lai
- Department of Burn, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.,Department of Burn, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, China
| | - Zhuhong Cai
- Department of Ultrasonography, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Shengyong Wu
- Department of Military Health Statistics, Naval Medical University, Shanghai, 200433, China
| | - Wei Zhang
- Department of Burn, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Jiali Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, China
| | - Guosheng Wu
- Department of Burn, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Sun K, Zhou Y, Wu Y, Zeng Y, Xu J, Shen B. Elevated Red Blood Cell Distribution Width Is Associated with Poor Prognosis in Fractured Patients Admitted to Intensive Care Units. Orthop Surg 2022; 15:525-533. [PMID: 36573278 PMCID: PMC9891954 DOI: 10.1111/os.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Red blood cell distribution width (RDW) with prognosis in various infectious diseases. For fractured patients admitted to the intensive care units (ICU), an accurate and fast appraisal is essential. To investigate the association between RDW and prognosis in fractured patients admitted to the ICU utilizing the MIMIC-III database. METHODS A retrospective cohort from the MIMIC III database from 2001 and 2012 was constructed. RDW and other information were collected with in-hospital mortality as the primary outcome and 90-day mortality and hospital and intensive care unit (ICU) length of stay (LOS) as secondary outcomes. Univariate and multivariate logistic regression models with propensity score inverse probability of treatment weighting (IPTW) were used to investigate the prognostic value of RDW. A nomogram was built with significant prognostic factors to predict in-hospital mortality, and the performance of the nomogram was evaluated and compared with other severity assessment scores. Subgroup analysis was also conducted. RESULTS A total of 2721 fracture patients admitted to the ICU were identified. After IPTW, the group with higher RDW was significantly associated with elevated in-hospital mortality (odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.19-2.37), 90-day mortality (OR: 1.39, 95% CI: 1.04-1.86), prolonged hospital LOS (OR: 1.25, 95% CI: 1.03-1.50), and ICU LOS significantly (OR: 1.26, 95% CI: 1.05-1.53) in the multivariate logistics model. The nomogram showed optimal discriminative ability and predictive accuracy with an area under the receiver operating characteristic curve of 0.77. CONCLUSION RDW independently predicted in-hospital mortality, 90-day mortality, and hospital and ICU LOS in fractured patients admitted to ICU. The nomogram including RDW could also be a promising tool with potential clinical benefits.
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Affiliation(s)
- Kaibo Sun
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yannan Zhou
- West China School of MedicineSichuan UniversityChengduChina
| | - Yuangang Wu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yi Zeng
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Jiawen Xu
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Bin Shen
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Malik A, Gewarges M, Pezzutti O, Allan KS, Samman A, Akioyamen LE, Ruiz M, Brijmohan A, Basuita M, Tanaka D, Scales D, Luk A, Lawler P, Kalra S, Dorian P. Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2022; 179:172-182. [PMID: 35728744 DOI: 10.1016/j.resuscitation.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA. METHODS We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest. Random-effects inverse variance meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI). The GRADE approach was used to assess evidence quality. RESULTS Thirty studies including 1,068,788 patients had female proportion of 41%. There was no association for female sex with survival to discharge (OR 1.03, 95% CI 0.95-1.12; I2=89%). Subgroup analysis of low risk of bias studies demonstrated increased survival to discharge for female sex (OR 1.20, 95% CI 1.18-1.23; I2=0%) and with high certainty, the absolute increase in survival was 2.2% (95% CI 0.1%-3.6%). Female sex was not associated with survival to 30 days post-OHCA (OR 1.02, 95% CI 0.92-1.14; I2=79%). CONCLUSIONS In adult patients experiencing OHCA, with high certainty in the evidence from studies with low risk of bias, female sex had a small absolute difference for the outcome survival to discharge and no difference in survival at 30 days. Future models that aim to stratify risk of survival post-OHCA should focus on sex-specific factors as opposed to sex as an isolated prognostic factor.
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Affiliation(s)
- Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mena Gewarges
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Olivia Pezzutti
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Anas Samman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Leo E Akioyamen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Ruiz
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Angela Brijmohan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Manpreet Basuita
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dustin Tanaka
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Damon Scales
- Division of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Adriana Luk
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Patrick Lawler
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Sanjog Kalra
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada.
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Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases. Diagnostics (Basel) 2022; 12:diagnostics12041011. [PMID: 35454059 PMCID: PMC9032964 DOI: 10.3390/diagnostics12041011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Despite great advances in medicine, numerous available laboratory markers, and radiological imaging, the diagnosis of acute appendicitis (AA) in some cases still remains controversial and challenging for clinicians. Because of that, clinicians are still looking for an ideal marker that would be specific to AA. The red blood cell distribution width (RDW) has been recently investigated in several studies as a potential biomarker for AA. The aim of this systematic review and meta-analysis was to systematically summarize and compare all relevant data on RDW as a diagnostic biomarker for AA. Methods: This systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Scopus, Web of Science, and Excerpta Medica database—EMBASE) were systematically searched for relevant comparative studies by two independent researches using keywords ((red cell distribution width) OR rdw) AND (appendicitis). An independent assessment of the methodological quality was performed by two authors using the Downs and Black scale. RevMan 5.4 software was used to perform the meta-analysis. Results: Fifteen studies were included in the final meta-analysis; the majority of the studies was retrospective. Nine studies compared the RDW values between AA and non-AA; four studies compared the same between AA and healthy controls, while two studies compared the RDW values among all three groups. The estimated heterogeneity among the studies for all outcome was statistically significant (I2 = 92−99%, p < 0.00001). The pooling the data demonstrated no statistically significant difference in the RDW values (weighted mean difference (WMD) = 0.03, 95% CI = (−0.46, 0.52), p = 0.91) between AA and healthy controls as well as between AA and non-AA cases (WMD = 0.23, 95%CI = (−0.19, 0.65), p = 0.28). A separate subanalysis was performed to evaluate the utility of this biomarker for the pediatric age group. Pooling the data demonstrated no significant difference among the AA and non-AA groups in terms of the RDW values (WMD = 0.99, 95% CI = (−0.35, 2.33), p = 0.15). Conclusion: The RDW value difference demonstrated no statistically significant difference in AA versus healthy individuals and AA versus non-AA individuals. At the moment, there is no evidence of RDW utility in diagnostic testing of AA. Further research with prospective, multicenter studies and studies targeting special patient groups with a large sample size are needed in this field.
