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Dynamic changes in mean corpuscular volume could be integrated into longitudinal prediction frameworks for
Markward Britsch1,2,3,4,5,6, Tobias Becher1,2, Simon Lindner1,2
1Cardiology, Haemostaseology, and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
Abstract:
ObjectiveTo evaluate whether early variability in mean corpuscular volume (MCV) during the first five days of intensive care unit stay is associated with in-hospital mortality in critically ill patients.MethodsWe retrospectively studied all adult patients treated on intensive care units (ICU) at the University Medical Center Mannheim between 2018 and 2022 with more than one MCV measurement within the first five days, including at least one on the day of admission. The primary endpoint was in-hospital mortality. MCV variation, expressed as the coefficient of variation (CV), was analyzed using generalized additive models, multivariable logistic and Cox regression.ResultsAmong 5,327 patients (median age 66 years, 38.9% female, mortality 28.3%), median MCV variation was 1.86% (IQR 1.15-2.74%). Patients with high variation (CV >2.5%) showed higher mortality rates (34.7% vs. 20.1%, p<0.0001). In a baseline-adjusted model, this association remained significant (OR 1.65, 95% CI 1.46-1.87, p<0.001). By contrast, baseline MCV at admission showed a univariat association with mortality but was not independently associated with mortality after multivariate adjustment (OR 1.02, 95% CI 0.98-1.06, p=0.31). Determinants of high variation (>2.5%) included elevated CRP, transfusion volume, respiratory disease, and fluid balance disturbances. In a second, severity-adjusted model including lactate, mean arterial pressure, and fluid balance, the previously observed association between high MCV variation and mortality was no longer significant (adjusted OR 1.16, p = 0.57, CI: 0.84-1.59).ConclusionsEarly variation in MCV during the initial five days after ICU admission is associated with in-hospital mortality in unadjusted analyses. However, this relationship is not independent of established clinical severity markers, suggesting that MCV variability reflects disease severity. Nonetheless, MCV variation may serve as a readily accessible adjunctive marker of physiological instability in critically ill patients, meriting further investigation.
Insights
Early variation in mean corpuscular volume (MCV) in intensive care units (ICUs) is linked to higher mortality. However, this association diminishes when considering established clinical severity markers, suggesting MCV variability reflects overall patient condition.
Area of Science:
- Critical Care Medicine
- Hematology
- Clinical Pathology
Background:
- Mean corpuscular volume (MCV) is a standard red blood cell parameter.
- Variability in MCV may indicate physiological instability in critically ill patients.
- The prognostic value of early MCV variability in intensive care unit (ICU) settings requires further elucidation.
Purpose of the Study:
- To investigate the association between early MCV variability within the first five days of ICU admission and in-hospital mortality.
- To determine if MCV variability is an independent predictor of mortality in critically ill patients.
Main Methods:
- Retrospective analysis of 5,327 adult ICU patients with serial MCV measurements.
- MCV variation quantified using the coefficient of variation (CV).
- Statistical analysis included generalized additive models, multivariable logistic, and Cox regression.
Main Results:
- Higher MCV variation (CV >2.5%) was associated with increased in-hospital mortality (34.7% vs. 20.1%, p<0.0001).
- This association remained significant in baseline-adjusted models (OR 1.65).
- After adjusting for clinical severity markers, the association between MCV variation and mortality was no longer significant.
Conclusions:
- Early MCV variation in critically ill patients is associated with mortality in unadjusted analyses.
- MCV variability appears to reflect underlying disease severity rather than being an independent predictor.
- MCV variation may serve as an accessible marker of physiological instability, warranting further research.
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