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ABSTRACT

Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65)). Of 6973 consecutive adult patients with a clinical diagnosis of sepsis and 2 sets of blood culture ordered by physicians, 477 (6.8%) died. The mortality group had higher RDW levels than the survival group (15.7% vs 13.8%). After dividing RDW into quartiles, the patients in the highest RDW quartile (RDW >15.6%; mortality, 16.7%) had more than twice the risk of in-hospital mortality compared with patients in the second highest quartile (RDW >14% and <15.6%; mortality, 7.3%), whereas the mortality rate in the lowest RDW quartile (<13.1%) was only 1.6%. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.75 (95% confidence interval, 0.72–0.77), which is significantly higher than the areas under the curve of clinical prediction rules (SIRS, MEDS, and CURB65). After integrating RDW into these scores, all scores performed better in predicting mortality (0.73, 0.72, and 0.77, for SIRS, MEDS, and CURB65, respectively). RDW could be an independent predictor of mortality among septic patients. Clinicians could classify the septic patients into different risk groups according to RDW quartiles. For more accurate mortality prediction, RDW could be a potential parameter to be incorporated into clinical prediction rules.

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Mortality distribution in RDW quartiles. CI = confidence interval, RDW = red blood cell distribution width.
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Figure 2: Mortality distribution in RDW quartiles. CI = confidence interval, RDW = red blood cell distribution width.

Mentions: To illustrate the capacity to discriminate the risk of mortality stratified by RDW quartile, we plotted mortality rates by RDW quartile (Fig. 2). For patients in the very high RDW quartile, the mortality rate was 16.7%, twice that of patients in the high quartile (7.3%, supplementary Table 4). On the contrary, the mortality rate of patients in the lowest RDW quartile was only 1.6% (diagnostic odds ratio: 5.69, 95% CI: 3.81–8.84, sensitivity = 93.7%, 95% CI: 91.2–95.6%). Using 12% as a cutoff of RDW, the sensitivity in predicting mortality would be 99.4% (negative likelihood ratio: 0.30). On the other hand, the specificity in predicting mortality would be 89.9% if 17% used as the cutoff of RDW (positive likelihood ratio: 3.16). Patients with liver disease, malignancy, or immunocompromised status were more likely to have a wider RDW distribution (all P values for trend <0.05). Patients with a wider RDW tended to have lower hemoglobin, platelet, and albumin and higher BUN, creatinine, total bilirubin, and ammonia levels (all P values for trend <0.05). Patients with wider RDW tended to have higher mortality as well as higher ICU admission rates (all P values for trend <0.05). Interestingly, we also observed more severely septic patients in the wider RDW groups (all P values for trend <0.05).


STARD-compliant article
Mortality distribution in RDW quartiles. CI = confidence interval, RDW = red blood cell distribution width.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998434&req=5

Figure 2: Mortality distribution in RDW quartiles. CI = confidence interval, RDW = red blood cell distribution width.
Mentions: To illustrate the capacity to discriminate the risk of mortality stratified by RDW quartile, we plotted mortality rates by RDW quartile (Fig. 2). For patients in the very high RDW quartile, the mortality rate was 16.7%, twice that of patients in the high quartile (7.3%, supplementary Table 4). On the contrary, the mortality rate of patients in the lowest RDW quartile was only 1.6% (diagnostic odds ratio: 5.69, 95% CI: 3.81–8.84, sensitivity = 93.7%, 95% CI: 91.2–95.6%). Using 12% as a cutoff of RDW, the sensitivity in predicting mortality would be 99.4% (negative likelihood ratio: 0.30). On the other hand, the specificity in predicting mortality would be 89.9% if 17% used as the cutoff of RDW (positive likelihood ratio: 3.16). Patients with liver disease, malignancy, or immunocompromised status were more likely to have a wider RDW distribution (all P values for trend <0.05). Patients with a wider RDW tended to have lower hemoglobin, platelet, and albumin and higher BUN, creatinine, total bilirubin, and ammonia levels (all P values for trend <0.05). Patients with wider RDW tended to have higher mortality as well as higher ICU admission rates (all P values for trend <0.05). Interestingly, we also observed more severely septic patients in the wider RDW groups (all P values for trend <0.05).

View Article: PubMed Central - PubMed

ABSTRACT

Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65)). Of 6973 consecutive adult patients with a clinical diagnosis of sepsis and 2 sets of blood culture ordered by physicians, 477 (6.8%) died. The mortality group had higher RDW levels than the survival group (15.7% vs 13.8%). After dividing RDW into quartiles, the patients in the highest RDW quartile (RDW &gt;15.6%; mortality, 16.7%) had more than twice the risk of in-hospital mortality compared with patients in the second highest quartile (RDW &gt;14% and&#8202;&lt;15.6%; mortality, 7.3%), whereas the mortality rate in the lowest RDW quartile (&lt;13.1%) was only 1.6%. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.75 (95% confidence interval, 0.72&ndash;0.77), which is significantly higher than the areas under the curve of clinical prediction rules (SIRS, MEDS, and CURB65). After integrating RDW into these scores, all scores performed better in predicting mortality (0.73, 0.72, and 0.77, for SIRS, MEDS, and CURB65, respectively). RDW could be an independent predictor of mortality among septic patients. Clinicians could classify the septic patients into different risk groups according to RDW quartiles. For more accurate mortality prediction, RDW could be a potential parameter to be incorporated into clinical prediction rules.

No MeSH data available.