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

Spadaro, Savino; Taccone, Fabio Silvio; Fogagnolo, Alberto; Franchi, Federico; Scolletta, Sabino; Ragazzi, Riccardo; Fanni, Alberto; Marangoni, Elisabetta; Govoni, Maurizio; Reverberi, Roberto; Volta, Carlo Alberto

doi:10.1111/trf.14759

Cited by 32 publications

(22 citation statements)

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“…We did not systematically record A-V O 2diff and O 2 ER after transfusion and, therefore, cannot describe the A-V O 2diff and O 2 ER changes before and after RBC transfusion in the "appropriate" and "inappropriate" groups. In addition, although we showed a trend to an association of higher RDW values and mortality, as recently described [42], this was not confirmed in the multivariable analysis; nonetheless, there is a complex relationship between RDW values, iron deficiency, and RBC transfusion [43,44], and our study was not designed to investigate this issue. Fifth, A-V O 2diff measurement requires a correctly placed central venous catheter; although widely used in critically ill patients, the central venous catheter is not always available or not placed in the superior vena cava.…”

Section: Discussioncontrasting

confidence: 66%

Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

et al. 2020

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Background: Guidelines recommend a restrictive red blood cell transfusion strategy based on hemoglobin (Hb) concentrations in critically ill patients. We hypothesized that the arterial-venous oxygen difference (A-V O 2diff), a surrogate for the oxygen delivery to consumption ratio, could provide a more personalized approach to identify patients who may benefit from transfusion. Methods: A prospective observational study including 177 non-bleeding adult patients with a Hb concentration of 7.0-10.0 g/dL within 72 h after ICU admission. The A-V O 2diff , central venous oxygen saturation (ScvO 2), and oxygen extraction ratio (O 2 ER) were noted when a patient's Hb was first within this range. Transfusion decisions were made by the treating physician according to institutional policy. We used the median A-V O 2diff value in the study cohort (3.7 mL) to classify the transfusion strategy in each patient as "appropriate" (patient transfused when the A-V O 2diff > 3.7 mL or not transfused when the A-V O 2diff ≤ 3.7 mL) or "inappropriate" (patient transfused when the A-V O 2diff ≤ 3.7 mL or not transfused when the A-V O 2diff > 3.7 mL). The primary outcome was 90-day mortality. Results: Patients managed with an "appropriate" strategy had lower mortality rates (23/96 [24%] vs. 36/81 [44%]; p = 0.004), and an "appropriate" strategy was independently associated with reduced mortality (hazard ratio [HR] 0.51 [95% CI 0.30-0.89], p = 0.01). There was a trend to less acute kidney injury with the "appropriate" than with the "inappropriate" strategy (13% vs. 26%, p = 0.06), and the Sequential Organ Failure Assessment (SOFA) score decreased more rapidly (p = 0.01). The A-V O 2diff , but not the ScvO 2 , predicted 90-day mortality in transfused (AUROC = 0.656) and non-transfused (AUROC = 0.630) patients with moderate accuracy. Using the ROC curve analysis, the best A-V O 2diff cutoffs for predicting mortality were 3.6 mL in transfused and 3.5 mL in non-transfused patients. Conclusions: In anemic, non-bleeding critically ill patients, transfusion may be associated with lower 90-day mortality and morbidity in patients with higher A-V O 2diff. Trial registration: ClinicalTrials.gov, NCT03767127. Retrospectively registered on 6 December 2018.

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Section: Discussioncontrasting

confidence: 66%

Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

et al. 2020

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“…In addition, haemoglobin disorders [35] , myelodysplastic syndromes [36] and red blood cell (RBC) transfusion increased RDW values [37] ; however, we are aware no patients in our series suffered of those disorders or received RBC transfusion before RDW determination.…”

Section: Discussionmentioning

confidence: 90%

Association between red blood cell distribution width and mortality of COVID-19 patients

Lorente

Martı́n

Argüeso

et al. 2021

Anaesthesia Critical Care & Pain Medicine

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“…It is conventionally increased in patients with anemia attributable to iron de ciency [7], folic acid/vitamin B12 de ciency, patients with autoimmune disorders [8], myelodysplastic syndrome, hemolytic anemia, liver impairment, sickle cell disease [9], and blood transfusions. [10] RDW value is increased among the red blood cell transfused patients [11] and a cutoff value of RDW to predict the mortality of critically ill patients was higher in comparison to non-transfused patients [12]. The normal range of RDW is 11.5% to 14.5% with no clinical scenarios that produce RDW <11.5%.…”

Section: Introductionmentioning

confidence: 98%

The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal

Ghimire

Shakya

Shrestha

et al. 2020

Preprint

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Background: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. Predicting prognosis is always a difficult task in busy emergency rooms using present scores, which has several variables to calculate. Red cell distribution width (RDW) is an easy, cheap, and efficacious score to predict the severity and mortality of patients with sepsis.Methods: This prospective analytical study was conducted in the emergency room of Tribhuvan University Teaching Hospital among the patients age ≥16 years and with a clinical diagnosis of sepsis using qSOFA score. 148 patients were analyzed in the study by using a non-probability purposive sampling method. Results: RDW has fair efficacy to predict the mortality in sepsis (Area under the Curve of 0.734; 95% C. I= 0.649-0.818; p-value=0.000) as APACHE II (AUC of 0.728; 95% C. I= 0.637 to 0.819; p-value=0.000) or SOFA (AUC of 0.680, 95% C.I =0.591-0.770; p-value=0.001). Youden Index was maximum (37%) at RDW value 14.75, which has a sensitivity of 83% (positive likelihood ratio=1.81) and specificity of 54% (negative likelihood ratio=0.32). Out of 44 patients with septic shock 16 died (36.4 %) and among 104 patients without septic shock, 24 died (22.9%) which had the odds ratio of 0.713 (p=0.555, 95% C. I= 0.231-2.194). Overall mortality was 27.02% (n=40). RDW group analysis showed no mortality in RDW <13.1 group, 3.6% mortality in 13.1 to 14 RDW group, 22.0% mortality in 14 to >15.6 RDW group and 45.9% mortality in >15.6 RDW group. Significant mortality difference was seen in 14 to >15.6 and >15.6 RDW subgroups with a p-value of 0.003 and 0.008 respectively.Conclusion: Area under the curve value for RDW is fair enough to predict the mortality of patients with sepsis in the emergency room. It can be integrated with other severity scores (APACHE II or SOFA score) for better prediction of prognosis of septic patients.

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

Abstract: RBC transfusion significantly increased RDW values. This intervention should be accurately reported in the studies evaluating the prognostic role of RDW.

Cited by 32 publications

References 36 publications

Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

Using arterial-venous oxygen difference to guide red blood cell transfusion strategy

Association between red blood cell distribution width and mortality of COVID-19 patients

The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal

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