Influence of Red Blood Cell Distribution Width on All-Cause Death in Critical Diabetic Patients with Acute Kidney Injury

Abstract

Objective To explore the relationship between red blood cell distribution width (RDW) and all-cause death in critical diabetic patients with acute kidney injury (AKI). Methods The clinical data of critical diabetic patients with AKI in MIMIC-III database were analyzed retrospectively. According to the survival status of 28-day after AKI and levels of RDW, patients were divided into survival and death groups, high RDW (RDW > 15.3%) and low RDW groups (RDW ≤ 15.3%). Kaplan–Meier curves were used to compare the survival rates of diabetic patients with AKI in different RDW and AKI stages, and Cox regression analysis was used to evaluate the risk factors of 28-day all-cause death in critical diabetic patients with AKI. Results A total of 5200 patients with critical diabetic patients with AKI were included in this study with the male to female ratio of 1.53:1. The mean follow-up time was 24.97 ± 7.14 days, and the 28-day all-cause mortality was 17.9% (931/5200). Age, RDW, blood urea nitrogen, serum creatinine, lactic acid, proportion of AKI stage, sepsis and respiratory failure in the death group were higher than those in the survival group, while mean arterial pressure (MAP) and red blood cell count were lower than those in the survival group. Kaplan–Meier analysis showed that the 28-day survival rate of the high RDW group was significantly lower than that of the low RDW group (log-rank χ 2 = 9.970, P = 0.002). Multivariate Cox regression analysis showed that advanced age (HR = 1.042, 95% CI = 1.021–1.063), decreased MAP (HR = 0.984, 95% CI = 0.969–0.998), stage 3 AKI (HR = 3.318, 95% CI = 1.598–6.890) and increased RDW (HR = 1.255, 95% CI = 1.123–1.403) were independent risk factors of 28-day all-cause death in critical diabetic patients with AKI ( P < 0.05). Conclusion High level of RDW is an important risk factor of all-cause death in critical diabetic patients with AKI, and it may be used as a valuable index to classify the mortality.

Prevalence, hematological parameters, and coagulation profiles

“…10 Red distribution width has also been associated with inflammation in rheumatoid arthritis, cancer, autoimmune hepatitis, COVID-19 infection, and autoimmune diseases. 11 Mean platelet volume (MPV) is a platelet activation measure that is commonly utilized for routine screening and has been demonstrated to be a prognostic predictor in CVD patients. 12 The MPV hemogram measurement has been associated with a diverse range of inflammatory diseases, including type 2 DM, diabetic nephropathy, hypothyroidism, vertebral discopathies, infection, irritable bowel syndrome, rheumatoid arthritis, obesity, mortality in ICU population, and liver fibrosis.…”

Red blood cell distribution width to albumin ratio is linked to all-cause mortality in critically ill patients with acute kidney injury: a retrospective cohort study

“…AKI originates from a complex interaction between renal insufficiency and subsequent inflammation and coagulation [21]. Studies have indicated that RDW is closely linked to unfavorable prognosis in critically ill patients with AKI and represents an indicator of chronic inflammation that is considered a valid predictor for the prognosis of AKI [10,11,22]. Although we identified the predictive value of RDW for all-cause mortality risk has been revealed, the mechanisms underlying the relationship between these factors remain unclear.…”

Association between red cell distribution width–and–albumin ratio and the risk of peripheral artery disease in patients with diabetes

“…Hemogram parameters were widely reported to be associated with the risk of CVDs (6,7). Previously, red blood cell distribution width (RDW) was reported to be associated with the severity of chronic kidney disease (CKD), macrovascular and microvascular complications, and all-cause mortality in in patients with diabetes (8,9). In addition, albumin was also a predictor for the progression of CKD in patients with newly diagnosed type 2 diabetes (10).…”