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Red cell distribution width (RDW) as a biomarker for respiratory failure in a pediatric ICU
Tom Schepens1,2, Jozef J De Dooy2, Walter Verbrugghe2
1Department of Anesthesia, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
Insights
Red cell distribution width (RDW) on admission to the pediatric intensive care unit (PICU) indicates a higher likelihood of needing mechanical ventilation. Elevated RDW is linked to poorer respiratory outcomes in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Respiratory Medicine
Background:
- Red cell distribution width (RDW) measures red blood cell size variation and is linked to worsened pulmonary function in adults.
- Processes releasing reticulocytes increase RDW, indicating potential physiological stress.
- Elevated RDW is associated with poorer outcomes in adult populations.
Purpose of the Study:
- To investigate the association between RDW and respiratory failure in critically ill children.
- To determine if RDW is a prognostic marker for respiratory dysfunction in a pediatric intensive care unit (PICU).
Main Methods:
- Retrospective cohort study including patients admitted between January 2009 and June 2015.
- Analysis of 960 pediatric patients in a tertiary university hospital's PICU.
- Correlation of admission RDW values with mechanical ventilation needs, ventilator-free days, and oxygenation ratios.
Main Results:
- 15.5% of patients had elevated RDW values on admission.
- Higher RDW was associated with fewer ventilator-free days and increased need for mechanical ventilation, independent of anemia, age, and PRISM scores.
- In ventilated patients, RDW correlated with lower PaO2/FiO2 (P/F) ratios.
Conclusions:
- Admission RDW is a significant predictor of increased mechanical ventilation requirement and poorer respiratory outcomes in critically ill children.
- RDW is a valuable, accessible, and inexpensive prognostic parameter for respiratory dysfunction in the PICU.
- The findings suggest RDW can aid in risk stratification for pediatric intensive care patients with respiratory compromise.
Background:
The red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. Any process that releases reticulocytes in the circulation will result in an increase in RDW. Elevated RDW values are linked to worsened pulmonary function in the adult population. We performed a retrospective cohort study to describe the association between RDW and respiratory failure in critically ill children in a in a pediatric intensive care unit (PICU) in a tertiary university hospital.
Subjects:
All patients admitted between January 2009 and June 2015 were considered eligible for inclusion.
Methods:
Retrospective cohort study.
Results:
In total, 960 patients were included in the cohort analysis. Of those patients, 149 (15.5%) had elevated RDW values. RDW on admission was associated with lower 28 day ventilator-free days. The highest quintile of RDW was associated with the need for mechanical ventilation, even when correcting for anaemia, age and Pediatric Risk of Mortality (PRISM) scores. In the subgroup of ventilated patients, RDW was associated with nadir PaO2/FiO2(P/F) ratios.
Conclusion:
The RDW value on admission of our PICU patients is associated with a greater need for invasive mechanical ventilation, lower 28 day ventilator-free days and lower nadir P/F ratios in the patients with highest RDW values on admission. RDW may be a valuable, cheap and universally available, prognostic parameter for respiratory dysfunction in the PICU.
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