Red blood cell distribution width during the first week is associated with severity and mortality in septic patients

Leonardo Lorente, María M Martín, Pedro Abreu-González, Jordi Solé-Violán, José Ferreres, Lorenzo Labarta, César Díaz, Oswaldo González, Daida García, Alejandro Jiménez, Juan M Borreguero-León, Leonardo Lorente, María M Martín, Pedro Abreu-González, Jordi Solé-Violán, José Ferreres, Lorenzo Labarta, César Díaz, Oswaldo González, Daida García, Alejandro Jiménez, Juan M Borreguero-León

Abstract

Objective: Higher values of red blood cell distribution width (RDW) have been found in non-surviving than in surviving septic patients. However, it is unknown whether RDW during the first week of sepsis evolution is associated with sepsis severity and early mortality, oxidative stress and inflammation states, and these were the aims of the study.

Methods: We performed a prospective, observational, multicenter study in six Spanish Intensive Care Units with 297 severe septic patients. We measured RDW, serum levels of malondialdehyde (MDA) to assess oxidative stress, and tumour necrosis factor (TNF)-α to assess inflammation at days 1, 4, and 8. The end-point was 30-day mortality.

Results: We found higher RDW in non-surviving (n = 104) than in surviving (n = 193) septic patients at day 1 (p = 0.001), day 4 (p = 0.001), and day 8 (p = 0.002) of ICU admission. Cox regression analyses showed that RDW at day 1 (p<0.001), 4 (p = 0.005) and 8 (p = 0.03) were associated with 30-day mortality. Receiver operating characteristic curves showed that RDW at day 1 (p<0.001), 4 (p<0.001), and 8 (p<0.001) could be used to predict 30-day mortality. RDW showed a positive correlation with serum MDA levels at day 1 and day 4, with serum TNF-α levels at days 4 and 8, and with SOFA score at days 1, 4 and 8.

Conclusions: The major findings of our study were that non-surviving septic patients showed persistently higher RDW during the first week of ICU stay than survivors, that RDW during the first week was associated with sepsis severity and mortality, that RDW during the first week could be used as biomarker of outcome in septic patients, and that there was an association between RDW, serum MDA levels, and serum TNF-α levels during the first week.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Red blood cell distribution width…
Figure 1. Red blood cell distribution width (RDW) in survivor and non-survivor septic patients.
Figure 2. Receiver operation characteristic (ROC) curve…
Figure 2. Receiver operation characteristic (ROC) curve using red blood cell distribution width (RDW) at day 1, 4 and 8 as predictor of mortality at 30 days in septic patients.
Figure 3. Survival curves at 30 days…
Figure 3. Survival curves at 30 days using red blood cell distribution width (RDW) higher or lower than 15.5%.

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