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Cheng Y, Peng H, Zhang J, Zhu J, Xu L, Cao X, Qin L. Associations between red cell distribution width and outcomes of adults with in-hospital cardiac arrest: A retrospective study. Medicine (Baltimore) 2022; 101:e28750. [PMID: 35089252 PMCID: PMC8797596 DOI: 10.1097/md.0000000000028750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023] Open
Abstract
Previous studies found that high red cell distribution width (RDW) value is associated with poor outcomes among out-of-hospital cardiac arrest survivors. The aim of this study was to investigate whether post-ROSC RDW value was associated with survival and neurological outcomes of in-hospital cardiac arrest (IHCA) patients achieving return of spontaneous circulation (ROSC) but remaining critically ill.This retrospective single-center observational study included IHCA adults with sustained ROSC between January 1, 2017 and January 1, 2021 at an academic medical center in China. PostROSC RDW values were measured within 1 hour after sustained ROSC. The primary outcome was survival to hospital discharge and the secondary outcome was favorable neurological outcome at hospital discharge. The associations between postROSC RDW value and outcomes among IHCA patients with ROSC were evaluated by using multivariate logistic regression.A total of 730 patients with sustained ROSC following IHCA were ultimately included in this study. Of whom 194 (26.6%) survived to hospital discharge and 116 (15.9%) had a favorable neurological outcome at hospital discharge. In multivariable logistic regression analysis, lower postROSC RDW value was independently associated with survival to hospital discharge (odds ratio 0.19, 95% confidence interval 0.15-0.63, P = .017, cut-off value: 15.5%) and favorable neurological outcome at hospital discharge (odds ratio 0.23, 95% confidence interval 0.07-0.87, P < .001, cut-off value: 14.6%). Other independent factors including younger age, initial shockable rhythm, shorter total cardiopulmonary resuscitation duration and post-ROSC percutaneous coronary intervention were also associated with survival to hospital discharge. Regarding favorable neurological outcome at hospital discharge, significant variables other than the aforementioned factors included postROSC targeted temperature management and absence of pre-existing neurological insufficiency.Low postROSC RDW value was associated with survival to hospital discharge and favorable neurological outcome at hospital discharge.
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Affiliation(s)
- Yanwei Cheng
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Hailin Peng
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Jiange Zhang
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Juan Zhu
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Lijun Xu
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Xue Cao
- Department of Rheumatology and Immunology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Lijie Qin
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
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Jain K, Sharma D, Patidar M, Nandedkar S, Pathak A, Purohit M. Red Cell Distribution Width as a Predictor of Mortality in Patients With Clinical Sepsis: Experience From a Single Rural Center in Central India. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2022; 15:2632010X221075592. [PMID: 35141523 PMCID: PMC8819754 DOI: 10.1177/2632010x221075592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/05/2022] [Indexed: 12/14/2022]
Abstract
Introduction: Early diagnosis of sepsis and its severity is essential for appropriate
treatment to improve patient survival, especially in resource-limited
settings. The aim of the present study was to study the role of red blood
cell distribution (RDW) as a biomarker for the early detection of severe
sepsis defined clinically and also in the prediction of mortality from
sepsis. Methods: The cross-sectional study included a total of 175 subjects who met the
inclusion criteria for the diagnosis of severe sepsis. After a thorough
clinical examination, blood samples were taken from all patients within
3 hours of presenting the disease. The RDW values and other investigations
were studied on the day of admission compared to other severity markers with
the mortality index of 30 days. Result: The RDW value was significantly higher in patients with severe sepsis and in
non-survivor patients than in survivors (P < .0001).
There was a strong correlation between the SOFA score and RDW in predicting
the disease outcome with the Pearson correlation coefficient of
r = .46. The area under the receiver operating
characteristic curve was found to be 0.852 at a CI of 95% (0.796-0.909) with
RDW 17.15, sensitivity was 88.6% and specificity was 63.5%. There was a
positive correlation with Pearson’s correlation coefficient of
r = .46 between RDW and the SOFA score. Conclusions: RDW can be used as a potential marker for the early detection of severe
sepsis and in the prediction of the outcome. Large multicenter prospective
studies can confirm the utility of this routinely available marker for
patients with sepsis.
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Affiliation(s)
- Kavita Jain
- Department of Pathology, R.D. Gardi Medical College, Ujjain, India
| | - Darshita Sharma
- Department of Pathology, R.D. Gardi Medical College, Ujjain, India
| | - Mala Patidar
- Department of Pathology, R.D. Gardi Medical College, Ujjain, India
| | | | - Ashish Pathak
- Department of Paediatrics, R.D. Gardi Medical College, Ujjain, India.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Manju Purohit
- Department of Pathology, R.D. Gardi Medical College, Ujjain, India.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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11
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Red blood cell distribution width to platelet ratio substantiates preoperative survival prediction in patients with newly-diagnosed glioblastoma. J Neurooncol 2021; 154:229-235. [PMID: 34347223 PMCID: PMC8437903 DOI: 10.1007/s11060-021-03817-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
Object The conception of individual patient-adjusted treatment strategies is constantly emerging in the field of neuro-oncology. Systemic laboratory markers may allow insights into individual needs and estimated treatment benefit at an earliest possible stage. Therefore, the present study was aimed at analyzing the prognostic significance of preoperative routine laboratory values in patients with newly-diagnosed glioblastoma. Methods Between 2014 and 2019, 257 patients were surgically treated for newly-diagnosed glioblastoma at the Neuro-Oncology Center of the University Hospital Bonn. Preoperative routine laboratory values including red blood cell distribution width (RDW) and platelet count were reviewed. RDW to platelet count ratio (RPR) was calculated and correlated to overall survival (OS) rates. Results Median preoperative RPR was 0.053 (IQR 0.044–0.062). The receiver operating characteristic (ROC) curve indicated an optimal cut-off value for RPR to be 0.05 (AUC 0.62; p = 0.002, 95% CI 0.544–0.685). 101 patients (39%) presented with a preoperative RPR < 0.05, whereas 156 patients (61%) had a RPR ≥ 0.05. Patients with preoperative RPR < 0.05 exhibited a median OS of 20 months (95% CI 17.9–22.1), which was significantly higher compared to a median OS of 13 months (95% CI 10.9–15.1) in patients with preoperative RPR ≥ 0.05 (p < 0.001). Conclusions The present study suggests the RPR to constitute a novel prognostic inflammatory marker for glioblastoma patients in the course of preoperative routine laboratory examinations and might contribute to a personalized medicine approach.
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12
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Gupta MK, Yadav G, Singh Y, Bhalekar A. Correlation of the changing trends of red cell distribution width and serum lactate as a prognostic factor in sepsis and septic shock. J Anaesthesiol Clin Pharmacol 2021; 36:531-534. [PMID: 33840936 PMCID: PMC8022044 DOI: 10.4103/joacp.joacp_105_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/20/2019] [Accepted: 03/06/2020] [Indexed: 01/20/2023] Open
Abstract
Background and Aims: Various biomarkers are used for predicting outcome from sepsis and septic shock but single value doesn't give clear-cut picture. Changing trends of serum lactate and red cell distribution width (RDW) gives more accurate information of patient outcome. So, aim of this prospective observational study was to identify the correlation, for initial and changing trend of blood lactate level and RDW, with 28-day mortality in sepsis and septic shock. Material and Methods: Patient who fulfills the criteria of sepsis and septic shock, according to the consensus conference published in 2016, were included in this study. All patients were resuscitated and managed according to institutional protocol for sepsis and septic shock. Serum lactate and RDW was obtained from arterial blood gas and complete blood count, respectively. Serum lactate and RDW were recorded at 0 h, 6 h, 24 h, day 2, day 3, day 7, week 2, and week 3. Mean between two groups were compared with student t-test. Pearson and Spearman correlation coefficient was used for establishing correlation between two continuous data. P value < 0.05 indicates significant difference between two groups. Results: There is positive correlation between serum lactate and RDW at all-time point in non-survival group while negative correlation was found in survival group except on day1 and 2. Conclusion: Changing trends of serum lactate and RDW can be used as a prognostic marker in patient of sepsis and septic shock.
