Outcome Prediction Value of Red Cell Distribution Width in Critically-ill Children

Introduction: Red cell distribution width (RDW) is a frequently overlooked parameter in routine haematological reports. It is a simple and inexpensive test which has been found by many adult studies to be a prognostic indicator of mortality in intensive care units. The objective of this study was to see if high RDW could be used as a marker to predict mortality in critically ill children. Methods: This was a prospective observational study conducted in the paediatric intensive care unit (PICU) of a tertiary hospital of Western Nepal over a period of one year. Study subjects were selected by purposive sampling method. RDW at admission and relative change in RDW (ΔRDW) was compared to see if they had any role in predicting mortality in this group of children. Receiver operating curve analysis was plotted to find an optimal cut-off point to define high and low RDW and various outcome parameters were analysed. Results: Out of 131 children, there were 12 (9.1%) mortalities. Admission RDW was higher in the death group as compared to the survivor group (17 vs 14.6; p = 0.012). Similar finding was seen with ΔRDW (0.45 vs 0.00; p = 0.006). ΔRDW above the cut-off value of 0.15 was found to be associated with a generally more complicated course during hospitalisation as well as had more risk of mortality. Conclusions: Both RDW and ΔRDW above the cut-off value were found to be associated with mortality. In addition, high ΔRDW was also found to predict a more complicated course during hospitalisation.

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Red cell distribution width as a prognostic marker in mechanically ventilated children admitted in pediatric critical care unit of tertiary care centre, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183508 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1794

Author(s):

Swati M. Gadappa ◽

Manas Kumar Behera

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Critically Ill ◽

Red Cell Distribution Width ◽

Critically Ill Children ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Mechanically Ventilated ◽

Prospective Longitudinal

Background: Paediatric population is a vulnerable group necessitating standard care for medically and surgically ill children. Red cell distribution width (RDW) is a simple and low-cost measure that denotes the variability in red blood cell size. Any process that releases reticulocytes in the circulation will result in an increase in RDW. RDW may also be useful as a biomarker of disease severity and clinical outcomes in critically ill patients. Methods: Retrospective cohort study of all patients between 1month-12yrs of age, mechanically ventilated in Paediatric intensive care unit. Those patients with RDW on admission and complete data for PIM3 (Paediatric Index of Mortality 3) were included. Analyses included correlation, logistic regression analysis, and receiver operating characteristic (ROC) curves.Results: Retrospective analysis of data on 93 consecutive critically ill children admitted in PICU was done between Jan 2015- June 2016. We noted statistically significant correlation between mortality and anemia (10.24 g/dL, SD 2.26; 8.78 g/dL, SD 2.60.p = 0.009), LOS on MV (p = 0.008), RDW (p = 0.002), shock (p = 0.004) and ventilator associated Pneumonia (p = 0.024). Mortality increased as length of stay on mechanical ventilation increased (4.13 days, SD 2.125 versus 6.94 days, SD 7.603 p = 0.008). The cut-off of 18.10 was chosen as Mean RDW. Based on AUROC, RDW is independently associated with high risk of mortality.Conclusions: RDW measured within 24 hours of PICU admission was independently associated with length of stay on mechanical ventilation and mortality in a general PICU population. We recommend the need for multicentric, prospective longitudinal studies to determine the optimum utility of RDW to enhance decision making in PICU.

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A Meta-analysis of the Utility of Red Cell Distribution Width as a Biomarker to Predict Outcomes in Pediatric Illness (PROSPERO CRD42020208777)

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1735876 ◽

2021 ◽

Author(s):

Devin Murphy ◽

Etan Orgel ◽

Wouter Koek ◽

Melissa Frei-Jones ◽

Christopher Denton ◽

...

Keyword(s):

Systematic Review ◽

Critical Care ◽

Critically Ill ◽

Meta Analysis ◽

Red Cell Distribution Width ◽

Critically Ill Children ◽

Red Cell ◽

Cell Distribution ◽

Pediatric Critical Care ◽

Distribution Width

AbstractRed cell distribution width (RDW) is an average of the variation in red blood cell (RBC) sizes reported on a complete blood count. An elevated RDW indicates a pathological process that is affecting erythropoiesis. Studies showed that as the severity of disease process increases, the RDW often increases as well. Particularly in resource-limited countries, RDW has been studied as an outcome predictor for conditions in a variety of disciplines and is offered as an adjunct monitoring tool that is cost effective, readily available, and indicative of pathological processes amenable to intervention. Particularly in pediatric critical care settings, RDW has been shown to be a reliable tool for surveillance of disease states such as sepsis. Despite the increased attention of RDW as a marker for disease outcome, collective evaluation on the utility of RDW as a marker for outcome in pediatric critical care settings is lacking. We offer a systematic review and meta-analysis of published studies to assess the ability of RDW to predict illness severity and mortality among pediatric critical care patients. Among eight studies of over 4,800 patients, we found over a two-fold increase in odds for mortality in critically ill children whose RDW was above 15.7%. This is the first systematic review of RDW being used to predict mortality in critically ill children and findings of this study may prompt early intervention in the pediatric critical care setting.

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