Red Cell Distribution Width as a Prognostic Factor and Its Comparison with Lactate in Patients with Sepsis.

Tsung-Han Wang,Yin-Chou Hsu

doi:10.3390/diagnostics11081474

Tsung-Han Wang, Yin-Chou Hsu

Open Access

https://doi.org/10.3390/diagnostics11081474

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Journal: Diagnostics	Publication Date: Aug 14, 2021
Citations: 8	License type: CC BY 4.0

Affiliation: I-Shou University, E-Da Hospital

Abstract

Sepsis remains the leading cause of death in critically ill patients. Thus, regular measurement of lactate levels has been proposed in sepsis guidelines. Elevated red cell distribution width (RDW) is associated with mortality risk in patients with sepsis. This study aimed to investigate the association between RDW and the risk of other adverse outcomes in patients with sepsis and to compare the mortality discriminative ability between lactate and RDW levels. This is a single-centered, retrospective, case-control study that included 504 adult patients with sepsis in the emergency department between 1 January 2020 and 31 December 2020. Eligible patients were divided into normal (RDW ≤ 14.5%) and high (RDW > 14.5%) groups. The baseline characteristics and adverse outcomes were recorded and compared. Compared with the normal RDW group, the patients in the high RDW group had a significantly higher rate of ICU admission (48.8% vs. 32.4%, p = 0.03), septic shock (39.2% vs. 23.5%, p < 0.01), and 30-day in-hospital mortality (32.0% vs. 20.7%, p < 0.01). Furthermore, the RDW (area under curve (AUC) = 0.71) had superior mortality discriminative ability compared to lactate (AUC = 0.63) levels (p = 0.02). Clinicians could rely on this simple and rapid parameter for risk stratification to initiate prompt treatment for patients with sepsis.

Highlights

An updated practice guideline proposed by the Surviving Sepsis Campaign (SSC) recommended that serum lactate measurement is vital for patients with sepsis and septic shock, as increased levels may represent tissue hypoxia or other life-threatening scenarios [2]
After excluding patients with no data on lactate measurement (n = 12), a cardiac arrest event before emergency department (ED) visit (n = 8), known hematological disease (n = 12), human immunodeficiency virus (HIV) infection (n = 8), immunosuppressant use (n = 12), and those who received recent blood transfusion (n = 9), 504 patients with sepsis were enrolled for further analysis
We demonstrated that high red cell distribution width (RDW) in septic patients was associated with an increased risk of 30-day in-hospital mortality, and with septic shock development and intensive care unit (ICU) admission