Correlation of red cell distribution width with prognosis in patients with severe traumatic brain injury

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Objective To investigate the correlation between red cell distribution width (RDW) and prognosis in patients with severe traumatic brain injury. Methods A total of 264 consecutive patients with severe traumatic brain injury admitted from May 2012 to November 2014 were enrolled. The patients were divided into low-RDW group (RDW<15%, n=198) and high-RDW group (RDW≥15%, n=66) based on their RDW levels. Between-group differences were evaluated on general conditions, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), inflammatory markers [high sensitivity C-reactive proteins(hs-CRP) and arterial lactate], liver/renal dysfunction, and 28-day mortality. Spearman correlation analysis of RDW with mortality was conducted. Independent factors of 28-day mortality were identified using multivariate Logistic regression. Kaplan-Meier 28-day survival curve was analyzed and survival probability of the two groups was compared using Log-Rank test. Results The 28-day mortality was significantly enhanced in high-RDW group compared to that in low-RDW group (43.9% vs 26.8%, P<0.01). RDW≥15% related positively to APACHE Ⅱ and mortality(r=0.172 and 0.253 respectively, P<0.01) , but negatively to Glagow coma score (GCS) (r=-0.169, P<0.01). RDW≥15% was the independent risk factor for predicting the 28-day mortality (OR=2.144, 95%CI 1.202-3.826, P<0.01). After adjusted gender, age, and other relative factors, RDW≥15% was still strongly correlated with the 28-day mortality(OR=2.244, 95%CI 1.076-4.678, P<0.05). Significantly lower 28-day survival rate was found in high-RDW group than in low-RDW group (P<0.01). Conclusions RDW level rises beyond the normal range on admission in patients with severe traumatic brain injury, which is closely correlated with the 28-day poor outcome. RDW≥15% has significant predictive value in the prognosis. Key words: Craniocerebral trauma; Prognosis; Red cell distribution width