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Red blood cell distribution width (RDW) as a predictor of multiple organ dysfunction in pediatric critical care: a
Syed M Dayyan Hassan1, Abdul Hadi Shahid1, Zuhaib Ali1
1Medical College, Aga Khan University, Karachi, 74800, Pakistan.
Insights
Red blood cell distribution width (RDW) may indicate critical illness severity in children. Higher RDW levels correlated with increased mortality and organ dysfunction, though not always significantly, suggesting its potential as an early biomarker.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Biomarker research
Background:
- Red blood cell distribution width (RDW) is a complete blood count variable linked to immature red blood cell release and systemic inflammation.
- Elevated RDW correlates with inflammatory markers (ESR, CRP, IL-6) and predicts severity in critically ill adults.
- RDW's role as an early biomarker for pediatric multiple organ dysfunction syndrome (MODS) is not well-established.
Purpose of the Study:
- To evaluate the prognostic value of RDW in predicting length of stay, mortality, and early identification of MODS in pediatric intensive care unit (PICU) patients.
- To investigate the association between RDW levels and MODS within the first seven days of PICU admission.
Main Methods:
- Retrospective review of 680 PICU patients (September 2018-December 2022).
- Exclusion criteria: <48h admission, recent transfusions, anemia.
- RDW > 14.0% considered elevated; MODS defined as dysfunction in ≥2 organs. Patients stratified into three RDW groups.
Main Results:
- Higher RDW associated with younger age and higher PRISM III scores.
- RDW Group III showed trends towards longer hospital stays, higher mortality, and MODS incidence, but lacked statistical significance.
- Elevated RDW linked to inflammation and critical illness severity, but not strongly with pediatric severity scores or MODS trends.
Conclusions:
- Higher RDW levels in pediatric patients were associated with increased mortality, longer length of stay, and higher rates of sepsis and MODS, though not statistically significant.
- RDW reflects inflammation and critical illness severity but has limited correlation with pediatric severity scores or early MODS trends.
- Multicenter studies are recommended to further explore RDW's utility in predicting pediatric organ dysfunction and critical illness outcomes.
Background:
RBC distribution width is a key variable in complete blood counts, associated with immature RBC release into circulation due to various processes, including systemic inflammation. RDW correlates with elevated acute inflammatory markers like ESR, CRP, and interleukin-6, and is a biomarker in conditions like kidney disease and multiple myelomas. It independently predicts disease severity in critically ill adults and is associated with morbidity, mortality and length of stay in pediatric intensive care unit, though its potential as an early biomarker for detecting pediatric patients with multiple organ dysfunction (MODS) remains unknown.
Methods:
The study retrospectively reviewed PICU patients admitted to Aga Khan University Hospital from September 2018 to December 2022, excluding those admitted for less than 48 h for elective procedures, received recent RBC transfusions, or were anemic. RDW > 14.0% was considered elevated. MODS, defined as dysfunction in two or more organs, was the primary outcome. Data included demographics, PRISM III scores, laboratory values (RDW, BUN, creatinine, CRP, etc.), and clinical outcomes. Patients were stratified into three RDW groups: <13.4%, 13.4-14.3%, and > 14.4%. Analysis focused on associations between RDW levels and MODS within the first 7 days of PICU admission.
Results:
The study included 680 patients. Higher RDW was associated with younger age and higher PRISM III scores, but not with sex. RDW Group III had longer hospital stays, higher mortality, and higher incidence of MODS, but not significant. Hemoglobin and MCHC levels were lower in Group III, whereas BUN and creatinine levels showed no significant differences across groups. The OR for MODS was highest for Group II.
Conclusions:
This retrospective study evaluated the prognostic value of RDW in predicting length of stay, mortality, and early identification of MODS within seven days. Among 680 pediatric patients, higher RDW levels were associated with increased mortality, longer LOS, and higher rates of sepsis and MODS, though these findings lacked statistical significance. Elevated RDW was linked to inflammation and critical illness severity but did not correlate well with pediatric severity scores or MODS trends. Future multicenter studies are recommended to explore RDW's utility in predicting early organ dysfunction and critical illness outcomes.
