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Red blood cell distribution width as a predictor of mortality in critically ill pediatric patients: a systematic
Yinhong Yu1, Xiaomei Hu1, Yaping Shen1
1Department of Paediatrics, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Zhejiang, China.
Insights
Red blood cell distribution width (RDW) may predict mortality in pediatric intensive care units (PICUs). Higher RDW levels are linked to increased mortality risk in critically ill children, warranting further investigation.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Clinical Outcomes Research
Background:
- Red blood cell distribution width (RDW) is a known predictor of outcomes in adult critical care.
- The prognostic value of RDW in pediatric intensive care unit (PICU) settings is not well-established.
- This study investigates the association between RDW and mortality in critically ill children.
Purpose of the Study:
- To systematically review and meta-analyze existing evidence on the association between RDW and mortality in the PICU.
- To determine if RDW can serve as a predictive biomarker for mortality in pediatric critical care.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science databases.
- Included observational studies published up to November 4, 2024, that assessed RDW and PICU mortality.
- A meta-analysis was performed on the extracted data.
Main Results:
- Seven studies involving 6,327 pediatric patients were included.
- Five studies indicated a significant association between elevated RDW and increased PICU mortality.
- Meta-analysis revealed a statistically significant increased risk of mortality with incremental RDW increase (OR: 1.24) and higher RDW values (OR: 1.73).
Conclusions:
- RDW shows potential as a predictor of mortality in the PICU.
- Findings should be interpreted cautiously due to the limited number and heterogeneity of studies.
- Further research is recommended to confirm these results and strengthen the evidence base.
Objective:
Red blood cell distribution width (RDW) has been found to predict outcomes in critically ill adult patients. However, its utility in pediatric patients remains unexplored. We reviewed published evidence and conducted a meta-analysis to assess whether RDW can be used to predict mortality in the pediatric intensive care unit (PICU).
Methods:
All observational studies assessing the association between RDW and PICU mortality available on the databases of PubMed, Embase, Scopus, and Web of Science up to 4th November 2024 were included. A detailed review of study outcomes was conducted with a meta-analysis.
Results:
Seven studies were included. 6,327 pediatric patients were included in these studies. On qualitative analysis, five of the seven studies found a statistically significant association between high RDW and PICU mortality. Four studies used RDW as a continuous variable, while three studies reported specific RDW cut-offs. Meta-analysis showed that an incremental increase in RDW was associated with a statistically significant increased risk of mortality (OR: 1.24 95% CI: 1.07, 1.44 I2 = 32%). Pooled analysis of studies using RDW as a categorical variable showed that higher values of RDW were associated with significantly higher risk of mortality (OR: 1.73 95% CI: 1.02, 2.92 I2 = 77%).
Conclusions:
RDW could be a potential predictor of mortality in the PICU. Results need to be interpreted with caution owing to the limited number of studies with variable study populations. Additional studies are needed to strengthen evidence.
Systematic Review Registration:
PROSPERO (CRD42024606208).
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