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Red Blood Cell Distribution Width and Pediatric Community-Acquired Pneumonia Disease Severity
Jaclyn Lee1, Yuwei Zhu2, Derek J Williams3
1Vanderbilt University School of Medicine.
Insights
Higher red blood cell distribution width (RDW) levels in children indicate an increased risk of severe community-acquired pneumonia (CAP). This inexpensive measure can aid clinical assessment for pediatric CAP severity.
Area of Science:
- Pediatric Medicine
- Clinical Diagnostics
- Pulmonology
Background:
- Community-acquired pneumonia (CAP) in children lacks a standardized risk assessment tool.
- Red blood cell distribution width (RDW) is a readily available blood test parameter.
Purpose of the Study:
- To investigate the association between red blood cell distribution width (RDW) and the severity of pediatric CAP.
- To determine if RDW can serve as a predictive marker for severe pediatric CAP.
Main Methods:
- Prospective data from 1459 pediatric patients with confirmed CAP were analyzed.
- Red blood cell distribution width (RDW) values on admission were assessed in quintiles and as a continuous variable.
- Multivariable logistic regression and restricted cubic splines modeled the association between RDW and CAP severity (moderate vs. severe).
Main Results:
- Higher RDW levels were associated with an increased risk of severe CAP.
- A nonlinear, positive association was observed between RDW and CAP severity, with risk increasing up to RDW values of 15% (P = .027).
- The adjusted odds ratio for severe CAP increased with higher RDW quintiles, particularly in the fourth quintile.
Conclusions:
- Elevated presenting RDW is linked to a higher risk of severe CAP in hospitalized children.
- RDW is an inexpensive and objective biomarker that can assist clinicians in assessing pediatric CAP severity.
- Further research may validate RDW as a component of pediatric CAP risk stratification tools.
Background And Objectives:
No standardized risk assessment tool exists for community-acquired pneumonia (CAP) in children. This study aims to investigate the association between red blood cell distribution width (RDW) and pediatric CAP.
Methods:
Data prospectively collected by the Etiology of Pneumonia in the Community study (2010-2012) was used. Study population was pediatric patients admitted to tertiary care hospitals in Nashville and Memphis, Tennessee with clinically and radiographically confirmed CAP. The earliest measured RDW value on admission was used, in quintiles and also as a continuous variable. Outcomes analyzed were: severe CAP (requiring ICU, mechanical ventilation, vasopressor support, or death) or moderate CAP (hospital admission only). Analysis used multivariable logistic regression and restricted cubic splines modeling.
Results:
In 1459 eligible children, the median age was 29 months (interquartile range: 12-73), median RDW was 13.3% (interquartile range: 12.5-14.3), and 289 patients (19.8%) developed severe disease. In comparison with the lowest RDW quintile (Q1), the adjusted odds ratio (95% CI) for severe CAP in subsequent quintiles were, Q2: 1.20 (0.72-1.99); Q3: 1.28 (0.76-2.14); Q4: 1.69 (1.01-2.82); Q5: 1.25 (0.73-2.13). Consistently, RDW restricted cubic splines demonstrated an independent, nonlinear, positive association with CAP severity (P = .027), with rapid increases in the risk of severe CAP with RDW values up to 15%.
Conclusions:
Higher presenting RDW was associated with an increased risk of severe CAP in hospitalized children. Widely available and inexpensive, RDW can serve as an objective data point to help with clinical assessments.
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