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Affiliation(s)
- Mukesh K Gupta
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Yashpal Singh
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Arvind Bhalekar
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
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13
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Initial red cell distribution width as a predictor of poor neurological outcomes in out-of-hospital cardiac arrest survivors in a prospective, multicenter observational study (the KoCARC study). Sci Rep 2020; 10:17549. [PMID: 33067528 PMCID: PMC7568563 DOI: 10.1038/s41598-020-74842-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 10/06/2020] [Indexed: 12/29/2022] Open
Abstract
This study aimed to investigate whether the initial red cell distribution width (RDW) at the emergency department (ED) is associated with poor neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. We performed a prospective observational analysis of patients admitted to the ED between October 2015 and June 2018 from the Korean Cardiac Arrest Research Consortium registry. We included OHCA patients who visited the ED and achieved return of spontaneous circulation. Initial RDW values were measured at the time of the ED visit. The primary outcome was a poor neurological (Cerebral Performance Category, or CPC) score of 3–5. A total of 1008 patients were ultimately included in this study, of whom 712 (70.6%) had poor CPC scores with unfavorable outcomes. Higher RDW quartiles (RDW 13.6–14.9%, RDW ≥ 15.0%), older age, female sex, nonshockable initial rhythm at the scene, unwitnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), medical history, low white blood cell counts and high glucose levels were associated with poor neurological outcomes in univariate analysis. In multivariate analysis, the highest RDW quartile was independently associated with poor neurological outcomes (odds ratio 2.04; 95% confidence interval 1.12–3.69; p = 0.019) at hospital discharge after adjusting for other confounding factors. Other independent factors including age, initial rhythm, bystander CPR and high glucose were also associated with poor neurological outcomes. These results show that an initial RDW in the highest quartile as of the ED visit is associated with poor neurological outcomes at hospital discharge among OHCA survivors.
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14
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Pinho J, Silva L, Quintas-Neves M, Marques L, Amorim JM, Reich A, Ferreira C. Red Cell Distribution Width is Associated with 30-day Mortality in Patients with Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2020; 34:825-832. [PMID: 32959199 PMCID: PMC8179905 DOI: 10.1007/s12028-020-01103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
Background Red cell distribution width (RDW) has been associated with mortality and outcome in a wide variety of non-neurological and neurological diseases, namely in myocardial infarction and acute ischemic stroke, and the reason for this is not completely understood. We aimed to investigate RDW as a potential prognostic marker in patients with intracerebral hemorrhage (ICH). Methods This is a retrospective study of consecutive patients with acute non-traumatic ICH admitted to a single center during a 4-year period. We reviewed individual clinical records to collect demographic and baseline information, including RDW at admission, 3-month functional status, and incidence of death during follow-up. Baseline computed tomography imaging was reviewed to classify the location of ICH, and to measure ICH volume and perihematomal edema volume. Patients were divided according to quartile distribution of RDW (RDW-Q1-4). Results The final study population consisted of 358 patients, median age 71 years (interquartile range [IQR] 60–80), 55% were male, and median Glasgow Coma Scale was 14 (IQR 10–15), with a mean follow-up of 17.6 months. Patients with higher RDW values were older (p = 0.003), more frequently presented with an active malignancy (p = 0.005), atrial fibrillation (p < 0.001), intraventricular hemorrhage (p = 0.048), and were anticoagulated (p < 0.001). Three-month functional independence was similar throughout RDW quartiles. RDW-Q4 was independently associated with increased 30-day mortality (adjusted odds ratio = 3.36, 95%CI = 1.48–7.62, p = 0.004), but not independently associated with increased mortality after 30 days (adjusted hazards ratio = 0.71, 95%CI = 0.29–1.73, p = 0.448). Conclusions RDW is a robust and independent predictor of 30-day mortality in non-traumatic ICH patients, and further studies to understand this association are warranted. Electronic supplementary material The online version of this article (10.1007/s12028-020-01103-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- João Pinho
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Lénia Silva
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | | | | | - Arno Reich
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Carla Ferreira
- Neurology Department, Hospital de Braga, Braga, Portugal
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15
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Ghimire R, Shakya YM, Shrestha TM, Neupane RP. The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal. BMC Emerg Med 2020; 20:43. [PMID: 32456665 PMCID: PMC7249690 DOI: 10.1186/s12873-020-00337-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background Sepsis is a common problem encountered in the emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency rooms using present scores, which has several variables to calculate. Red cell distribution width (RDW) is an easy, cheap, and efficacious score to predict the severity and mortality of patients with sepsis. Methods This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among the patients age ≥ 16 years and with a clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in the study by using a non-probability purposive sampling method. Results RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I = 0.649–0.818; p-value = 0.000) as APACHE II (AUC of 0.728; 95% C. I = 0.637 to 0.819; p-value = 0.000) or SOFA (AUC of 0.680, 95% C. I = 0.591–0.770; p-value = 0.001). Youden Index was maximum (37%) at RDW value 14.75, which has a sensitivity of 83% (positive likelihood ratio = 1.81) and specificity of 54% (negative likelihood ratio = 0.32). Out of 44 patients with septic shock 16 died (36.4%) and among 104 patients without septic shock, 24 died (22.9%) which had the odds ratio of 0.713 (p = 0.555, 95% C. I = 0.231–2.194). Overall mortality was 27.02% (n = 40). RDW group analysis showed no mortality in RDW < 13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to > 15.6 RDW group and 45.9% mortality in > 15.6 RDW group. Significant mortality difference was seen in 14 to > 15.6 and > 15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively. Conclusion Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.
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Affiliation(s)
- Rajan Ghimire
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Yogendra Man Shakya
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tirtha Man Shrestha
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ram Prasad Neupane
- Department of General Practice and Emergency Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Fogagnolo A, Spadaro S, Taccone FS, Ragazzi R, Romanello A, Fanni A, Marangoni E, Franchi F, Scolletta S, Volta CA. The prognostic role of red blood cell distribution width in transfused and non-transfused critically ill patients. Minerva Anestesiol 2019; 85:1159-1167. [DOI: 10.23736/s0375-9393.19.13522-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Fernandez R, Cano S, Catalan I, Rubio O, Subira C, Masclans J, Rognoni G, Ventura L, Macharete C, Winfield L, Alcoverro JM. High red blood cell distribution width as a marker of hospital mortality after ICU discharge: a cohort study. J Intensive Care 2018; 6:74. [PMID: 30473793 PMCID: PMC6240256 DOI: 10.1186/s40560-018-0343-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/01/2018] [Indexed: 01/08/2023] Open
Abstract
Background High red blood cell distribution width (RDW) is associated with worse outcome in diverse scenarios, including in critical illness. The Sabadell score (SS) predicts in-hospital survival after ICU discharge. We aimed to determine RDW’s association with survival after ICU discharge and whether RDW can improve the accuracy of the SS. Design Retrospective cohort study. Setting: general ICU at a university hospital. Patients We included all patients discharged to wards from January 2010 to October 2016. Methods We analyzed associations between RDW and variables recorded on admission (age, comorbidities, severity score), during the ICU stay (treatments, complications, length of stay (LOS)), and at ICU discharge (SS). The primary outcome was hospital mortality. Statistical analysis included multivariable logistic regression and receiver operating characteristic curve (ROC) analyses. Results We discharged 3366 patients to wards; median ward LOS was 7 [4–13] days; ward mortality was 5.2%. Mean RDW at ICU discharge was 15.4 ± 2.5%. Ward mortality was higher at each quartile of RDW (0.7%, 2.9%, 7.5%, 10.3%; area under ROC 0.81). A logistic regression model with Sabadell score obtained an excellent accuracy for ward mortality (area under ROC 0.863), and the addition of RDW slightly improved accuracy (AUROC 0.890, p < 0.05). Recursive partitioning demonstrated higher mortality in patients with high RDW at each SS level (1.6% vs. 0.3% in SS0, 9.7% vs. 1.1% in SS1, 21.9% vs. 9.7% in SS2), but not in SS3. Conclusion High RDW is a marker of severity at ICU discharge and improves the accuracy of Sabadell score in predicting ward mortality except in the more extreme SS3.
