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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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Receiver operating characteristic (ROC) curves. Comparison of the performance of RDW as a continuous variable in predicting mortality with clinical prediction rules (A) and common biomarkers utilized clinically (B). ROC curves of RDW as a quartile indicator with and without clinical prediction rules (C) and in the severely septic group (D). CRP = C-reactive protein, CURB65 = Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older score, MEDS = Mortality of Emergency Department Sepsis score, PCT = procalcitonin, RDW = red blood cell distribution width, RDWQ = RDW in quartile form, SIRS = Systemic Inflammatory Response Syndrome.
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Figure 3: Receiver operating characteristic (ROC) curves. Comparison of the performance of RDW as a continuous variable in predicting mortality with clinical prediction rules (A) and common biomarkers utilized clinically (B). ROC curves of RDW as a quartile indicator with and without clinical prediction rules (C) and in the severely septic group (D). CRP = C-reactive protein, CURB65 = Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older score, MEDS = Mortality of Emergency Department Sepsis score, PCT = procalcitonin, RDW = red blood cell distribution width, RDWQ = RDW in quartile form, SIRS = Systemic Inflammatory Response Syndrome.

Mentions: Fig. 3 illustrates the ROC curves obtained from RDW, different clinical prediction rules, and biomarkers in predicting in-hospital mortality for septic patients. The AUC of RDW to predict mortality was 0.75 (95% confidence interval, 0.72–0.77), which is significantly higher than the AUCs of clinical prediction rules such as SIRS, MEDS, and CURB-65 and common biomarkers utilized clinically such as CRP, PCT, and lactate (Fig. 3A, all P <0.001). After adjusting for possible confounders including age, diabetes, cerebral vascular accident, chronic kidney disease, status of hemodialysis and chemotherapy, hemoglobin level, mean corpuscular volume, white blood cell count, liver disease, immunocompromise, and ICU admission the AUC of RDW was still superior to other scores such as SIRS, MEDS, and CURB-65 (0.74 [95% confidence interval, 0.72–0.76] vs 0.45 [0.43–0.48], 0.60 [0.57–0.63], and 0.55 [0.53–0.59], respectively; all P <0.001; Table 2), and the adjusted Diagnostic Odds Ratio of mortality between the highest and lowest RDW quartiles was 4.94 (95% CI: 3.24–7.54). When we integrated the RDW quartile into these prediction scores as a parameter, all prediction scores performed better, as shown in Fig. 3C (0.73, 0.72, and 0.77 for SIRS, MEDS, and CURB-65, respectively).


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Receiver operating characteristic (ROC) curves. Comparison of the performance of RDW as a continuous variable in predicting mortality with clinical prediction rules (A) and common biomarkers utilized clinically (B). ROC curves of RDW as a quartile indicator with and without clinical prediction rules (C) and in the severely septic group (D). CRP = C-reactive protein, CURB65 = Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older score, MEDS = Mortality of Emergency Department Sepsis score, PCT = procalcitonin, RDW = red blood cell distribution width, RDWQ = RDW in quartile form, SIRS = Systemic Inflammatory Response Syndrome.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Receiver operating characteristic (ROC) curves. Comparison of the performance of RDW as a continuous variable in predicting mortality with clinical prediction rules (A) and common biomarkers utilized clinically (B). ROC curves of RDW as a quartile indicator with and without clinical prediction rules (C) and in the severely septic group (D). CRP = C-reactive protein, CURB65 = Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older score, MEDS = Mortality of Emergency Department Sepsis score, PCT = procalcitonin, RDW = red blood cell distribution width, RDWQ = RDW in quartile form, SIRS = Systemic Inflammatory Response Syndrome.
Mentions: Fig. 3 illustrates the ROC curves obtained from RDW, different clinical prediction rules, and biomarkers in predicting in-hospital mortality for septic patients. The AUC of RDW to predict mortality was 0.75 (95% confidence interval, 0.72–0.77), which is significantly higher than the AUCs of clinical prediction rules such as SIRS, MEDS, and CURB-65 and common biomarkers utilized clinically such as CRP, PCT, and lactate (Fig. 3A, all P <0.001). After adjusting for possible confounders including age, diabetes, cerebral vascular accident, chronic kidney disease, status of hemodialysis and chemotherapy, hemoglobin level, mean corpuscular volume, white blood cell count, liver disease, immunocompromise, and ICU admission the AUC of RDW was still superior to other scores such as SIRS, MEDS, and CURB-65 (0.74 [95% confidence interval, 0.72–0.76] vs 0.45 [0.43–0.48], 0.60 [0.57–0.63], and 0.55 [0.53–0.59], respectively; all P <0.001; Table 2), and the adjusted Diagnostic Odds Ratio of mortality between the highest and lowest RDW quartiles was 4.94 (95% CI: 3.24–7.54). When we integrated the RDW quartile into these prediction scores as a parameter, all prediction scores performed better, as shown in Fig. 3C (0.73, 0.72, and 0.77 for SIRS, MEDS, and CURB-65, respectively).

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.


Related in: MedlinePlus