Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit

Abstract

Background/Aims: We investigated the hypothesis that RDW is an independent predictor of acute kidney injury (AKI) and mortality in patients in the coronary care unit (CCU). Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU at Zhongnan Hospital of Wuhan University from January 1, 2014 to June 1, 2015. AKI was defined based on the KDIGO-AKI criteria. The survivors were followed up for up to 2 years after hospital discharge. The primary endpoint of the study was the incidence of AKI, while the secondary endpoints of the study were in-hospital mortality and 2-year mortality. Results: RDW was significantly correlated with the acute physiology and chronic health evaluation II (APACHEII) score, hemoglobin, mean corpuscular volume, inflammatory marker levels, nutrition and renal function at the time of CCU admission. The incidence of AKI was much higher in the high RDW group (RDW ≥14.0%) than in the low RDW group, a finding that was confirmed by multivariable logistic regression, which showed that RDW was independently associated with the incidence of AKI (odds ratio (OR), 1.059, 95% coincidence interval (95% CI), 1.024-1.095, P=0.001). A total of 61 patients died during their hospital stay, and baseline RDW was also an independent predictor of in-hospital mortality (hazard ratio (HR), 1.129, 95% CI 1.005-1.268, P=0.041). Patients with a high RDW exhibited significantly higher 2-year mortality than patients with a low RDW during a median follow-up period of 19.8 months (P<0.001), and RDW independently predicted the risk of 2-year mortality (HR, 1.189, 95% CI 1.045 to 1.354, P=0.009) in the multivariate Cox proportional hazard analysis after adjustments for other clinical and laboratory variables. Conclusion: RDW is an independent predictor of AKI and mortality in patients in the CCU.

Red blood cell distribution width predicts long-term mortality in critically ill patients with acute kidney injury: a retrospective database study

“…We demonstrated that higher RDW predicted worse prognosis of AKI patients. Our results were consistent with previous studies on short-term www.nature.com/scientificreports www.nature.com/scientificreports/ outcomes, which mainly focused on how RDW was related with survival in AKI patients after percutaneous transluminal coronary intervention or with other coronary diseases, especially contrast-induced AKI 8,28,29 . Survivors of AKI had a lower RDW value.…”

“…Mizuno and colleagues showed the potential predictive ability of RDW combined with the Mehran risk score but not RDW only for contrast-induced AKI in myocardial infarction patients 35 . Acute physiology and chronic health evaluation II scores were also confirmed to be better than RDW in predicting in-hospital mortality as well as 2-year mortality 8 . Inconsistent with previous studies, however, RDW showed a better predictive value of four-year mortality than commonly used severity scoring systems in our study.…”

Prognostic value of Red Blood Cell Distribution Width in Acute Kidney Injury Patients: A Systematic Review and Meta-analysis

“…Currently, RDW was reported to be an independent predictor in patients with AKI [17][18][19][20] and the result remains inconclusion. Our meta-analysis was conducted to screen the current literature to evaluate prognostic value of RDW in the patients with AKI and explain this conflicting result.…”

Serum Anion Gap Predicts All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury: Analysis of the MIMIC-III Database

“…In the presence of AKI, patient mortality within 1 year after ICU admission is significantly elevated, as high as 60%-70% [4,5]. Because of the high incidence and poor prognosis of AKI in critically ill patients, researchers are attempting to identify prognostic predictors in AKI [6,7]. Unfortunately, most of them are not widely used in clinical practice.…”