Red Cell Distribution Width Levels Research Articles

Evaluation of hematological indices in terms of COVID-19 related mortality and ICU admission

Introduction: The COVID-19 pandemic has shown that patients should be categorized according to their risk group, patient follow-up and the use of health resources should be arranged according to this categorization. Therefore, practical and inexpensive biomarkers are needed. In this study, the relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV) and red blood cell distribution width (RDW) levels, which can be easily calculated by complete blood count, with mortality and intensive care unit (ICU) admission in COVID-19 disease was evaluated.
 Materials and Methods: 748 inpatients with positive COVID-19 PCR test were evaluated retrospectively. The NLR, PLR, MPV and RDW levels calculated from the complete blood count parameters of the patients at hospital admissions and their relationship with the mortality and the ICU admission in COVID-19 disease were evaluated.
 Results: In terms of mortality, a statistically significant difference was found between RDW levels in the evaluation performed in the patient groups who survived and died (p: 0.014). No statistically significant difference was found in NLR, PLR and MPV levels. In the evaluation made between ICU (+) and ICU (-) groups, a statistically significant difference was found in RDW and NLR levels (p: 0.042, p: 0.01, respectively). There was no statistically significant difference between PLR and MPV levels for ICU admission.
 Conclusion: RDW level was found to be associated with COVID-19 related mortality and ICU admission.

Predictive value of red blood cell distribution width level on histological response and prognosis in colorectal liver metastases.

The red blood cell distribution width (RDW) level is a potential prognostic factor for solid tumours. We aimed to investigate the predictive value of pre-neoadjuvant chemotherapy (pre-NAC) RDW, preoperative RDW and the change in RDW on the pathological response and prognosis of patients with colorectal liver metastasis (CRLM), which was helpful for treatment decision-making, surveillance and prognostication. This retrospective study analyzed clinicopathologic data, treatments and outcomes of 150 CRLM patients treated with NAC followed by liver resection at our hospital. The primary outcomes were progression-free survival (PFS) and overall survival (OS). The secondary outcome was postoperative major complications. The RDW level was presented as the RDW-SD level and the RDW-CV level. The optimal cut-off of RDW level was determined by X-tile analysis. The change in RDW was scored as 0 (decreased pre-NAC RDW and decreased preoperative RDW), 2 (elevated pre-NAC RDW and elevated preoperative RDW), or 1 (all other combinations). Multivariable logistic regression analysis was performed to determine the relationships between the tumour characteristics and pathological response and the postoperative major complications. A multivariate Cox proportional hazards model was used to evaluate the prognostic factors associated with survival. The optimal cut-off values of the RDW-CV and RDW-SD levels for survival were 13.5% and 42.2 fl, respectively. The multivariate analysis showed that a preoperative RDW-CV ≥13.5% (OR =3.215, 95% CI: 1.299-7.958, P=0.012) significantly predicted a favorable pathological response. The multivariate analysis revealed that a pre-NAC RDW-CV ≥13.5% (OR =2.462, 95% CI: 1.080-5.615, P=0.032) significantly predicted postoperative major complications. In the multivariate analysis, an RDW-CV change =2 (HR =0.487, 95% CI: 0.309-0.768, P=0.002) was a significant predictor of better PFS. The multivariate analysis also revealed that an RDW-SD change =2 (HR =0.532, 95% CI: 0.332-0.854, P=0.009) were an independent predictor of better OS. This study revealed that pre-NAC RDW, preoperative RDW and RDW changes may be reliable markers that could predict a pathological response and prognosis in CRLM patients receiving NAC followed by liver resection.

Usefulness of red cell distribution width to predict mortality in patients undergoing endovascular repair of abdominal aortic aneurysms.