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Affiliation(s)
- Rafael Fernandez
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Silvia Cano
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Ignacio Catalan
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Olga Rubio
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Carles Subira
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Jaume Masclans
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Gina Rognoni
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Lara Ventura
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Caroline Macharete
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Len Winfield
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
| | - Josep Mª Alcoverro
- Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.,2Universitat Internacional de Catalunya, Barcelona, Spain.,3CIBERES, Madrid, Spain
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18
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Relationship of Red Cell Distribution Width to Adverse Outcomes in Adults With Congenital Heart Disease (from the Boston Adult Congenital Heart Biobank). Am J Cardiol 2018; 122:1557-1564. [PMID: 30217370 DOI: 10.1016/j.amjcard.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 02/08/2023]
Abstract
Red cell distribution width (RDW), a measure of variability in red cell size, predicts adverse outcomes in acquired causes of heart failure. We examined the relation of RDW and outcomes in adults with congenital heart disease. We performed a prospective cohort study on 696 ambulatory patients ≥18years old enrolled in the Boston Adult Congenital Heart Disease Biobank between 2012 and 2016 (mean age 38.7 ± 13.5 years; 49.9% women). The combined outcome was all-cause mortality or nonelective cardiovascular hospitalization. Most patients had moderately or severely complex congenital heart disease (42.5% and 38.5%, respectively). Mean RDW was 14.0 ± 1.3%. RDW >15% was present in 81 patients (11.6%). After median 767days of follow-up, 115 patients sustained the primary combined outcome, including 31 who died. Higher RDW predicted both the combined outcome (hazard ratio [HR] for RDW >15% = 4.5, 95% confidence interval [CI] 3.0 to 6.6; HR per + 1SD RDW = 1.8, 95% CI 1.6 to 2.0, both p <0.0001) and death alone (HR for RDW >15% = 7.1, 95% CI 3.5 to 14.4; HR per + 1SD RDW = 1.8, 95% CI 1.6 to 2.0, both p <0.0001). RDW remained an independent predictor of the combined outcome after adjusting for age, cyanosis, congenital heart disease complexity, ventricular systolic function, New York Heart Association functional class, hemoglobin concentration, mean corpuscular volume, high-sensitivity C-reactive protein and estimated glomerular filtration rate (HR per + 1SD RDW = 1.5, 95% CI 1.2 to 1.9, p <0.0001). RDW also remained an independent predictor of mortality alone after adjustment for age plus each variable individually. In conclusion, elevated RDW is an independent predictor of all-cause mortality or nonelective cardiovascular hospitalization in adults with congenital heart disease. This simple clinical biomarker identifies increased risk for adverse events even among patients with preserved functional status.
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19
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Spadaro S, Taccone FS, Fogagnolo A, Franchi F, Scolletta S, Ragazzi R, Fanni A, Marangoni E, Govoni M, Reverberi R, Volta CA. The effects of blood transfusion on red blood cell distribution width in critically ill patients: a pilot study. Transfusion 2018; 58:1863-1869. [DOI: 10.1111/trf.14759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care; Erasme Hospital, Université Libre de Bruxelles; Brussels Belgium
| | - Alberto Fogagnolo
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care; University Hospital of Siena; Siena Italy
| | - Sabino Scolletta
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care; University Hospital of Siena; Siena Italy
| | - Riccardo Ragazzi
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Alberto Fanni
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Elisabetta Marangoni
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Maurizio Govoni
- Blood Transfusion Service, Sant'Anna Hospital; Ferrara Italy
| | | | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
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20
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Abdullah HR, Sim YE, Sim YT, Ang AL, Chan YH, Richards T, Ong BC. Preoperative Red Cell Distribution Width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study. Sci Rep 2018; 8:6226. [PMID: 29670189 PMCID: PMC5906451 DOI: 10.1038/s41598-018-24556-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/06/2018] [Indexed: 12/20/2022] Open
Abstract
Increased red cell distribution width (RDW) is associated with poorer outcomes in various patient populations. We investigated the association between preoperative RDW and anaemia on 30-day postoperative mortality among elderly patients undergoing non-cardiac surgery. Medical records of 24,579 patients aged 65 and older who underwent surgery under anaesthesia between 1 January 2012 and 31 October 2016 were retrospectively analysed. Patients who died within 30 days had higher median RDW (15.0%) than those who were alive (13.4%). Based on multivariate logistic regression, in our cohort of elderly patients undergoing non-cardiac surgery, moderate/severe preoperative anaemia (aOR 1.61, p = 0.04) and high preoperative RDW levels in the 3rd quartile (>13.4% and ≤14.3%) and 4th quartile (>14.3%) were significantly associated with increased odds of 30-day mortality - (aOR 2.12, p = 0.02) and (aOR 2.85, p = 0.001) respectively, after adjusting for the effects of transfusion, surgical severity, priority of surgery, and comorbidities. Patients with high RDW, defined as >15.7% (90th centile), and preoperative anaemia have higher odds of 30-day mortality compared to patients with anaemia and normal RDW. Thus, preoperative RDW independently increases risk of 30-day postoperative mortality, and future risk stratification strategies should include RDW as a factor.
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Affiliation(s)
- H R Abdullah
- Consultant, Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore Assistant Professor, Duke-NUS Medical School, Singapore, Singapore.
| | - Y E Sim
- Senior Resident, Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Y T Sim
- Medical Student, University of Tasmania School of Medicine, Hobart, Australia
| | - A L Ang
- Senior Consultant, Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Y H Chan
- Head, Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - T Richards
- Professor of Surgery, Division of Surgery, University College, London, United Kingdom
| | - B C Ong
- Chairman Medical Board, Sengkang Health, Singapore, Singapore
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Pinho J, Marques SA, Freitas E, Araújo J, Taveira M, Alves JN, Ferreira C. Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis. Thromb Res 2018; 164:4-8. [DOI: 10.1016/j.thromres.2018.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/28/2018] [Accepted: 02/06/2018] [Indexed: 01/14/2023]
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Fontana V, Spadaro S, Bond O, Cavicchi FZ, Annoni F, Donadello K, Vincent JL, De Backer D, Taccone FS. No relationship between red blood cell distribution width and microcirculatory alterations in septic patients. Clin Hemorheol Microcirc 2017; 66:131-141. [PMID: 28128746 DOI: 10.3233/ch-160154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased red cell distribution width (RDW), a quantitative measure of erythrocyte size variability, has been associated with increased mortality in critically ill patients. METHODS In this post-hoc analysis of prospectively collected data, we studied 122 septic patients with and without shock who had undergone sublingual microcirculatory assessment using Sidestream Dark Field (SDF) videomicroscopy. Patient demographics, comorbidities, the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission and the Sequential Organ Failure Assessment (SOFA) score on the day of the microcirculatory assessment were collected. The RDW was retrospectively collected on the day of the microcirculatory evaluation from the routine daily blood count analysis. RESULTS Median patient age was 68[55-77] years, and median APACHE II and SOFA scores were 22[17-28] and 10[8-12], respectively; ICU mortality was 43%. On the day of the microcirculatory analysis, the median RDW was 13.8[12.8-15.5]% and was elevated (>13.4%) in 74 (61%) patients. There was no correlation between RDW and microcirculatory parameters (functional capillary density, r2 = 0.12; proportion of small perfused vessels, r2 = 0.17; mean flow index, r2 = 0.14). RDW was not related to disease severity, the presence of shock or survival. CONCLUSIONS RDW is not associated with microcirculatory alterations or prognosis in septic patients.
