The Association between Red Blood Cell Distribution Width and Mortality in Critically Ill Patients with Acute Kidney Injury

Background. Several investigators have sought risk factors for mortality in acute kidney injury (AKI). However, no epidemiological studies have investigated the impact of red blood cell distribution width (RDW) on prognosis for critically ill patients with AKI. The aim of this study was to investigate the association of RDW with mortality in these patients. Methods. We analyzed data from the MIMIC-III. RDW was measured upon ICU admission. The association between RDW and mortality of AKI was determined using a multivariate logistic regression and was expressed as the adjusted odds ratio with associated 95% confidence interval (CI). We also conducted subgroup analyses to determine the consistency of this association. Results. A total of 14,078 critically ill patients with AKI were eligible for this analysis. In multivariate analysis, adjusted for age and gender and compared with the reference group (RDW 11.1-13.4%) related to hospital mortality, the adjusted ORs (95% CIs) for RDW levels 13.5-14.3%, 14.4-15.6%, and 15.7-21.2% were 1.22 (1.05, 1.43), 1.56 (1.35, 1.81), and 2.66 (2.31, 3.06), respectively. After adjusting for confounding factors, with high RDW linked to an increase in mortality (RDW 15.7-21.2% versus 11.1-13.4%: OR, 1.57; 95% CI, 1.22 to 2.01; P trend <0.0001). A similar trend was observed for 30-day mortality. Conclusions. RDW appeared to be an independent prognostic marker in critically ill patients with AKI and higher RDW was associated with increased risk of mortality in these patients.

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The predictive value of red blood cell distribution width and platelet-to -lymphocyte ratio for acute kidney injury in critically ill patients

10.21203/rs.3.rs-1006561/v1 ◽

2021 ◽

Author(s):

Yan Tang ◽

Fen Jiang ◽

Li Zhang ◽

Jiaxuan Xiang ◽

Jie Lei ◽

...

Keyword(s):

Acute Kidney Injury ◽

Blood Cell ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Cell Distribution ◽

Platelet To Lymphocyte Ratio ◽

Distribution Width ◽

Red Blood Cell Distribution

Abstract Background Red blood cell distribution width (RDW) and the platelet-to-lymphocyte ratio (PLR) are associated with different types of prognoses in critically ill patients. But, the value of RDW and PLR in predicting the occurrence of acute kidney injury (AKI) in critically ill patients are unknown. The purpose of the study was to explore the associations of RDW and PLR with AKI incidence. Methods Among 1500 adult patients in the intensive care unit (ICU) between January 2016 and December 2019 were enrolled, we examined the associations of baseline RDW and PLR with the risk of AKI development using logistical analysis. In addition, we explored the value of RDW and PLR in predicting in-hospital mortality. Results The study participants included 951 men and 549 women, aged 60.1±16.14 years. The subjects had a mean RDW of 14.65±2.14% and a mean PLR of 188.16±129.2. Overall, 615 (41%) patients were diagnosed with AKI. There were remarkable differences in RDW and the PLR between the AKI and non-AKI groups (P<0.001). After adjustment, the association of RDW with AKI development risk strengthened (OR: 1.28, 95% CI: 1.19-1.36). Moreover, we divided the groups into two subgroups each; the high-RDW (≥14.045%) group had a high risk of developing AKI (OR=5.189, 95% CI: 4.088-6.588), while the high-PLR(≥172.067)group had a risk of developing AKI (OR=9.11,95% CI:7.09-11.71). The areas under the receiver operating characteristic curves (AUCs) for the prediction of AKI incidence based on RDW and PLR were 0.780 (95% CI: 0.755-0.804) and 0.728 (95% CI:0.702-0.754) (all P< 0.001), with cut-off values of 14.045 and 172.067, respectively. Moreover, a higher RDW was associated with a higher rate of hospital mortality (OR: 2.907, 2.190-3.858), and the risk of in-hospital mortality related to PLR was 1.534 (95%CI: 1.179-1.995). The AUC for in-hospital mortality based on RDW was 0.663 (95%CI:0.628-0.698), while the AUC for in-hospital mortality based on the PLR was 0.552 (0.514-0.589). Conclusions A higher RDW related to a higher risk of the occurrence of AKI and in-hospital mortality in ICU.The PLR also showed predictive value for the occurrence of AKI but did not show any clear prediction value of in-hospital mortality.

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