Red cell distribution width (RDW) reflecting impaired erythropoyesis, has been associated with poor prognosis and mortality in several conditions. The aim of this study was to determine the relationship between RDW and the 5-year survival after the endovascular repair of abdominal aortic aneurysms (EVAR) and its ability to improve the discriminative power of a survival predictive score. Retrospective analysis of 284 patients undergoing EVAR at a single centre. The pattern of relationship between RDW and survival was assessed with penalized smoothing splines. Categorized RDW values were added to a predictive score based in standard preoperative variables, whose improvement in discriminative power was calculated on the basis of changes in the C-statistics and the continuous Net Reclassification Index (c-NRI). The survival rate at 5 years was 66.2% and was independently associated with hemoglobin (HR=0.85, P<0.004), statin intake (HR=0.54, P<0.004), heart failure (HR=2.53, P<0.018), atrial fibrillation (HR=2.53, P<0.000) and the non-revascularized coronary artery disease (HR=2.15, P<0.005). The relationship between RDW values and 5-year survival was linear. RDW-CV and RDW-SD were categorized to cut-off values of ≥15% (N.=83, 29.2%) and ≥50 fL (N.=82, 28.9%) that were independently associated with poorer 5-year survival rates (HR=2.03, CI 95%=1.29-3.19, P=0.002 and HR=1.89, CI 95%=1.21-2.95, P=0.005, respectively). The addition of the RDW CV or the RDW-SD to the baseline predictive score significantly improved the c-NRI (0.437, P<0.001 and 0.442, P<0.001, respectively). High preoperative RDW levels were linear and adversely related to 5-year survival after EVAR, improved the discriminative power of a predictive score based in standard preoperative variables and may help in decision-making at the time of surgical planning.

High red blood cell distribution width levels could increase the risk of hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients.

The association between the red blood cell distribution width (RDW) and hemorrhagic transformation (HT) after thrombolysis in acute ischemic stroke patients remains inconclusive. Our study aimed to assess whether high RDW levels are associated with the occurrence of HT after thrombolysis. Data were consecutively collected and retrospectively analyzed for stroke patients treated with thrombolysis between 1 January 2017 and 31 December 2019. The primary outcomes were the occurrence of HT and symptomatic HT. Among the 286 patients enrolled, 36 (12.6%) developed HT and15 (5.2%) were classified as symptomatic HT. Patients with high RDW levels were associated with a higher percentage of HT and symptomatic HT (P<0.05). The RDW levels in the HT and symptomatic HT groups were also greater compared with the no-HT group (P<0.001). Multivariable logistic regression analysis revealed that high RDW levels were independently associated with an increased risk of HT (adjusted odds ratio 2.5, 95 % CI, 1.74–3.83 P < 0.001). In conclusion, we found that high RDW levels may be an independent predictor of HT in stroke patients after thrombolysis.

Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?

Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P<.001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P<.001). According to attack severity, low RDW values were determined. Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.

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

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.

Red Cell Distribution Width at Admission Predicts the Frequency of Acute Kidney Injury and 28-Day Mortality in Patients With Acute Respiratory Distress Syndrome.

ABSTRACTObjectives:To determine the association of red cell distribution width (RDW) at admission with frequency of acute kidney injury (AKI) and 28-day mortality in acute respiratory distress syndrome (ARDS) patients.Methods:Two hundred fifty-eight ARDS patients were investigated in retrospective and prospective studies. The primary outcome was frequency of AKI. The secondary outcome was 28-day mortality.Results:The retrospective study included 193 ARDS patients, of which 67 (34.7%) were confirmed AKI and 76 (39.4%) died within 28 days. The RDW level in the AKI group was significantly higher than in the non-AKI group ([15.15 ± 2.59]% vs. [13.95 ± 1.89]%). Increased RDW was a significant predictor of frequency of AKI (odds ratio: 1.247, 95% confidence interval [CI]: 1.044, 1.489). The area under the receiver operating characteristic curve of RDW for predicting AKI was 0.687 (95%CI: 0.610, 0.764) and the cut-off value was 14.45 (sensitivity, 56.7%; specificity, 72.8%). In addition, the proportion of patients with RDW ≥ 14.45% in the non-survival group was notably higher compared with the survival group (48.7% vs. 29.1%). Furthermore, cox regression analysis revealed that RDW ≥ 14.45% was associated with 28-day mortality (hazard ratio: 1.817, 95%CI: 1.046, 3.158), while Kaplan–Meier analysis showed patients with RDW ≥ 14.45% had a significantly lower survival rate than those with RDW < 14.45%. The prospective study, on the other hand, included 65 ARDS patients, with frequency of AKI and 28-day mortality in the RDW ≥ 14.45% group significantly higher than in RDW < 14.45%.Conclusion:RDW was a significant, independent predictor for frequency of AKI and 28-day mortality in ARDS patients.

