Association Between Red Cell Distribution Width and Hospital Mortality in Patients with Sepsis

ObjectiveSepsis is the leading cause of death in patients admitted to adult intensive care units (ICUs). We aimed to determine the predictive value of red blood cell distribution width (RDW) in patients with sepsis in a large cohort.MethodsThis retrospective observational study used data from the eICU Collaborative Research Database. The prognostic value of RDW was investigated using the receiver operating characteristic (ROC) curve, multiple logistic regression model, integrated discriminatory index (IDI), and net reclassification index (NRI).ResultsIn total, 9743 patients were included. The area under the ROC curve of the RDW for predicting hospital mortality was 0.631 (95% confidence interval [CI]: 0.616–0.645). Based on the multiple logistic regression model, an RDW of ≥14.5% was correlated with hospital mortality, regardless of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scores (odds ratio [OR]: 1.838, 95% CI: 1.598–2.119). Using SOFA and APACHE IV scores as reference, the IDI and continuous NRI of RDW for hospital mortality was about 0.3 and 0.014, respectively.ConclusionsThe RDW may be useful in predicting hospital mortality in patients with sepsis, offering extra prognostic value beyond SOFA and APACHE IV scores.     

维持性血液透析患者红细胞体积分布宽度及相关影响因素研究

目的：了解维持性血液透析患者的红细胞体积分布宽度（redbloodcelldistributionwidth,RDW）及其影响因素。方法：分析2012年1月-3月复旦大学附属中山医院血液净化中心维持性透析患者356例,其中男性226例,女性130例;年龄（59．2±14．5）岁;透析龄（64．3±42．5）个月。收集所有患者的临床病史,并于周中透析前检测血红蛋白（Hb）、RDW、电解质、高敏C反应蛋白（hsCRP）、血清白蛋白、前白蛋白、铁蛋白、转铁蛋白饱和度、甲状旁腺素和N端脑钠肽前体（NT-proBNP）,透析前后检测血肌酐、尿素氮并计算单室尿素清除指数（spKt／V）。结果：整组患者RDW为（15．14±1．22）％（13．0％～20．4％）,中位数14．9％;241例（67．7％）患者RDw水平超过参考值上限。男性患者RDW水平低于女性患者[（15．03±1．11）％比（15．33±1．39）％,P〈0．05]。Spearman相关分析提示,RDw与年龄（r=0．269,P〈0．00I）、透析龄（r=0．116,P=0．033）、每周促红细胞生成素（erythropoietin,EP0）剂量（r=0．250,P〈0．001）、EPo／Hb比值（r=0．214,P〈0．001）、hsCRP（r=0．335,P=d0．001）及NT—proBNP（r=0．133,P=0．027）呈正相关。RDW与血清白蛋白（r=-0．241,P〈0．001）、前白蛋白（r=-0．334,P〈0．001）呈负相关。多元线性逐步回归模型结果提示,RDW与血清白蛋白呈显著负相关（P〈0．01）。结论：血液透析患者中RDW水平异常并不少见,且与年龄、透析龄、营养水平、炎性反应状态、心脏功能、EPO剂量及反应等多项临床指标有关。RDW对透析人群预后的预测作用有待于进一步研究证实。     

Prognostic Significance of Red Cell Distribution Width in Idiopathic Pulmonary Fibrosis and Combined Pulmonary Fibrosis Emphysema

ObjectiveThe red cell distribution width (RDW) is an inexpensive, readily available prognostic indicator of several diseases. RDW has been assessed as a prognostic biomarker in patients with idiopathic pulmonary fibrosis (IPF) in only one study; furthermore, the relationship between the RDW and combined pulmonary fibrosis emphysema (CPFE) has yet to be reported.Subjects and MethodsThis single-center study was conducted between January 2015 and December 2018 in the Atatürk Chest Diseases and Chest Surgery Education and Research Hospital. Baseline characteristics, laboratory results, and survival status of patients were recorded.ResultsThe RDW value was significantly higher in the CPFE group than in the IPF group (median [IQR 25–75]; 16.8 [15.5–19] vs. 15.3 [13.7–16.8], p = 0.028). High RDW values were correlated with carbon monoxide diffusion capacity (DLCO) (r: −0.653 p = 0.001), 6-minute walking test (6MWT) distance (r: −0.361 p = 0.017), arterial partial oxygen pressure (PaO₂) (r: −0.692 p < 0.001), and systolic pulmonary arterial pressure (SPAP) (r: 0.349 p = 0.022) in patients with fibrotic lung disease. The RDW value was significantly higher in the exitus group than in the survivors (median [IQR 25–75]; 18.4 [15.4–19] vs. 15.2 [13.5–17.2], p = 0.016). A univariate Cox regression analysis identified DLCO, SPAP, PaO₂, and RDW as potential covariates of mortality. In a multivariate analysis, the DLCO (HR 1.21, 95% CI 1.11–1.47, p = 0.012) and RDW level (HR 1.65, 95% CI 1.09–2.47, p = 0.023) remained independent predictors of mortality.ConclusionHigh RDW values appear to be a simple prognostic factor in patients with IPF or CPFE.     

