Prognostic Significance of Red Blood Cell Distribution width (RDW) in Critically ill Paediatric Patients at Sohag University Hospital
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Keywords
critically ill children, RDW, severity scores
Abstract
Background: RDW has been recently reported as a strong prognostic factor in several diseases of various organ systems , In critically ill children, it is crucial to assess the severity of illness and organ dysfunction.
Aim: this study aimed to evaluate RDW as a marker for illness severity in critically ill paediatric patients
Patients and methods: One hundred and eleven children, 55 males (49.5 %). were included in this cross-sectional hospital-based study. All critically ill paediatric patients, 1 month to 12 years of age, which were admitted to the Paediatric intermediate & Intensive Care Unit (PICU), at Sohag University Hospital, over six months period were included in the study, Investigations performed ; Complete
Blood Count, Serum electrolytes, Blood gases, Coagulation profile , Liver and kidney functions, CRP, Serum lactate, serum fibrinogen, Blood urea nitrogen (BUN) and b-type natriuretic peptide. Observation for the patient if a mechanical ventilation and or inotropes were needed, and for the duration of hospital stay and for the outcome of the case. Calculation of critical illness scores including pediatric multiple organ dysfunction syndrome (PMODS), the pediatric risk of mortality (PRISM), pediatric sequential organ failure assessment (PSOFA) and pediatric logistic organ dysfunction-2 (PELOD-2).
Results: Mortality among critically ill children was significantly associated with high RDW >16.9 with p-value <0.001.Critically ill children with low RDW <16.9 had significantly longer duration of PICU admission with p-value =0.015.Critically ill children with high RDW >16.9 had significantly lower GCS during their PICU admission with p-value<0.001. There was a statistically significant positive correlation between R DW level, PRISM III, SOFA, PLEOD II, and PMODS scores with pvalue <0.001. High RDW > 16.9 had a statistically significant predictor for survival of critically ill children with p-value <0.001.Univariate regression analysis shows that PRISM III, PSOFA, PLEOD
II, PMODS and RDW% had statistically significant effect on PICU survival among critically ill children with p-value <0.001.
Conclusion: Red blood cell distribution width ( RDW) is a good predictor of critical illness severity in pediatrics being significantly correlated with severity scores including SOFA, PLEOD II, and PRISM scores
References
2. Graciano AL, Balko JA, Rahn DS, Ahmad N, & Giroir BP. The Pediatric Multiple Organ Dysfunction Score (P-MODS): development and
validation of an objective scale to measure the severity of multiple organ dysfunction in critically ill children. Critical care medicine,
33(7), 1484-1491. 2005.
3. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, & Rhee, J. E. Red cell distribution width is a prognostic factor in severe sepsis and septic
shock. The American journal of emergency medicine, 31(3), 545-548. 2013.
4. Wang B, Lu H, Gong Y, Ying B, & Cheng B. The association between red blood cell distribution width and mortality in critically ill patients with acute kidney injury. BioMed Research International, 2018.
5. Schepens T, De Dooy JJ, Verbrugghe W, & Jorens PG. Red cell distribution width (RDW) as a biomarker for respiratory failure in a pediatric ICU. Journal of Inflammation. 14(1), 1-7. 2017.
6. Fujita B, Strodthoff D, Fritzenwanger M, Pfeil A, Ferrari M, Goebel B, & Jung C. Altered red blood cell distribution width in overweight adolescents and its association with markers of inflammation. Pediatric obesity, 8(5), 385-391. 2013.
7. Sadaka F, O’Brien J, & Prakash S. Red cell distribution width and outcome in patients with septic shock. Journal of intensive care medicine, 28(5), 307-313. 2013.
8. Semba RD, Patel KV, Ferrucci L, Sun K, Roy CN, Guralnik JM, & Fried L. P. Serum antioxidants and inflammation predict red cell
distribution width in older women: the Women's Health and Aging Study I. Clinical nutrition, 29(5), 600-604.2010
9. Kumar S, Sudhakar A, Mohan M, Balachandran R, Raj B, Sumangala SG, Kumar RK. Elevated red cell distribution width is associated with delayed postoperative recovery after correction of Tetralogy of Fallot. Annals of pediatric cardiology. 6(2):121. Jul 2013.
10. Sachdev A, Simalti A, Kumar A, Gupta N, Gupta D, & Chugh P. Outcome prediction value of red cell distribution width in critically-ill children. Indian pediatrics, 55(5), 414-416. 2018.
11. Ramby AL, Goodman DM, Wald EL, Weiss SL. Red Blood Cell Distribution Width as a Pragmatic Marker for Outcome in Pediatric Critical Illness. PLoS One . 10(6):e0129258.2015
12. Sukewanti NM, Hartawan INB, Wati DK, Suparyatha IBG, & Ryalino C. Correlation of red cell distribution width and serum lactate levels in critically ill pediatric patients. Bali Journal of Anesthesiology, 4(3), 104. 2020.
13. Said AS, Spinella PC, Hartman ME, Steffen KM, Jackups Jr R, Holubkov R & Doctor A. Red blood cell distribution width: biomarker for red cell dysfunction and critical illness outcome?.Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 18(2), 134. 2017.
14. Ha EJ, Park SJ, & Jhang WK. Evaluation of the usefulness of red blood cell distribution width in critically ill pediatric patients. Medicine, 99(36). 2020
15. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, & Rhee, J. E. Red cell distribution width is a prognostic factor in severe sepsis and septic
shock. The American journal of emergency medicine, 31(3), 545-548. 2013.
16. Hartawan INB, Saputra Y, & Ryalino C. Correlation of red cell distribution width value with the duration of mechanical ventilator usage in patients treated in pediatric intensive care unit. Bali Journal of Anesthesiology, 4(3), 99.2020
17. Bazick HS, Chang D, Mahadevappa K, Gibbons FK, & Christopher KB. Red Cell Distribution Width and all cause mortality in critically ill
patients. Critical care medicine, 39(8), 1913.2011
18. Khanbabaee G, Hashemi SM, Salarian S, Fariborzi MR, & Kiumarsi A. Red cell distribution width elevation and sepsis in pediatric critically ill patients. Archives of Pediatric Infectious Diseases, 6(2). 2018
19. Hunziker S, Celi LA, Lee J, Howell MD. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients. Crit Care . 16(3):R89.2012
20. Agarwal AM. Diagnostic approach to Anemia. University of Utah School of Medicine, Department of Pathology, ARUP Laboratories.
2014
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