An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock

Chan Ho Kim, Jung Tak Park, Eun Jin Kim, Jae Hyun Han, Ji Suk Han, Jun Yong Choi, Seung Hyeok Han, Tae-Hyun Yoo, Young Sam Kim, Shin-Wook Kang, Hyung Jung Oh, Chan Ho Kim, Jung Tak Park, Eun Jin Kim, Jae Hyun Han, Ji Suk Han, Jun Yong Choi, Seung Hyeok Han, Tae-Hyun Yoo, Young Sam Kim, Shin-Wook Kang, Hyung Jung Oh

Abstract

Introduction: A potential independent association was recently demonstrated between high red blood cell distribution width (RDW) and the risk of all-cause mortality in critically ill patients, although the mechanism underlying this relationship remains unclear. Little is known about the impact changes in RDW may have on survival in critically ill patients. Therefore, we investigated the prognostic significance of changes in RDW during hospital stay in patients with severe sepsis or septic shock.

Methods: We prospectively enrolled 329 patients who were admitted to the emergency department (ED) and received a standardized resuscitation algorithm (early-goal directed therapy) for severe sepsis or septic shock. The relationship between the changes in RDW during the first 72 hours after ED admission and all-cause mortality (28-day and 90-day) were analyzed by categorizing the patients into four groups according to baseline RDW value and ΔRDW72hr-adm (RDW at 72 hours - RDW at baseline).

Results: The 28-day and 90-day mortality rates were 10% and 14.6%, respectively. Patients with increased RDW at baseline and ΔRDW72hr-adm >0.2% exhibited the highest risks of 28-day and 90-day mortality, whereas the patients with normal RDW level at baseline and ΔRDW72hr-adm ≤0.2% (the reference group) had the lowest mortality risks. For 90-day mortality, a significantly higher mortality risk was observed in the patients whose RDW increased within 72 hours of ED admission (normal RDW at baseline and ΔRDW72hr-adm >0.2%), compared to the reference group. These associations remained unaltered even after adjusting for age, sex, Sequential Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index, renal replacement therapy, albumin, hemoglobin, lactate, C-reactive protein and infection sites in multivariable models.

Conclusions: We found that an increase in RDW from baseline during the first 72 hours after hospitalization is significantly associated with adverse clinical outcomes. Therefore, a combination of baseline RDW value and an increase in RDW can be a promising independent prognostic marker in patients with severe sepsis or septic shock.

Figures

Figure 1
Figure 1
Flow diagram of study subjects. From November 2001 to November 2011, 436 patients who received early-goal directed therapy (EGDT) in the emergency department (ED) were assessed for possible enrollment according to inclusion and exclusion criteria, and 329 patients were included in the final analysis.
Figure 2
Figure 2
Kaplan-Meier plots for cumulative 28-day (A) and 90-day (B) survival according to baseline red blood cell distribution width (RDW) value and ΔRDW72hr-adm (ΔRDW72hr-adm, RDW at 72 hours – RDW at baseline). Group 1 included patients with RDW levels in the reference range (normal RDW level) at baseline and ΔRDW72hr-adm ≤0.2%, group 2 comprised patients with increased RDW at baseline and ΔRDW72hr-adm ≤0.2%, group 3 included patients with normal RDW at baseline and ΔRDW72hr-adm >0.2%, and group 4 was made up of patients with increased RDW at baseline and ΔRDW72hr-adm >0.2% (P <0.001 by log-rank test for overall comparison among groups in both 28-day and 90-day cumulative survival plots).

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