Red blood cell distribution width is associated with mortality in elderly patients with sepsis

Introduction

RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients.

冠心病患者红细胞体积分布宽度变化及其临床意义

目的观察冠心病患者红细胞体积分布宽度(RDW)的变化,探讨其临床应用价值。方法选择我院2008年1月～2010年10月冠心病515例,随机分为心绞痛组365例,急性心肌梗死(AMI)组103例,急性心力衰竭(AHF)组47例,并选取同期健康体检430例作为对照组。均检测血红蛋白(Hb)、RDW、超敏C反应蛋白(hs-CRP)、B型脑钠肽(BNP)并进行比较。结果 515例冠心病RDW水平较对照组明显增高,差异有统计学意义(P<0.01);AHF组RDW水平较心绞痛组增高,差异有统计学意义(P<0.05);按照RDW四分位数分组,随着RDW的逐级增高,AMI、AHF的发病率逐级增高,冠心病患者病死率也逐级增高;RDW与BNP呈正相关(r=0.415,P<0.01),与hs-CRP亦呈正相关(r=0.234,P<0.01),但相关性较弱。结论 RDW可能为冠心病患者预后的独立预测因子,有助于判断冠心病患者的预后。     

急性心肌梗死患者红细胞分布宽度与N末端脑钠肽前体的关系研究

目的：红细胞分布宽度（RDW）越高,急性心肌梗死（AMI）患者预后越差,本研究探讨AMI患者RDW升高的内在机制。方法：102例确诊AMI患者（AMI组）、与150例稳定性冠心病的患者（CAD组）。所有入选者均检测RDW、高敏C反应蛋白（hsCRP）和N末端脑钠肽前体（NT—proBNP）,比较AMI组与cAD组RDW、hsCRP、NT—proBNP的差异。结果：CAD组的RDW显著低于AMI组（13．0％±0．7％比13．3％±0．9％;P=0．003）,但校正NT—proBNP后,2组间RDW水平的差异无统计学意义（P=0．488）。单变量线性相关及多变量分析提示,NT—proBNP而非hsCRP是RDw的独立预测因子。将入院第7天与入院第1天测得的变量差值进行分析发现,RDw的差值（△RDW）与NT—proBNP的对数差值（△logNT—proBNP）具有相关性。△RDw对NT—proBNP的变化具有中度预测价值（曲线下面积为0．71±0．05;P〈0．01）。结论：NT—proBNp而非hsCRP与AMI患者中RDW呈正相关,即心梗后心功能的恶化可能是导致患者RDw升高的主要原因。     

急性心肌梗死外周血红细胞分布宽度变化与临床预后的关系研究

目的:探讨外周血红细胞分布宽度(RDW)变化与急性心肌梗死(AMI)患者临床预后的关系。方法:以2012年1月-2014年1月我科收治的AMI患者162例为研究组,同期体检健康者80例为对照组,比较两组RDW及其与AMI临床预后的关系。结果:研究组RDW的水平明显高于对照组[(14.04±1.22)%vs(13.27±1.12)%,P0.05]。研究组中死亡组的RDW水平显著高于存活组[(15.58±1.59)%,vs(13.41±1.00)%,P0.05];研究组中RDW增高组91例与正常组71例的病死率无明显差异(P0.05),而RDW增高组患者心力衰竭、恶性心律失常及再发心肌梗死发生率分别43.96%、38.46%和24.18%,均显著高于RDW值正常组的15.49%、11.27%和7.04%(P0.05)。结论:AMI患者的RDW水平高于健康人,且RDW水平与临床预后具有一定相关性。     

