Red cell distribution width (RDW) as a biomarker for respiratory failure in a pediatric ICU

Abstract

BackgroundThe red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. Any process that releases reticulocytes in the circulation will result in an increase in RDW. Elevated RDW values are linked to worsened pulmonary function in the adult population. We performed a retrospective cohort study to describe the association between RDW and respiratory failure in critically ill children in a in a pediatric intensive care unit (PICU) in a tertiary university hospital.SubjectsAll patients admitted between January 2009 and June 2015 were considered eligible for inclusion.MethodsRetrospective cohort study.ResultsIn total, 960 patients were included in the cohort analysis. Of those patients, 149 (15.5%) had elevated RDW values. RDW on admission was associated with lower 28 day ventilator-free days. The highest quintile of RDW was associated with the need for mechanical ventilation, even when correcting for anaemia, age and Pediatric Risk of Mortality (PRISM) scores. In the subgroup of ventilated patients, RDW was associated with nadir PaO2/FiO2(P/F) ratios.ConclusionThe RDW value on admission of our PICU patients is associated with a greater need for invasive mechanical ventilation, lower 28 day ventilator-free days and lower nadir P/F ratios in the patients with highest RDW values on admission. RDW may be a valuable, cheap and universally available, prognostic parameter for respiratory dysfunction in the PICU.

A Tool to Early Predict Severe Corona Virus Disease 2019 (COVID-19) : A Multicenter Study using the Risk Nomogram in Wuhan and Guangdong, China

“…RDW, one of the numbers or blood cell indices, reflects the variation in the size of RBC (red blood cells), which has been tightly correlated with critical disease [10][11][12] but negligent in COVID-19. It is a robust predictor of the risk of all cause patient mortality and bloodstream infection in the critically ill [11][12][13][14], including acute exacerbation of interstitial pneumonia, ARDS [10,15]. RDW also can predict prognosis of sepsis, which was tied to poor COVID-19 outcomes-death [16].…”

The effects of blood transfusion on red blood cell distribution width in critically ill patients: a pilot study

“…1 However, many recent studies reported an association between elevated RDW and risk of mortality in different populations, such as elderly patients, 2 patients with coronary artery disease, 3,4 hemodialysis patients, 5 heart failure, 6 and ischemic stroke. 7,8 More recently, RDW was associated with increased short-term mortality in unselected critically ill patients, 9 in pediatric critically ill patients, 10 after cardiac arrest, 11 in septic patients, 12,13 or in those suffering from subarachnoid hemorrhage. 14 Moreover, in a retrospective study, RDW improved the prognostic performance of the Simplified Acute Physiology Score for both short-and long-term mortality in critically ill patients.…”

“…More recently, RDW was associated with increased short‐term mortality in unselected critically ill patients, in pediatric critically ill patients, after cardiac arrest, in septic patients, or in those suffering from subarachnoid hemorrhage . Moreover, in a retrospective study, RDW improved the prognostic performance of the Simplified Acute Physiology Score for both short‐ and long‐term mortality in critically ill patients …”

Red blood cell distribution width as a useful marker for severity in pediatric acute gastroenteritis

“…Red cell distribution width (RDW) is a widely used, inexpensive, and highly reproducible test that is automatically reported in the hemogram test, and which reflects the size distribution of circulating red blood cells. Any process that triggers the release of reticulocytes to circulation increases RDW . The acute systemic inflammatory response resulting from many different etiologies can affect both erythropoiesis and erythrocyte maturation.…”

“…These studies have demonstrated the role of RDW in various inflammatory events and pathophysiological conditions such as septic shock, acute appendicitis, pulmonary disease, and cardiovascular disease . In addition, many studies suggest that RDW can be used as a useful biomarker for disease severity and clinical outcome evaluation in the critical patient group . But to the best of our knowledge, there is no study investigating the role of RDW in the severity assessment of childhood AGE.…”