Diagnostic accuracy of a dynamically increased red blood cell distribution width in very low birth weight infants with serious bacterial infection

Bin-Fang Guo,Su-Zhen Sun

doi:10.1186/s13052-021-00994-w

Abstract

ObjectiveSerious bacterial infection (SBI) remains an important cause of morbidity and mortality in preterm infants. The objective of this study was to evaluate the dynamically increased value of the red cell distribution width (RDW) in the diagnosis of SBI.MethodsThis retrospective study enrolled 334 preterm infants with birth weight less than 1500 g. The initial RDW and the maximum value of RDW during hospitalization were extracted from the MIMIC-III database (version 1.4). Infants were categorized into four groups according to baseline RDW value and ΔRDW (ΔRDW = RDW at maximum- RDW at baseline). Logistic regression analysis was used to assess the risk of developing SBI in each group. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of RDW at baseline alone, ΔRDW alone, and in combination.ResultsInfants with increased RDW at baseline (> 17%) and ΔRDW > 2% exhibited the highest risk of developing SBI, whereas the patients with normal RDW level at baseline (≤ 17%) and ΔRDW≤2% (the reference group) had the lowest risk. This association remained unaltered even after adjustment in multivariable models. Basing on ROC curve analysis, the area under the curve predicted by the combination of RDW at baseline and ΔRDW for SBI was 0.81 (95% CI, 0.76–0.87). Sensitivity and specificity were 78.16 and 72.47% respectively.ConclusionsWe observed that combination of elevated RDW at baseline and dynamic increases during hospitalization is significantly associated with SBI. Therefore, that combination could be a promising independent diagnostic indicator of SBI in newborns.

Highlights

Infections account for 40% of neonatal deaths worldwide each year [1]
Preterm infants weighing less than 1500 g, called very low birth weight (VLBW) infants, represent a more vulnerable group of newborns
A total of 334 infants with more than one red cell distribution width (RDW) value were included in the final analyses, and of 87 infants with Serious bacterial infection (SBI) (75 of bacteremia, 5 of meningitis, 1 of urinary tract infection (UTI), 10 of bacteremia and meningitis, 2 of bacteremia and UTI)

Summary

Introduction

Infections account for 40% of neonatal deaths worldwide each year [1]. Preterm infants weighing less than 1500 g, called very low birth weight (VLBW) infants, represent a more vulnerable group of newborns. Almost 25% of VLBW infants experience more than one episode of nosocomial infection [2]. Efforts to address neonatal infections are critical to achieving survival goals in newborns [3], early recognition of infection and timely responses are vital to reduce morbidity and mortality among neonates. In the clinical work, cultures are the gold standard for laboratory diagnosis of bacterial infection even though they lack sensitivity in neonates [4]. Despite serving as predictors of sepsis in neonates, C-reactive protein, IL-6 and procalcitonin have some limitations and are not available in some centers [5]

Methods

Results

Conclusion