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Affiliation(s)
- Vito Fontana
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Ottavia Bond
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Federica Zama Cavicchi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Filippo Annoni
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Katia Donadello
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel De Backer
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care and Emergency, CHIREC Hospitals, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Kong T, Park JE, Park YS, Lee HS, You JS, Chung HS, Park I, Chung SP. Usefulness of serial measurement of the red blood cell distribution width to predict 28-day mortality in patients with trauma. Am J Emerg Med 2017; 35:1819-1827. [DOI: 10.1016/j.ajem.2017.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022] Open
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Prognostic Value of Red Blood Cell Distribution Width in Non-Cardiovascular Critically or Acutely Patients: A Systematic Review. PLoS One 2016. [PMID: 27936006 DOI: 10.1371/journal.pone.0167000.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND RDW (red cell distribution width) has been reported to been associated with the prognosis of patients with cardiovascular diseases. However, RDW is often overlooked by clinicians in treating patients with non-cardiovascular diseases, especially in an emergency. The objective of this systematic review is to explore the prognostic value of RDW in non-cardiovascular emergencies. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched from their inception to December 31, 2015. We included studies examining the relationship between RDW and mortality rate by adjusting important covariables in non-cardiovascular emergencies. All included studies were divided into three groups. Group A: general critically ill patients; Group B: patients with infectious disease; Group C: other conditions. We extracted each study' characteristics, outcomes, covariables, and other items independently. RESULTS A total of 32 studies were eligible for inclusion in our meta-analysis. Six studies belonged to Group A, 9 studies belonged to Group B and 17 studies belonged to Group C. Among these included studies, RDW was assessed as a continuous variable (per 1% increase) in 16 studies, as a binary variable in 8 studies, and as a categorical variable in 8 studies. In addition, AUCs (area under the receiver operating characteristic curve) of RDW for predicting mortality were reported in 25 studies. All studies were published between 2011-2015. The qualities of included 32 studies were moderate or high. CONCLUSION The present systematic review indicates that the increased RDW is significantly associated with a higher mortality rate in an non-cardiovascular emergency. The low cost and readily accessible of this laboratory variable may strengthen its usefulness in daily practice in the future.
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Luo R, Hu J, Jiang L, Zhang M. Prognostic Value of Red Blood Cell Distribution Width in Non-Cardiovascular Critically or Acutely Patients: A Systematic Review. PLoS One 2016; 11:e0167000. [PMID: 27936006 PMCID: PMC5147853 DOI: 10.1371/journal.pone.0167000] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/07/2016] [Indexed: 01/23/2023] Open
Abstract
Background RDW (red cell distribution width) has been reported to been associated with the prognosis of patients with cardiovascular diseases. However, RDW is often overlooked by clinicians in treating patients with non-cardiovascular diseases, especially in an emergency. The objective of this systematic review is to explore the prognostic value of RDW in non-cardiovascular emergencies. Methods PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched from their inception to December 31, 2015. We included studies examining the relationship between RDW and mortality rate by adjusting important covariables in non-cardiovascular emergencies. All included studies were divided into three groups. Group A: general critically ill patients; Group B: patients with infectious disease; Group C: other conditions. We extracted each study’ characteristics, outcomes, covariables, and other items independently. Results A total of 32 studies were eligible for inclusion in our meta-analysis. Six studies belonged to Group A, 9 studies belonged to Group B and 17 studies belonged to Group C. Among these included studies, RDW was assessed as a continuous variable (per 1% increase) in 16 studies, as a binary variable in 8 studies, and as a categorical variable in 8 studies. In addition, AUCs (area under the receiver operating characteristic curve) of RDW for predicting mortality were reported in 25 studies. All studies were published between 2011–2015. The qualities of included 32 studies were moderate or high. Conclusion The present systematic review indicates that the increased RDW is significantly associated with a higher mortality rate in an non-cardiovascular emergency. The low cost and readily accessible of this laboratory variable may strengthen its usefulness in daily practice in the future.
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Affiliation(s)
- Rubin Luo
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine& Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine& Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
| | - Libing Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine& Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine& Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
- * E-mail:
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Chung SP, Yune HY, Park YS, You JS, Hong JH, Kong T, Park JW, Chung HS, Park I. Usefulness of mean platelet volume as a marker for clinical outcomes after out-of-hospital cardiac arrest: a retrospective cohort study. J Thromb Haemost 2016; 14:2036-2044. [PMID: 27437641 DOI: 10.1111/jth.13421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 06/27/2016] [Indexed: 01/06/2023]
Abstract
Essentials It is unknown whether mean platelet volume (MPV) estimates outcomes after cardiac arrest (CA). We investigated whether MPV was associated with 30-day neurologic outcome and mortality after CA. Elevated MPV at admission was associated with poor neurological outcomes and mortality at 30 days. Identifying levels of MPV is helpful for estimating disease severity among resuscitated patients. SUMMARY Background Whole-body ischemia followed by reperfusion during cardiac arrest and after return of spontaneous circulation (ROSC) triggers systemic sterile inflammatory responses, inducing a sepsis-like state during post-cardiac arrest syndrome. Activated platelets are enlarged, and contain vasoactive and prothrombic factors that aggravate systemic inflammation and endothelial dysfunction. Objectives To investigate whether mean platelet volume (MPV) is useful as a marker for early mortality and neurologic outcomes in patients who achieve ROSC after out-of-hospital cardiac arrest (OHCA). Methods OHCA records from the Emergency Department Cardiac Arrest Registry were retrospectively analyzed. Patients who survived for > 24 h after ROSC were included. We evaluated mortality and cerebral performance category scores after 30 days. Results We analyzed records from 184 patients with OHCA. Increased 30-day mortality among patients who achieved ROSC after OHCA was associated with MPV at admission (hazard ratio [HR] 1.36; 95% confidence interval [CI] 1.06-1.75). An elevated MPV at admission was also associated with poor neurologic outcomes (HR 1.28; 95% CI 1.06-1.55). Conclusions An elevated MPV was independently associated with increased 30-day mortality, with the highest discriminative value being obtained upon admission after OHCA. An elevated MPV on admission was associated with poor neurologic outcomes. High MPVs are helpful for estimating 30-day mortality and neurologic outcomes among patients who achieve ROSC after OHCA.
