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A Meta-analysis of the Utility of Red Cell Distribution Width as a Biomarker to Predict Outcomes in Pediatric Illness
Devin Murphy1, Etan Orgel2,3, Wouter Koek1
1Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United Sates.
Insights
Elevated red cell distribution width (RDW) in critically ill children, above 15.7%, is linked to a doubled risk of mortality. This finding highlights RDW as a valuable, cost-effective tool for predicting outcomes in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Clinical Pathology
Background:
- Red cell distribution width (RDW) measures red blood cell (RBC) size variation.
- Elevated RDW signifies impaired erythropoiesis and often correlates with disease severity.
- RDW is a cost-effective, accessible tool for monitoring pathological processes, particularly in resource-limited settings.
Purpose of the Study:
- To systematically review and meta-analyze studies evaluating RDW's predictive ability for illness severity and mortality in pediatric critical care patients.
- To address the lack of collective evaluation on RDW's utility in this specific patient population.
Main Methods:
- Systematic review and meta-analysis of published studies.
- Inclusion of eight studies encompassing over 4,800 pediatric critical care patients.
- Analysis focused on the association between RDW levels and mortality risk.
Main Results:
- A RDW level above 15.7% was associated with more than a two-fold increase in the odds of mortality.
- The findings were consistent across multiple studies included in the meta-analysis.
Conclusions:
- RDW is a reliable and significant predictor of mortality in critically ill children.
- This study is the first systematic review to demonstrate RDW's utility in predicting mortality in this demographic.
- Findings support the use of RDW for early intervention strategies in pediatric critical care.
Abstract:
Red cell distribution width (RDW) is an average of the variation in red blood cell (RBC) sizes reported on a complete blood count. An elevated RDW indicates a pathological process that is affecting erythropoiesis. Studies showed that as the severity of disease process increases, the RDW often increases as well. Particularly in resource-limited countries, RDW has been studied as an outcome predictor for conditions in a variety of disciplines and is offered as an adjunct monitoring tool that is cost effective, readily available, and indicative of pathological processes amenable to intervention. Particularly in pediatric critical care settings, RDW has been shown to be a reliable tool for surveillance of disease states such as sepsis. Despite the increased attention of RDW as a marker for disease outcome, collective evaluation on the utility of RDW as a marker for outcome in pediatric critical care settings is lacking. We offer a systematic review and meta-analysis of published studies to assess the ability of RDW to predict illness severity and mortality among pediatric critical care patients. Among eight studies of over 4,800 patients, we found over a two-fold increase in odds for mortality in critically ill children whose RDW was above 15.7%. This is the first systematic review of RDW being used to predict mortality in critically ill children and findings of this study may prompt early intervention in the pediatric critical care setting.