Study of red cell distribution width levels and its correlation with severity of disease in patient with chronic obstructive pulmonary disease

Background:COPD has been accepted as component of systemic inflammatory syndrome. Red cell distribution width (RDW) is a measure of coefficient of variation of mean corpuscular volume which increases in chronic systemic inflammation. The aim of the study was to evaluate the RDW as a predictor of severity of COPD using BODE index.Methods:In this cross-sectional study 107 COPD patients were evaluated by measuring RDW and this was correlated with the severity of disease using GOLD staging.Results:RDW correlates well with COPD patients. Significant correlation of RDW with BODE index (r=0.650, p and It; 0.001), gold staging (r=0.459, p and It; 0.001), 6MWT (r=0.697, p and It; 0.001) were observed.Conclusions: RDW was found to increase in patients with increasing severity of COPD. Hence its potential role as a marker of severity of disease and in predicting risk of cardiovascular disease can be explored.

The role of serum red blood cell distribution width level in predicting the short term mortality of community-acguired pneumonia, acute attack chronic pulmonary disease, and acute pulmonary thromboembolism

Background: There is a growing concern in inflammatory parameters that are commonly used in routine practice and can be measured cost-effectively for predicting mortality community-acquired pneumonia (CAP), acute-attack chronic obstructive pulmonary disease (COPD), and acute pulmonary thromboembolism (PTE). Red blood cell distribution width (RDW) is a significant parameter indicating the heterogeneity of the size of red blood cells (RBCs). The present study was designed to compare RDW levels among patients that were hospitalized due to CAP, acute PTE, and acute-attack COPD, all of which are characterized by persistent inflammation, and to investigate the role of RDW in predicting 30-day mortality.&#x0D; Materials and Methods: The RDW levels measured on admission in all three groups were evaluated retrospectively.&#x0D; Results:The 554 patients comprised 320 (57.76%) men and 234 (42.24%) women with a mean age of 67.074±14.73 years. The patients comprised 92 (16.6%) CAP, 265 (47.8%) acute PTE, and 197 (35.6%) acute-attack COPD patients. Mean RDW was 14.42%±2.73% (range, 3.77-28%) while it was 14.88%±3.30% in the CAP group, 13.21%±2.77% in the COPD group, and 15.15%±2.12% in the PTE group. In the COPD, CAP, and PTE groups, RDW levels were significantly higher in patients with 30-day mortality compared to those without mortality (p=0.008, p=0.020, and p

A simple model predicting in-hospital death in patients with type A acute aortic dissection.

Type A acute aortic dissection (TAAAD) is a destructive cardiovascular disease, with high morbidity and mortality rates. Identifying the high-risk TAAAD patients at an early stage is urgently necessary. A retrospective study of 160 patients was carried out. The admission data were retrospectively gathered. Logistic regression analysis and receiver operator characteristic curve (AUC) was utilized. Compared with the survivor group, the nonsurvivor group was older, had higher D-dimer levels, red blood cell distribution width (RDW) levels and platelet distribution width (PDW) levels, and lower fibrinogen levels, platelet levels and plateletcrit levels. Multivariate analysis displayed that four independent factors, age (hazard ratio (HR): 7.877, 95% confidence interval (CI) 2.740-22.641, p < 0.001), D-dimer (HR: 3.791, 95% CI 1.520-9.452, p = 0.004), RDW (HR: 3.300, 95% CI 1.109-9.825, p = 0.032), PDW (HR: 3.755, 95% CI 1.436-9.815, p = 0.007) were incorporated into the model. The predict accuracy of the model (AUC 0.861, 95% CI 0.798-0.911, p < 0.001) was best. Age, D-dimer, RDW and PDW are independent markers of in-hospital death in TAAAD patients and the newly established model has better performance in predicting high-risk patients. This model can be used as a quick screening tool to assess the prognosis of patients in individualizing.

