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Is elevated red cell distribution width a prognostic predictor in adult patients with community acquired pneumonia?
Eyal Braun1, Jad Kheir, Tanya Mashiach
1Departments of Medicine H and B, Rambam Health Care Campus, P,O, Box 9602, 31096 Haifa, Israel. e_braun@rambam.health.gov.il.
Insights
Elevated red blood cell distribution width (RDW) predicts worse outcomes in community-acquired pneumonia (CAP). Higher RDW levels correlate with increased mortality and severe complications in adult CAP patients.
Area of Science:
- Internal Medicine
- Pulmonology
- Critical Care Medicine
Background:
- Community-acquired pneumonia (CAP) is a significant cause of illness and death.
- Previous research indicated elevated red blood cell distribution width (RDW) is linked to higher mortality in younger CAP patients.
- This study examines RDW's prognostic value in a broader adult CAP population.
Purpose of the Study:
- To assess the predictive value of red blood cell distribution width (RDW) for mortality and severe morbidity in adult patients with community-acquired pneumonia (CAP).
Main Methods:
- Retrospective analysis of 3815 adult patients diagnosed with CAP between 2005 and 2010.
- Primary endpoint: 90-day mortality. Secondary endpoint: complicated hospitalization (in-hospital mortality, prolonged stay, or ICU admission).
- Binary logistic regression used to identify risk factors and associations with RDW levels.
Main Results:
- Elevated RDW (>15%) was independently associated with increased 90-day mortality and complicated hospitalization.
- Other mortality predictors included advanced age, high comorbidity index, low hemoglobin, low sodium, high BUN, and low systolic blood pressure.
- RDW's prognostic value was independent of hemoglobin levels, white blood cell count, age, or Charlson score.
Conclusions:
- Elevated RDW on admission is a significant predictor of mortality and severe morbidity in adult CAP patients.
- RDW serves as a valuable prognostic marker in CAP, irrespective of other common clinical indicators.
Background:
Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards.
Methods:
The cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization.
Results:
The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels.
Conclusions:
Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score.
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