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Affiliation(s)
- S P Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - H Y Yune
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - J S You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - J H Hong
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - T Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - J W Park
- Department of Emergency Medicine, Kosin University College of Medicine, Busan, Korea
| | - H S Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - I Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Demiray O, Cevik E, Cuce F. Association Between Complete Blood Count Parameters and Urinary Stone Disease. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24319. [PMID: 27651947 PMCID: PMC5020604 DOI: 10.5812/ircmj.24319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/02/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complete blood count (CBC) parameters may associated with multiple diseases. Urinary stone disease is common public problem. Predictive value of CBC parameters may be associated with urinary stone disease. OBJECTIVES To analyze the association between complete blood count (CBC) parameters and urinary stone disease. PATIENTS AND METHODS This study was a retrospective observational study of 3,099 patients who were admitted to the urology outpatient clinic or diagnosed with urinary stone disease in the emergency services department. There were 353 patients included in the study that had ultrasonography (USG) and/or non-contrast computerized tomography (NCCT) and a CBC. Patients who had non-urinary system inflammatory disease in USG or NCCT, had fever, non-urinary system infection, anemia or diagnosed hematologic malignancy were excluded (n = 27). Patients were divided into two groups: a stone group (n = 74) and a control group (n = 252). Data of patients were retrieved from the hospital database and statistical analysis was performed. RESULTS An increase in RDW, MPV, PDW, WBC, granulocyte percentage and a decrease in lymphocyte percentage is statistically associated with urinary stone disease (P < 0,001, P < 0.001, P = 0.006, P < 0.001, P = 0.003, P = 0.034, respectively). Microscopic hematuria is associated with urinary stone disease and the odds ratio for urinary stone prediction is 67.7 (P < 0.001). In addition, none of the CBC parameters were associated with stone burden. CONCLUSIONS When evaluating flank pain in patients, it is important to remember that CBC parameters may support urinary stone disease, and considering CBC results may be useful in the diagnosis of urinary stone disease.
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Affiliation(s)
- Ozay Demiray
- Department of Urology, Van Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey
| | - Erdem Cevik
- Department of Emergency Medicine, Van, Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey
- Corresponding Author: Erdem Cevik, Department of Emergency Medicine, Van Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey. Tel: +90-4322223329, E-mail:
| | - Ferhat Cuce
- Department of Radiology, Van Military Hospital, Van Askeri Hastanesi, Altintepe, Van, Turkey
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Red Blood Cell Distribution Width is Associated with Poor Clinical Outcome After Subarachnoid Hemorrhage: A Pilot Study. Neurocrit Care 2016; 23:217-24. [PMID: 25672971 DOI: 10.1007/s12028-015-0117-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The red cell distribution width (RDW) is a biomarker strongly associated with poor outcome in inflammatory and thrombotic diseases. Subarachnoid hemorrhage (SAH) is both an inflammatory and thrombotic state in which many biomarkers have been studied. In this exploratory pilot study, we sought to determine whether RDW predicts poor outcome in patients with SAH. METHODS Patients with moderate-to-severe SAH were prospectively enrolled in an observational study of biomarkers and outcome. CBC, ESR, high sensitivity CRP, D-dimer, and fibrinogen were obtained on post-bleed days (PBD) 1, 3, 5, 7, and 10. Poor outcome was defined as a modified Rankin score of 3-6 at 90-days. RESULTS Of 40 patients, 5 (12.5%) died and 19 (47.5%) had a poor outcome. RDW (p = 0.046) when measured serially over the study period, was significantly higher among patients with poor outcome. Maximum RDW (OR 2.3 95% CI 1.2-3.6; p = 0.014) and maximum WBC count (OR 1.29 95% CI 1.04-1.60; p = 0.018) were associated with poor outcome. Stepwise addition of maximum ESR, CRP, D-dimer, and fibrinogen yielded a model with RDW (OR 2.54 95% CI 1.21-5.35; p = 0.014) and fibrinogen (OR 1.01 95% CI 1.002-1.01; p = 0.004) predicting outcome. With addition of age and Hunt and Hess grade, RDW, fibrinogen, and high-grade status remained significantly associated with poor outcome. Use of PBD1 RDW in lieu of maximum RDW, resulted in a similar model. CONCLUSIONS An elevated RDW is associated with poor outcome in SAH patients. RDW may be a useful predictor of outcomes after SAH.
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Chen CK, Lin SC, Wu CC, Chen LM, Tzeng IS, Chen KF. STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department. Medicine (Baltimore) 2016; 95:e3692. [PMID: 27310948 PMCID: PMC4998434 DOI: 10.1097/md.0000000000003692] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65)). Of 6973 consecutive adult patients with a clinical diagnosis of sepsis and 2 sets of blood culture ordered by physicians, 477 (6.8%) died. The mortality group had higher RDW levels than the survival group (15.7% vs 13.8%). After dividing RDW into quartiles, the patients in the highest RDW quartile (RDW >15.6%; mortality, 16.7%) had more than twice the risk of in-hospital mortality compared with patients in the second highest quartile (RDW >14% and <15.6%; mortality, 7.3%), whereas the mortality rate in the lowest RDW quartile (<13.1%) was only 1.6%. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.75 (95% confidence interval, 0.72-0.77), which is significantly higher than the areas under the curve of clinical prediction rules (SIRS, MEDS, and CURB65). After integrating RDW into these scores, all scores performed better in predicting mortality (0.73, 0.72, and 0.77, for SIRS, MEDS, and CURB65, respectively). RDW could be an independent predictor of mortality among septic patients. Clinicians could classify the septic patients into different risk groups according to RDW quartiles. For more accurate mortality prediction, RDW could be a potential parameter to be incorporated into clinical prediction rules.
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Affiliation(s)
- Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shen-Che Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chin-Chieh Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Li-Min Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Shiang Tzeng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
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Kim S, Lee K, Kim I, Jung S, Kim MJ. Red cell distribution width and early mortality in elderly patients with severe sepsis and septic shock. Clin Exp Emerg Med 2015; 2:155-161. [PMID: 27752590 PMCID: PMC5052839 DOI: 10.15441/ceem.15.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the association of red cell distribution width (RDW) with 30-day mortality in elderly patients with severe sepsis and septic shock. Methods Patients were recruited from a single tertiary emergency department. Patients with age over 65 years were selected. The main outcome was 30-day mortality. Potential confounders as Acute Physiologic and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score along with initial vital signs were collected. Multivariate Cox proportional hazards analysis was performed to identify independent predictors of 30-day mortality. The discriminative ability of RDW for 30-day mortality was evaluated using receiver operating characteristic curve analysis. Results Overall, 458 patients were included. Univariate analysis showed that patients’ survival was significantly associated with sites of infection, comorbidities, and severity scores. In the multivariate Cox proportional hazard model, the RDW was an independent predictor of 30-day mortality (hazards ratio, 1.10; 95% confidence interval, 1.04 to 1.17; P<0.001). Conclusion In this study, initial RDW values were significantly associated with 30-day mortality in older patients hospitalized with severe sepsis and septic shock.
