Red cell distribution width (RDW) as a biomarker for respiratory failure in a pediatric ICU

Tom Schepens,Jozef J De Dooy,Walter Verbrugghe,Philippe G Jorens

doi:10.1186/s12950-017-0160-9

Tom Schepens, Jozef J De Dooy + Show 2 more

Open Access

https://doi.org/10.1186/s12950-017-0160-9

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Abstract

BackgroundThe red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. Any process that releases reticulocytes in the circulation will result in an increase in RDW. Elevated RDW values are linked to worsened pulmonary function in the adult population. We performed a retrospective cohort study to describe the association between RDW and respiratory failure in critically ill children in a in a pediatric intensive care unit (PICU) in a tertiary university hospital.SubjectsAll patients admitted between January 2009 and June 2015 were considered eligible for inclusion.MethodsRetrospective cohort study.ResultsIn total, 960 patients were included in the cohort analysis. Of those patients, 149 (15.5%) had elevated RDW values. RDW on admission was associated with lower 28 day ventilator-free days. The highest quintile of RDW was associated with the need for mechanical ventilation, even when correcting for anaemia, age and Pediatric Risk of Mortality (PRISM) scores. In the subgroup of ventilated patients, RDW was associated with nadir PaO2/FiO2(P/F) ratios.ConclusionThe RDW value on admission of our PICU patients is associated with a greater need for invasive mechanical ventilation, lower 28 day ventilator-free days and lower nadir P/F ratios in the patients with highest RDW values on admission. RDW may be a valuable, cheap and universally available, prognostic parameter for respiratory dysfunction in the PICU.

Highlights

The red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes
Our data demonstrate that RDW at the time of pediatric intensive care unit (PICU) admission is associated with different validated parameters for respiratory failure in our cohort of PICU patients
The need for mechanical ventilation, and the nadir P/F ratios in ventilated patients are both associated with RDW values on admission, and largely remain so in regression models after correcting for both disease severity and anaemia

Summary

Introduction

The red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. The red cell distribution width (RDW) is routinely reported in automated complete blood counts It is a widely available, inexpensive, and highly reproducible test reflecting the range of the size of the circulating red blood cells [1]. The different factors that might increase the heterogeneity in size, such as the red blood cell circulation half-life and RDW has been associated with adverse outcome and individual organ failure in both community-based cohorts and in critically ill adults [5,6,7,8]. In the critical care unit, RDW is associated with higher mortality in adult patients with single organ failure i.e. acute kidney injury necessitating

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