Association between preoperative RDW and in-hospital death in trauma patients: A multicenter retrospective cohort...

ObjectiveRed cell distribution width (RDW) is an emerging prognostic marker in trauma. This study aims to investigate the association between preoperative RDW and in-hospital mortality in surgical trauma patients.MethodsThis retrospective cohort study enrolled 34,848 surgical trauma patients sourced from three Chinese medical centers and the MIMIC-IV 2.2 database. Receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative ability of preoperative (at-admission) RDW for in-hospital mortality and to determine an optimal cutoff value for patient stratification. Propensity score matching (PSM) was performed with a caliper value of 0.01, balancing 18 covariates between the two groups, including demographic characteristics, vital signs, injury severity scores, comorbidities. After PSM, 7,697 pairs were matched. Binary logistic regression was applied to assess the relationship between RDW and in-hospital mortality.ResultsIn-hospital mortality was 3.02% (1,051/34,848). Preoperative RDW showed moderate discrimination for in-hospital mortality, with an area under the curve (AUC) of 0.777 (95% CI 0.763-0.792). Before PSM, in-hospital mortality was significantly higher in the Pre-RDW > 14.25% group compared to the Pre-RDW ≤ 14.25% group (7.58% vs. 1.11%, P < 0.001). After PSM, RDW was significantly higher in patients who died during hospitalization than in nonfatal patients (16.14 ± 2.75 vs. 14.63 ± 2.13, P < 0.001). Each 1% increase in RDW was associated with 24% higher odds of in-hospital death. Binary logistic regression showed that RDW > 14.25% was associated with 2.58-fold higher odds of in-hospital death (95% CI 2.17-3.05, P < 0.001).ConclusionsElevated preoperative RDW is independently associated with in-hospital mortality in trauma patients, and RDW > 14.25% indicates a significantly higher risk of in-hospital death.