尿酸联合红细胞分布宽度对脓毒症患者短期结局的预测价值

目的探讨尿酸联合红细胞分布宽度（RDW）在评估脓毒症患者短期临床预后中的诊断价值。 方法将216例脓毒症患者根据尿酸及RDW水平分为A组（尿酸≤ 258 μmol/L且RDW ≤ 14.1%，50例）、B组（尿酸≤ 258 μmol/L且RDW>14.1%，58例）、C组（尿酸>258 μmol/L且RDW ≤ 14.1%，58例）、D组（尿酸>258 μmol/L且RDW>14.1%，50例）。对各组患者的住院期间病死率、30 d病死率、尿酸及RDW进行比较；同时，应用Kaplan-Meier生存曲线比较各组患者随访30 d生存曲线变化；应用受试者工作特征（ROC）曲线判断尿酸、RDW及二者联合指标对脓毒症患者住院期间及随访30 d死亡风险的预测价值。 结果4组患者间住院期间病死率、30 d病死率、尿酸及RDW间比较，差异均有统计学意义（F= 16.211、19.206、132.755、59.771，P均<0.05）。进一步两两比较发现，住院期间病死率仅D组显著高于A组[40.00%（20/50）vs. 8.00%（4/50），P<0.008]，且与C组及D组比较，A组的30 d病死率[34.48%（20/58）、52.00%（26/50）、12.00%（6/50），P均<0.008]及A组与B组的尿酸水平[（411 ± 115）、（412 ± 117）、（170 ± 61）、（148 ± 66）μmol/L，P均<0.05]均显著较低；同时，B组与D组的RDW均显著高于A组与C组[（15.9 ± 2.0）%、（16.0 ± 2.1）%、（13.3 ± 0.6）%、（13.2 ± 0.6）%，P均< 0.05]。而C组与D组间住院期间病死率（P>0.008）、30 d病死率（P>0.008）及尿酸水平（P>0.05）的比较，差异均无统计学意义。4组患者间的Kaplan-Meier生存曲线比较，差异有统计学意义（χ²= 14.102，P= 0.003），且C组及D组的生存曲线均显著低于A组（P均<0.008）。ROC曲线显示，尿酸联合RDW对脓毒症患者住院期间及随访30 d死亡风险的预测价值均明显优于尿酸（Z= 2.043，P= 0.041；Z= 2.012，P= 0.044）及RDW（Z= 2.245，P= 0.025；Z= 2.322，P= 0.020）。 结论尿酸联合RDW能较好地预测脓毒症患者短期临床结局。     

再生障碍性贫血中红细胞参数和血细胞变化的临床意义

目的：通过分析再生障碍性贫血中红细胞参数和血细胞变化,为再生障碍性贫血临床诊断提供筛选指标。方法：长期观察的7例慢性再生障碍性贫血（SAAⅡ）病儿血红蛋白（Hb）、血小板（PLT）、白细胞（WBC）、平均红细胞体积（MCV）及红细胞分布宽度（RDW）进行回顾性分析。结果：7例慢性再生障碍性贫血病儿标本中除治愈那例外,其他,全部标本MCV大于100fl、RDW小于14.6%。治愈1例在MCV下降前有6个月出现RDW上升,最高15.6%。结论：大MCV和小RDW是再生障碍性贫血较为特异表现,可作为临床筛选SAA指标。     

红细胞分布宽度与危重症患者病死率的相关性研究

目的探讨危重症患者入重症监护室(intensive care unit,ICU)时红细胞分布宽度(red cell distribution width,RDW)与病死率的相关性。方法采用回顾性队列研究,纳入美国重症监护数据库Ⅱ版本2.6(Multiparameter Intelligent Monitoring in Intensive CareⅡversion 2.6,MIMIC-Ⅱv2.6)中单次入院且ICU住院时长> 24 h,同时有RDW检测记录的成年患者。根据RDW预测病死率的最佳cut-off值(14.55%)将研究对象分为低RDW组(RDW <14.55%)及高RDW组(RDW≥14.55%),比较两组的病死率,进一步使用单因素及多因素Logistic回归和Cox回归分析评估RDW与病死率的关系。结果本研究最终共有13 822例患者入组。高RDW组的医院病死率、ICU病死率、28 d病死率及1年病死率均高于低RDW组(分别为19.73%vs.8.42%,15.04%vs.6.65%,22.68%vs.9.12%,36.22%vs.14.45%,均P <0.001)。RDW作为连续变量,多因素分析结果显示,RDW越高,医院病死率(OR=1.227,95%CI 1.190~1.265)、ICU病死率(OR=1.180,95%CI 1.141~1.220)、28 d病死率(HR=1.161,95%CI 1.138~1.185)和1年病死率(HR=1.177,95%CI 1.159~1.195)越高。分组后回归分析结果显示,与低水平RDW组相比,高水平RDW组患者的医院病死率增加0.912倍(OR=1.912,95%CI 1.683~2.172),ICU病死率增加0.673倍(OR=1.673,95%CI 1.452~1.928),28 d病死率增加0.850倍(HR=1.850,95%CI 1.675~2.043),1年病死率增加1.045倍(HR=2.045,95%CI 1.891~2.212),且存在统计学意义(P <0.001)。结论入ICU首次RDW增高是危重症患者死亡的危险因素。     

Implementation of the Surviving Sepsis Campaign guidelines for severe sepsis and septic shock: We could go faster

Purpose

The aim of this study is to evaluate the feasibility of applying sepsis bundles in the intensive care unit (ICU) and their effect on outcomes.