Role of red blood cell distribution width in predicting the prognosis of patients with sepsis

Background:Sepsis is a dangerous disease with rapid development and high mortality rate, which is an important cause of death for critically ill patients. Therefore, timely and accurate assessment of patients’ condition is beneficial to improve prognosis and reduce mortality.Objective:This study was designed to investigate the potential correlation between red blood cell distribution width and 28‐day prognosis of patients with sepsis.Methods:A prospective observational study enrolling 236 patients with sepsis or septic shock was performed at our hospital. All cases were divided into survival versus non‐survival group on 28th day after diagnosis. The two groups were compared for general condition, underlying diseases, quick Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II score, C‐reactive protein, procalcitonin, and red blood cell distribution width at admission.Results:The red blood cell distribution width level in non‐survivors was higher than that in survivors (16.3 ± 2.8 vs 15.2 ± 1.7, p = 0.013). Cox regression analysis indicated that red blood cell distribution width was an independent predictor for 28‐day mortality (hazard ratio: 1.311, 95% confidence interval: 1.119–3.011, p = 0.018). The red blood cell distribution width cutoff value of red blood cell distribution width for 28‐day mortality was 16.1%, while patients with lower red blood cell distribution width levels had a better prognosis as demonstrated by Kaplan–Meier survival curves (log‐rank = 7.398, p = 0.007). Unlike the septic shock group, in the sepsis group, the red blood cell distribution width level was higher in the non‐survival group compared to the survival group (15.82% ± 0.93% vs 15.01% ± 0.89%, p &lt; 0.001).Conclusion:Increased red blood cell distribution width may be an important predictor of disease progression and prognosis in patients with sepsis and septic shock. In the sepsis group, higher red blood cell distribution width levels predict poor prognosis.

Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio levels are associated with keratoconus.

Purpose:The aim of this study was to assess the systemic immune-inflammation index (SII) levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with keratoconus (KC).Methods:A total of 42 patients with KC (KC group) and 42 age- and sex-matched healthy subjects (control group) were included into this cross sectional study. Complete blood count parameters were assayed. SII, NLR, red cell distribution width (RDW), and PLR values were calculated. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte).Results:SII, NLR, RDW, and PLR values were significantly higher in KC group compared to control group [709 ± 236 vs. 418 ± 117 (P < 0.001), 2.5 ± 0.8 vs. 1.76 ± 0.3 (P < 0.001), 14.3 ± 1.6% vs. 12.9 ± 0.54% (P < 0.001), and 143 ± 36 vs. 106 ± 23 (P < 0.001), respectively]. Using the receiver operating characteristics (ROC) curve analysis to predict KC, the highest area under the curve (AUC) was determined SII (0.846 for SII, 0.778 for NLR, and 0.796 for PLR).Conclusion:SII, NLR, RDW, and PLR levels were significantly increased in patients with KC. This study supports the idea that several inflammatory pathways may play important role in the pathogenesis of this disorder. SII may be much better marker than NLR and PLR for predicting the inflammatory status of the disease.

Acil Serviste Tanı Alan Stmı ve Nstmı Hastalarda Troponin Değerleri ve Scube 1 Değerlerinin Tanısal Karşılaştırılması