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Affiliation(s)
- Sejin Kim
- Department of Emergency Medicine, Myongji Hospital, Goyang, Korea
| | - Kyoungmi Lee
- Department of Emergency Medicine, Myongji Hospital, Goyang, Korea
| | - Inbyung Kim
- Department of Emergency Medicine, Myongji Hospital, Goyang, Korea
| | - Siyoung Jung
- Department of Emergency Medicine, Myongji Hospital, Goyang, Korea
| | - Moon-Jung Kim
- Department of Laboratory Medicine, Myongji Hospital, Goyang, Korea
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Yune HY, Chung SP, Park YS, Chung HS, Lee HS, Lee JW, Park JW, You JS, Park I, Lee HS. Delta neutrophil index as a promising prognostic marker in out of hospital cardiac arrest. PLoS One 2015; 10:e0120677. [PMID: 25798609 PMCID: PMC4370748 DOI: 10.1371/journal.pone.0120677] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/25/2015] [Indexed: 01/15/2023] Open
Abstract
Background The post-resuscitation phase after out-of-hospital cardiac arrest (OHCA) is characterised by a systemic inflammatory response (e.g., severe sepsis), for which the immature granulocyte count is a diagnostic marker. In this study we evaluated the prognostic significance of the delta neutrophil index (DNI), which is the difference in leukocyte subfractions as assessed by an automated blood cell analyser, for early mortality after OHCA. Materials and Methods OHCA records from the emergency department cardiac arrest registry were retrospectively analysed. Patients who survived at least 24 h after return of spontaneous circulation were included in the analysis. We evaluated mortality and cerebral performance category scores at 30 days. Results A total of 83 patients with OHCA were included in the study. Our results showed that DNI >8.4% on day 1 (hazard ratio [HR], 3.227; 95% CI, 1.485–6.967; p = 0.001) and DNI >10.5% on day 2 (HR, 3.292; 95% CI, 1.662–6.519; p<0.001) were associated with increased 30-day mortality in patients with OHCA. Additionally, DNI >8.4% on day 1 (HR, 2.718; 95% CI, 1.508–4.899; p<0.001) and DNI >10.5% on day 2 (HR, 1.709; 95% CI, 1.051–2.778; p = 0.02) were associated with worse neurologic outcomes 30 days after OHCA. Conclusion A higher DNI is a promising prognostic marker for 30-day mortality and neurologic outcomes after OHCA. Our findings indicate that patients with elevated DNI values after OHCA might be closely monitored so that appropriate treatment strategies can be implemented.
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Affiliation(s)
- Ho Young Yune
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Wook Lee
- Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon, Republic of Korea
| | - Jong Woo Park
- Department of Emergency Medicine, Changwon Fatima Hospital, Changwon, Republic of Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
- * E-mail: (JSY)
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hahn Shick Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Cohen MS, Cipriano A, Stawicki SP, Firstenberg MS, Papadimos TJ. What's New in Critical Illness and Injury Science: The decades-long quest for a valid prognostic sepsis biomarker continues. Int J Crit Illn Inj Sci 2015; 4:275-7. [PMID: 25625056 PMCID: PMC4296327 DOI: 10.4103/2229-5151.147517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marissa S Cohen
- Temple University/St. Luke's Medical School, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States ; Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Anthony Cipriano
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States ; Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Michael S Firstenberg
- Northeast Ohio Medical University and The Summa Health Care System, Akron, Ohio, United States
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, United States
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Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2014; 52:86-105. [PMID: 25535770 DOI: 10.3109/10408363.2014.992064] [Citation(s) in RCA: 592] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The red blood cell distribution width (RDW) is a simple and inexpensive parameter, which reflects the degree of heterogeneity of erythrocyte volume (conventionally known as anisocytosis), and is traditionally used in laboratory hematology for differential diagnosis of anemias. Nonetheless, recent evidence attests that anisocytosis is commonplace in human disorders such as cardiovascular disease, venous thromboembolism, cancer, diabetes, community-acquired pneumonia, chronic obstructive pulmonary disease, liver and kidney failure, as well as in other acute or chronic conditions. Despite some demographic and analytical issues related to the routine assessment that may impair its clinical usefulness, an increased RDW has a high negative predictive value for diagnosing a variety of disorders, but also conveys important information for short- and long-term prognosis. Even more importantly, the value of RDW is now being regarded as a strong and independent risk factor for death in the general population. Although it has not been definitely established whether an increased value of RDW is a risk factor or should only be considered an epiphenomenon of an underlying biological and metabolic imbalance, it seems reasonable to suggest that the assessment of this parameter should be broadened far beyond the differential diagnosis of anemias. An increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities such as shortening of telomere length, oxidative stress, inflammation, poor nutritional status, dyslipidemia, hypertension, erythrocyte fragmentation and alteration of erythropoietin function. As such, the aim of this article is to provide general information about RDW and its routine assessment, to review the most relevant implications in health and disease and give some insights about its potential clinical applications.
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Affiliation(s)
- Gian Luca Salvagno
- Clinical Chemistry Section, Department of Life and Reproductive Sciences, Academic Hospital of Verona , Verona , Italy
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Lorente L, Martín MM, Abreu-González P, Solé-Violán J, Ferreres J, Labarta L, Díaz C, González O, García D, Jiménez A, Borreguero-León JM. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients. PLoS One 2014; 9:e105436. [PMID: 25153089 PMCID: PMC4143268 DOI: 10.1371/journal.pone.0105436] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/20/2014] [Indexed: 12/12/2022] Open
Abstract
Objective Higher values of red blood cell distribution width (RDW) have been found in non-surviving than in surviving septic patients. However, it is unknown whether RDW during the first week of sepsis evolution is associated with sepsis severity and early mortality, oxidative stress and inflammation states, and these were the aims of the study. Methods We performed a prospective, observational, multicenter study in six Spanish Intensive Care Units with 297 severe septic patients. We measured RDW, serum levels of malondialdehyde (MDA) to assess oxidative stress, and tumour necrosis factor (TNF)-α to assess inflammation at days 1, 4, and 8. The end-point was 30-day mortality. Results We found higher RDW in non-surviving (n = 104) than in surviving (n = 193) septic patients at day 1 (p = 0.001), day 4 (p = 0.001), and day 8 (p = 0.002) of ICU admission. Cox regression analyses showed that RDW at day 1 (p<0.001), 4 (p = 0.005) and 8 (p = 0.03) were associated with 30-day mortality. Receiver operating characteristic curves showed that RDW at day 1 (p<0.001), 4 (p<0.001), and 8 (p<0.001) could be used to predict 30-day mortality. RDW showed a positive correlation with serum MDA levels at day 1 and day 4, with serum TNF-α levels at days 4 and 8, and with SOFA score at days 1, 4 and 8. Conclusions The major findings of our study were that non-surviving septic patients showed persistently higher RDW during the first week of ICU stay than survivors, that RDW during the first week was associated with sepsis severity and mortality, that RDW during the first week could be used as biomarker of outcome in septic patients, and that there was an association between RDW, serum MDA levels, and serum TNF-α levels during the first week.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
- * E-mail:
| | - María M. Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Pedro Abreu-González
- Deparment of Phisiology, Faculty of Medicine, University of the La Laguna, La Laguna, Tenerife, Spain
| | - Jordi Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Gran Canria, Spain
| | - José Ferreres
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - César Díaz
- Intensive Care Unit, Hospital Insular, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Oswaldo González
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Daida García
- Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Alejandro Jiménez
- Research Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
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Weng CL, Wang CH, Chen IC, Hsiao KY, Chang KP, Wu SY, Shih HM. Red cell distribution width is an independent predictor of mortality in necrotizing fasciitis. Am J Emerg Med 2014; 32:1259-62. [PMID: 25178850 DOI: 10.1016/j.ajem.2014.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rapidly progressing and potentially lethal infectious disease of the soft tissue. An elevated red blood cell distribution width (RDW) is associated with increased risk of death in patients with heart disease and infectious disease. We retrospectively assessed the association of elevated RDW with in-hospital mortality due to NF. METHODS All patients had diagnoses of NF and were admitted to the emergency department of a single institution in Taiwan over a 4-year period. Demographics, comorbidities, clinical presentations, and laboratory parameters were retrospectively reviewed. Red blood cell distribution width was categorized as elevated (>14.5%) or not elevated. Multivariate regression analysis was used to identify risk factors associated with mortality. RESULTS A total of 98 patients were enrolled, and the mortality rate was 23%. Univariate analysis indicated that advanced age, initial hypotension, low hemoglobin level, and elevated RDW (69.6% vs 20%, OR = 9.14, P < .001) were significantly associated with mortality. Multivariate analysis indicated that RDW was a significant and independent predictor of mortality in enrolled patients. CONCLUSIONS Elevated RDW is a significant and independent predictor of in-hospital mortality for patients with NF.
