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RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome?
Ahmed S Said1, Philip C Spinella, Mary E Hartman
11Department of Pediatrics, Washington University in St. Louis, St. Louis, MO. 2Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO. 3Department of Biostatistics, Washington University in St. Louis, St. Louis, MO. 4Department of Biochemistry & Molecular Biophysics, Washington University in St. Louis, St. Louis, MO. 5Department of Pediatrics, University of Utah, Salt Lake City, UT.
Red blood cell distribution width (RDW) predicts outcomes in critically ill children. Higher RDW and its change are linked to increased ICU mortality or ECMO use, suggesting it may indicate red blood cell injury.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Clinical pathology
Background:
- Red blood cell distribution width (RDW) is an established predictor of outcomes in various adult conditions.
- Its association with morbidity and mortality in critically ill children remains less understood.
Purpose of the Study:
- To investigate the association between RDW and outcomes in critically ill children.
- To determine if RDW is an independent predictor of mortality or morbidity in this population.
Main Methods:
- Retrospective observational study of 3,913 children admitted to a tertiary PICU.
- Collected data included demographics, laboratory values, hospitalization characteristics, and outcomes.
- Calculated admission RDW and the relative change in RDW within the first 7 days of hospitalization.
Main Results:
- Both admission RDW and its relative change were independently associated with ICU mortality or extracorporeal membrane oxygenation (ECMO) use.
- Odds ratios for mortality/ECMO were 1.13 for admission RDW and 1.04 for RDW change, after adjusting for illness severity.
- Both RDW measures weakly correlated with fewer ICU- and ventilator-free days.
Conclusions:
- Admission RDW is independently associated with ICU mortality and morbidity in critically ill children.
- RDW may serve as a biomarker for red blood cell injury impacting critical illness outcomes, potentially through impaired oxygen delivery.
- These findings highlight RDW's potential clinical utility in pediatric critical care.