Objective: In the present study we aimed to compare the levels of troponin and SCUBE1 markers to determine the diagnostic role of SCUBE1 in patients with STEMI-NSTEMI.&#x0D; &#x0D; Method: This study was prospectively conducted with 119 patients diagnosed with acute myocardial infarction at the emergency department and 30 control subjects between 01.10.2016 and 01.02.2017. The relationship between age, sex, acute myocardial infarction (AMI)type, white blood cell(WBC), lymphocyte, neutrophil, neutrophil/lymphocyte ratio, red cell distribution width(RDW), thrombocyte count, aspartate aminotransferase(AST), alanine aminotransferase(ALT), CK, CK-MB, troponin, and SCUBE 1 level was examined. Age, sex, and SCUBE 1 level were compared between the patient and control groups.&#x0D; &#x0D; Results: The patients had a mean age of 61.5±14.5 years, and 68.9% of them were male. The patients had a SCUBE 1 level of 79.7 ng/mL and the control group 53.2 ng/ml.SCUBE1 level was comparable between the patients with acute myocardial infarction and the control group. A correlation was found between the SCUBE1 level and age. Women in the patient group had a significantly higher SCUBE1 level. There was a positive correlation between the WBC, CKMB, and troponin levels, and SCUBE 1 level in the patient group. No correlation was found between SCUBE 1 level and neutrophil, lymphocyte, neutrophil/lymphocyte ratio, RDW, platelet, AST, ALT, and CK levels. There was no significant correlation between infarction type and SCUBE 1 level.&#x0D; &#x0D; Conclusion: SCUBE1 level did not significantly rise in patients with acute myocardial infarction. As the test had lower sensitivity and specificity compared to the other markers, we believe that it is not suitable for practical use.

Diagnostic Cut-Off Value of RDW for Screening Thalassemia and the Combined Determination of MCV, MCH, HBA 2 and RDW

To explore the value of red cell distribution width (RDW), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and hemoglobin (Hb) A2 combined determination scheme for screening thalassemia. The RDW levels of thalassemia group and healthy control group were detected and compared. The efficiency of RDW for screening thalassemia was evaluated by receiver operating characteristic (ROC) curve. The diagnostic cut-off value of RDW was also acquired by Youden index. Then, 3 groups for thalassemia screening scheme were set, including MCV+MCH+HBA 2, MCV+MCH+RDW(>16.0)+HBA 2 and MCV+MCH+RDW(>15.15)+HBA 2. The performances of the 3 groups were evaluated through screening 621 clinical suspected cases of thalassemia. The RDW level in thalassemia group was significantly higher than that in healthy control group (P<0.05). The diagnostic cut-off value for screening thalassemia was RDW>15.15, when the Youden index was the biggest among all data. The sensitivity, specificity, positive predictive value, negative predictive value, false negative rate and consistency rate of MCV+MCH+RDW(>15.15)+HBA 2 group was 75.46%, 48.83%, 26.50%, 89.06%, 24.54%, and 54.06%, respectively. The diagnostic cut-off value of RDW for thalassemia screening has been established. The group of MCV(<82.0 fl)+MCH(<27.0 pg)+HBA 2(<2.5% or ≥3.5%)+RDW(>15.15) has a best efficiency among the 3 groups to screen thalassemia.

Correlation among Hemolysis Biomarkers in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

Hemolysis is a common complication associated with mortality on extracorporeal membrane oxygenation (ECMO). Plasma-free hemoglobin (PFH) is the most commonly used biomarker reported for hemolysis on ECMO. This test is not readily available at all institutions, and other more readily available tests may indicate hemolysis nearly as well or as well as PFH. The purpose of this study was to study the correlation of other biomarkers of hemolysis to PFH on ECMO. All patients younger than 21 years placed on ECMO in a quaternary children's hospital between January 2013 and December 2016 were included in the study; biomarkers (urine hemoglobin [U-Hb], PFH, lactate dehydrogenase [LDH], aspartate aminotransferase [AST], gross hemolysis, and red cell distribution width (RDW)) were collected from the medical record. Descriptive statistics and repeated bivariate analyses were determined using SPSS 22.0. The median age on day 0 of ECMO was 29 days (.08 years) (IQR: 2; 319 days (.005; .875 years)). The median weight was 3.9 kg (IQR: 2.8; 8.6), and the median total duration of the ECMO run was 10.48 days (IQR: 4.25; 14), with 82% of all the patients being on venoarterial ECMO. There was no correlation between hematuria on urinalysis and the level of PFH (p= .338). There was a statistically significant positive correlation between PFH and the following respective biomarkers: gross hemolysis on the routine chemistry studies (p&lt; .01, Rho = .439), AST (p&lt; .01, Rho = .439), RDW (p&lt; .01, Rho = .190), LDH (p&lt; .01, Rho = .584), and AST (when associated elevated alanine transaminase (ALT) levels were censored) (p&lt; .01, Rho = .552). U-Hb correlated poorly with PFH. The serum biomarkers AST (in the absence of ALT elevation) and LDH can be useful surrogates for PFH to quantify hemolysis on ECMO in pediatric patients.