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Affiliation(s)
- Chia-Lung Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
| | - Cheng-Hsien Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
| | - I-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
| | - Kuang-Yu Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
| | - Kung-Pin Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
| | - Shih-Yun Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
| | - Hong-Mo Shih
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC).
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Kang C, Park IS, Kim DH, Kim SC, Jeong JH, Lee SH, Lee SB, Jung SM, Kang TS, Lee KW. Red cell distribution width as a predictor of mortality in organophosphate insecticide poisoning. Am J Emerg Med 2014; 32:743-6. [DOI: 10.1016/j.ajem.2014.02.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 11/28/2022] Open
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Red cell distribution width as a prognostic indicator in pediatric heart disease and after surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:681679. [PMID: 24745021 PMCID: PMC3973010 DOI: 10.1155/2014/681679] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/11/2014] [Indexed: 11/18/2022]
Abstract
Background. Red cell distribution width (RDW) is an important marker which reflects inflammatory activity in many chronic diseases. The objective of this study is to investigate the impact of RDW on morbidity and mortality before and after pediatric congenital heart surgery. Methods. 107 patients with congenital heart disease, cardiac case group, and 70 patients, control group, without heart disease were retrospectively analyzed. Pre-, and postoperative and at discharge RDW of the cardiac patients were determined. Lengths of hospital and intensive care unit (ICU) stay and exited patients were determined. Results. Mean lengths of ICU and hospital stay were 3.3 ± 2.7 and 7.3 ± 2.9 days. In control group, mean preoperative RDW was 12.6 ± 1.4, while in cardiac case group it was significantly higher (15.1 ± 3.5). In cardiac case group, postoperative RDW were significantly higher than preoperative period, while RDW at discharge were significantly lower than postoperative estimates. A significant and a positive correlation was detected between lengths of ICU and hospital stay and RDW. RDW of the exited patients were significantly higher than the survivors. Conclusions. This study demonstrates that RDW can be used as an important indicator in the prediction of morbidity and mortality during pre-, and postoperative period of the pediatric congenital heart disease surgery.
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Kim S, Cho J, Lim Y, Kim J, Yang H, Lee G. Change in Red Cell Distribution Width as Predictor of Death and Neurologic Outcome in Patients Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.4.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seongtak Kim
- Emergency Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jinseong Cho
- Emergency Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Yongsu Lim
- Emergency Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Jinjoo Kim
- Emergency Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Hyukjun Yang
- Emergency Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Gun Lee
- Emergency Medicine, Gil Medical Center, Gachon University, Incheon, Korea
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Narci H, Turk E, Karagulle E, Togan T, Karabulut K. The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study. World J Emerg Surg 2013; 8:46. [PMID: 24216220 PMCID: PMC3826504 DOI: 10.1186/1749-7922-8-46] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/31/2013] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The aim of this study was to seek whether red cell distribution width (RDW) has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of RDW with leukocyte count and C-reactive protein (CRP) level. METHODS This study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and February 2013 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. Age, gender, leukocyte count, CRP, and RDW values were recorded. This study is a case controlled retrospective clinical study. RESULTS A total of 590 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 711 subjects. The mean RDW levels were 15.4 ± 1.5% in the acute appendicitis group, while 15.9 ± 1.4% in the control group. CRP, leukocyte count were significantly higher in the acute appendicitis group, and RDW level were significantly lower in the acute appendicitis group (p < 0.001, p < 0.001, p = 0.001, respectively). RDW, leukocyte count, and CRP had a sensitivity and specificity of 47% and 67%; 91% and 74%; and 97% and 41%, respectively in acute appendicitis. RDW was not correlated with CRP and leukocyte levels. However, we found a correlation between CRP and leukocyte levels. CONCLUSION RDW level was lower in patients with acute appendicitis. The magnitude of difference in RDW seen between acute appendicitis and controls was so slight as to be of no utility in diagnostic testing.
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Affiliation(s)
- Huseyin Narci
- Department of Emergency Medicine, Baskent Universitesi Konya Hastanesi Hocacihan mah, Saray caddesi No: 1, Selcuklu, Konya 42080, Turkey.
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Sičaja M, Pehar M, Đerek L, Starčević B, Vuletić V, Romić Ž, Božikov V. Red blood cell distribution width as a prognostic marker of mortality in patients on chronic dialysis: a single center, prospective longitudinal study. Croat Med J 2013; 54:25-32. [PMID: 23444243 PMCID: PMC3583391 DOI: 10.3325/cmj.2013.54.25] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM To determine if red cell distribution width (RDW) is associated with all-cause mortality in patients on chronic dialysis and to evaluate its prognostic value among validated prognostic biomarkers. METHODS This is a single center, prospective longitudinal study. At the time of inclusion in January 2011, all patients were physically examined and a routine blood analysis was performed. A sera sample was preserved for determination of NT-pro-brain natriuretic peptide (NT-pro-BNP) and eosinophil cationic protein. Carotid intima media thickness (IMT) was also measured. Following one year, all-cause mortality was evaluated. RESULTS Of 100 patients, 25 patients died during the follow-up period of one-year. Patients who died had significantly higher median [range] RDW levels (16.7% [14.3-19.5] vs 15.5% [13.2-19.7], P<0.001. They had significantly higher Eastern Cooperative Oncology Group (ECOG) performance status (4 [2-4] vs 2 [1-4], Plt;0.001), increased intima-media thickness (IMT) (0.71 [0.47-1.25] vs 0.63 [0.31-1.55], P=0.011), increased NT-pro-BNP levels (8300 [1108-35000] vs 4837 [413-35000], P=0.043), and increased C-reactive protein (CRP) levels (11.6 [1.3-154.2] vs 4.9 [0.4-92.9], Plt;0.001). For each 1% point increase in RDW level as a continuous variable, one-year all cause mortality risk was increased by 54% in univariate Cox proportional hazard analysis. In the final model, when RDW was entered as a categorical variable, mortality risk was significantly increased (hazard ratio, 5.15, 95% confidence interval, 2.33 to 11.36) and patients with RDW levels above 15.75% had significantly shorter survival time (Log rank Plt;0.001) than others. CONCLUSIONS RDW could be an additive predictor for all-cause mortality in patients on chronic dialysis. Furthermore, RDW combined with sound clinical judgment improves identification of patients who are at increased risk compared to RDW alone.
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Affiliation(s)
- Mario Sičaja
- Department of Medicine, Dubrava University Hospital, Zagreb, Croatia.
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Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, Kang KW, Kim J, Rhee JE. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013; 31:545-8. [DOI: 10.1016/j.ajem.2012.10.017] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 10/17/2012] [Accepted: 10/23/2012] [Indexed: 01/07/2023] Open
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Prognostic implication of initial coagulopathy in out-of-hospital cardiac arrest. Resuscitation 2013; 84:48-53. [DOI: 10.1016/j.resuscitation.2012.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/24/2012] [Accepted: 09/03/2012] [Indexed: 11/18/2022]
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