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Association Between Elevated RBC Distribution Width and Multiple Organ Dysfunction in Pediatric Critical Illness
Sonia Matehuala1, Sanjiv Pasala1, Anthony Goudie2
1Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR.
Insights
High red blood cell distribution width (RDW) in children admitted to the pediatric intensive care unit (PICU) is linked to worse outcomes. Elevated RDW (>15.7%) is associated with multiple organ dysfunction and longer hospital stays.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Clinical Biomarkers
Background:
- Red blood cell distribution width (RDW) is a component of the complete blood count.
- Published studies indicate RDW is a significant biomarker for adverse health outcomes.
Purpose of the Study:
- To investigate the association between admission RDW values and clinical outcomes in pediatric intensive care unit (PICU) patients.
- To determine if RDW predicts multiple organ dysfunction, mechanical ventilation duration, and length of stay.
Main Methods:
- Retrospective, single-center study of patients admitted to a US tertiary pediatric hospital between 2016 and 2017.
- Exclusion criteria included age over 21, pregnancy, and recent packed red blood cell (RBC) transfusion.
- RDW values were categorized into four groups, with group IV representing RDW > 15.7%.
Main Results:
- Increased RDW at admission was significantly associated with multiple organ dysfunction syndrome within the first 7 days (30.1% in group IV vs. 11.8% in group I).
- Higher RDW correlated with increased median duration of mechanical ventilation (7 days vs. 5 days), hospital length of stay (13 days vs. 5 days), and PICU length of stay (4 days vs. 3 days).
- No statistically significant association was found between admission RDW and mortality.
Conclusions:
- Admission RDW values exceeding 15.7% in pediatric intensive care unit patients, without recent RBC transfusion, are linked to higher rates of multiple organ dysfunction syndrome.
- Elevated RDW is also associated with prolonged mechanical ventilation and extended hospital stays.
- RDW serves as a valuable predictive marker for adverse clinical outcomes in critically ill children.
Objectives:
RBC distribution width, a part of the complete blood count, has been shown in several published studies to be a strong biomarker of adverse outcomes. We sought to determine the association between admission RBC distribution width value and clinical outcomes including multiple organ dysfunction, mechanical ventilation days, PICU length of stay, and hospital length of stay in children admitted to the PICU.
Design:
Single center, retrospective study.
Setting:
A tertiary pediatric hospital in the United States.
Patients:
All subjects admitted to the PICU from 2016 to 2017.
Exclusions:
Greater than 21 years old, pregnancy, and history of packed RBC transfusion within 120 days prior to admission.
Interventions:
None.
Measurements And Main Results:
One-thousand five-hundred one subjects were screened and 856 were included in data analysis. RBC distribution width value was categorized into four separate groups: group I (RBC distribution width < 13.4%), group II (13.4-14.3%), group III (14.4-15.7%), and group IV (RBC distribution width > 15.7%). Increased RBC distribution width at admission was associated with multiple organ dysfunction syndrome in the first 7 days (group I = 11.8% vs group IV = 30.1%; p < 0.0001) (odds ratio, 3.22; 95% CI, 1.95-5.30; p < 0.0001). Increased RBC distribution width was associated with increased median mechanical ventilation duration (group IV = 7 d vs group I = 5 d; p = 0.001), median hospital length of stay (group IV = 13 d vs group I = 5 d; p < 0.0001), and median PICU length of stay (group IV = 4 d vs group I = 3 d; p = 0.01). Mortality was not statistically associated with admission RBC distribution width (p = 0.12).
Conclusions:
PICU admission RBC distribution width values greater than 15.7% obtained upon admission to the PICU in patients who have not received a RBC transfusion are associated with multiple organ dysfunction syndrome in the first 7 days of admission, increased duration of mechanical ventilation, and increased hospital length of stay.
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