Prognostic value of baseline RDW-CV in critically ill patients with pelvic fractures: A retrospective cohort study
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Published on: March 13, 2026
He Huang1, Lulu Gu2, Weihua Lu1
1Emergency Care Unit, Combat Trauma Treatment Center, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, Hubei, 430010, China.
Background:
Red blood cell distribution width coefficient of variation (RDW-CV) is a potential prognostic biomarker, but its prognostic significance in critically ill patients with pelvic fractures remains unclear. This study evaluated the association between baseline RDW-CV and mortality and developed a nomogram for predicting 365-day mortality.
Methods:
This retrospective cohort study included adult patients with pelvic fractures admitted to the intensive care unit (ICU) in the MIMIC-IV database. Baseline RDW-CV was defined as the first measurement after ICU admission. Associations with 30-, 90-, and 365-day mortality were evaluated using Kaplan-Meier analysis, Cox regression, restricted cubic splines (RCS), and subgroup analyses. A nomogram incorporating RDW-CV, age, and Acute Physiology Score III (APSIII) was internally validated.
Results:
Among 270 patients, 37 (13.7%) had elevated RDW-CV (>15.5%). Patients with elevated RDW-CV had higher 30-day (32.4% vs. 7.3%), 90-day (35.1% vs. 9.4%), and 365-day mortality (40.5% vs. 12.0%) than those with RDW-CV ≤ 15.5% (all P < 0.001), with significantly lower survival probabilities (log-rank P < 0.0001). In fully adjusted Cox models, elevated RDW-CV remained independently associated with 30-day (HR 2.68, 95% CI 1.20-5.99; P = 0.016), 90-day (HR 2.33, 95% CI 1.12-4.84; P = 0.024), and 365-day mortality (HR 2.21, 95% CI 1.14-4.26; P = 0.018). RCS analysis showed a significant overall association with 365-day mortality (P = 0.007), without significant nonlinearity (P = 0.079). Findings were consistent across prespecified subgroup and sensitivity analyses. The nomogram showed good calibration and discrimination for 365-day mortality (AUC 0.878). Exploratory analyses of dynamic RDW-CV changes during ICU stay showed no significant association with survival.
Conclusions:
Elevated baseline RDW-CV was independently associated with increased short- and long-term mortality in critically ill patients with pelvic fractures. Baseline RDW-CV may provide a practical marker for early risk stratification, while serial RDW-CV measurements offered limited additional prognostic value.