Red cell distribution width as a predictive index for multiorgan damage in disseminated intravascular coagulation

Abstract

Background Red cell distribution width (RDW) is raised in many diseases. Although disseminated intravascular coagulation (DIC)-triggering diseases such as sepsis and cancer are also associated with raised RDW, we believe that a superimposed DIC would further raise the RDW owing to fibrin deposition with attendant red cell fragmentation. Hence, we also believe that extensive fibrin deposition will lead to higher RDW (due to red cell fragmentation) and higher risk of multiorgan damage (MOD) (due to microvascular blockade) in DIC. This implies that high RDW in DIC would partly reflect the intensity of fibrin deposition and risk of MOD. We therefore hypothesize that RDW elevation may be associated with an increased risk of MOD in DIC. If our hypothesis is correct, DIC patients with MOD will have significantly higher RDW than their counterparts without MOD. Materials and methods We performed a retrospective comparative analysis of the frequencies of organ damage with respect to RDW values among 96 DIC patients seen from 1996 to 2007 in two tertiary hospitals in Nigeria. Results Patients with organ damage had higher mean values of RDW as compared with patients without organ damage (22.3 vs. 16.8%, P Discussion This study suggests that high RDW values were associated with organ damage, and the number of damaged organs increased with rising values of RDW, as revealed by a significant positive correlation between RDW values and number of damaged organs. This correlation suggests that higher RDW values were associated with higher risk of MOD. These findings have validated our hypothesis that fibrin deposition, which is a major cause of MOD in DIC, would also cause red cell fragmentation and elevation of RDW. We conclude that high RDW is a risk factor for MOD in DIC, and RDW values may be of predictive significance in assessing the risk of MOD in patients with DIC.