Methods

In this prospective, observational study in a 31-bed capacity department of intensive care, we measured the time taken to perform sepsis bundle interventions in 69 consecutive patients with severe sepsis or septic shock.

Results

Compliance with the 6-hour bundle was obtained in 44 (72%) of 61 patients; these patients had a lower mortality rate (16% vs 41%, P = .04) and shorter ICU stay (median [range], 5 [3-10] vs 9 [6-19] days, P = .01) than other patients. Compliance with the 24-hour bundle was obtained in 30 (67%) of 44 eligible patients. The mortality rate and duration of ICU stay were not significantly lower in the 24-hour compliant as compared with the noncompliant group (23% vs 33% and 6 [4-11] vs 9 [6-25] days, respectively; P value is not significant). Patients who complied with the 24-hour sepsis bundle after only 12 hours had a lower mortality rate (10% vs 39%, P = .036) and shorter stay (6 [4-10] vs 9 [6-25] days, P = .055) than those who were compliant after 24 hours.

Conclusions

Correct application of the sepsis bundles was associated with reduced mortality and length of ICU stay. Earlier implementation of the 24-hour management bundle could result in better outcomes.     

红细胞体积分布宽度与心衰患者血浆N末端脑钠肽关系的研究

目的观察心衰患者（HF）红细胞体积分布宽度（RDW）与N末端脑钠肽（NT-proBNP）的关系,从而探讨RDW作为maker评价心衰的价值。方法选择2008年10月至2010年3月我院心力衰竭病房明确诊断心衰的患者464例,男312例,女152例。平均年龄60±12岁。用自动化全血细胞分析仪测患者RDW,用酶联免疫吸附分析（ELISA）法测定NT-proBNP浓度,并进行对比分析。结果 464例心衰患者中有218例RDW值〉15.0%,异常率为47.0%（218/464）;RDW按四分位数分四组,比较各组间NT-proBNP浓度差异,结果显示NT-proBNP浓度在各组段之间均有显著差异（P〈0.001）,其中高于P75组段的NT-proBNP浓度（3455fmol/ml）是P25组段NT-proBNP浓度（646 fmol/ml）的五倍以上。RDW第3四分位数P75的NT-proBNP浓度（1902 fmol/ml）是第2四分位数P50的NT-proBNP浓度（985 fmol/ml）的两倍;采用统计学Spearman相关分析,RDW与NT-proBNP高度相关（r=0.637,P〈0.001）。结论心衰患者RDW水平升高与体内NT-proBNP浓度升高呈正相关,提示RDW可作为诊断心衰及判断预后的maker,是NT-proBNP的有力补充。     

Diagnostic and prognostic value of red blood cell distribution width in sepsis: A narrative review

Previous studies showed that red blood cell distribution width (RDW) can be used as a prognostic and diagnostic index in various non-hematological diseases, including severe infections and sepsis. Here, we provide a narrative review to summarize the findings of available studies investigating the relationship between RDW and sepsis. Current evidence suggests that increased RDW on admission, both in adults and neonates, may be associated with unfavorable outcomes on the short- and long-term. In patients with suspected sepsis, RDW has modest value for predicting positive blood culture. Accordingly, its diagnostic value for sepsis seems limited, whilts dynamic changes of RDW are associated with outcome of sepsis. Taken together, these results suggest that RDW could be used as a prognostic index in septic patients.     

Red blood cell distribution width is not related with inflammatory parameters in morbidly obese patients

Objective

Red blood cell distribution width (RDW) is a hematological parameter that has been studied in several clinical settings and has been found to be related to both anemia and inflammatory status. As obesity is related to increased inflammatory pattern, we aimed to analyze the RDW in this setting.

Methods

We determined hematological and inflammatory parameters in morbidly obese patients before bariatric surgery (n = 142) and normo-weight controls (n = 144).

Results

RDW was higher in patients than in controls (p < 0.001), along with C-reactive protein (p < 0.001) and fibrinogen, (p < 0.001) while hemoglobin (p = 0.026), serum iron (p < 0.001), MCH (p = 0.002) and MCHC (p < 0.001) were lower in morbidly obese patients. The logistic correlation analysis revealed that only low serum iron (< 62 μg/dL) and MCH (< 28.14 pg) levels were associated with RDW > 14% (OR 7.61, 95% CI: 1.93–30.04, p = 0.004; OR 5.67, 95% CI: 1.98–16.24, p = 0.001; respectively).

Conclusions

These data indicate that the elevated RDW in morbidly obese patients reflects a mild red blood cell hypochromia that does not relate to inflammatory parameters, but to hyposideremia and, consequently, to lower erythrocyte indices, possibly as a result of being on a very low-calorie diet before bariatric surgery. Therefore, RDW should not be considered as an inflammatory marker in this clinical setting.