Correlation among Hemolysis Biomarkers in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation.

Hemolysis is a common complication associated with mortality on extracorporeal membrane oxygenation (ECMO). Plasma-free hemoglobin (PFH) is the most commonly used biomarker reported for hemolysis on ECMO. This test is not readily available at all institutions, and other more readily available tests may indicate hemolysis nearly as well or as well as PFH. The purpose of this study was to study the correlation of other biomarkers of hemolysis to PFH on ECMO. All patients younger than 21 years placed on ECMO in a quaternary children's hospital between January 2013 and December 2016 were included in the study; biomarkers (urine hemoglobin [U-Hb], PFH, lactate dehydrogenase [LDH], aspartate aminotransferase [AST], gross hemolysis, and red cell distribution width (RDW)) were collected from the medical record. Descriptive statistics and repeated bivariate analyses were determined using SPSS 22.0. The median age on day 0 of ECMO was 29 days (.08 years) (IQR: 2; 319 days (.005; .875 years)). The median weight was 3.9 kg (IQR: 2.8; 8.6), and the median total duration of the ECMO run was 10.48 days (IQR: 4.25; 14), with 82% of all the patients being on venoarterial ECMO. There was no correlation between hematuria on urinalysis and the level of PFH (p = .338). There was a statistically significant positive correlation between PFH and the following respective biomarkers: gross hemolysis on the routine chemistry studies (p < .01, Rho = .439), AST (p < .01, Rho = .439), RDW (p < .01, Rho = .190), LDH (p < .01, Rho = .584), and AST (when associated elevated alanine transaminase (ALT) levels were censored) (p < .01, Rho = .552). U-Hb correlated poorly with PFH. The serum biomarkers AST (in the absence of ALT elevation) and LDH can be useful surrogates for PFH to quantify hemolysis on ECMO in pediatric patients.

POS-068 RED BLOOD CELL DISTRIBUTION WIDTH AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SEPSIS INDUCED ACUTE KIDNEY INJURY: 5 YEAR RETROSPECTIVE REVIEW STUDY FROM 2014-2018

Sepsis is the leading cause of Acute Kidney Injury (AKI). Patients with sepsis induced AKI have an increased risk of death and a longer duration of hospitalization. Red cell distribution width (RDW) measure the range of variation in the red cell volume and variability in size of erythrocytes. Inflammation and oxidative stress are essential components of sepsis cascade, and they have been suggested to reduce Red Blood Cell survival and suppress their maturation leading to a release of increased premature RBCs into circulation, thus, an elevated RDW. The study adapt a retrospective observational analytical cross-sectional review of patients admitted at University of Santo Tomas Hospital from January 2014 to December 2018. Information was gathered across the departments of Surgery, Obstetrics and GynecologyInternal Medicine that were referred to the Section of Nephrology. Total of 421 patients were analyzed, with median age of 67 years, 53% being female, and majority with diabetes. Patients had low median hemoglobin (118 g/dl) and elevated WBC (14.54 x 1000/µL); low mean serum albumin (2.98); and elevated median serum creatinine (2.12 mg/dl). The prevalence of stages 1, 2, and 3 AKI were 70%, 13%, and 17%, respectively. One in 10 patients underwent dialysis. There were 32 patients who had RDW of at least 15.1%. This group had higher median age (77.5 years), serum creatinine (3.78 mg/dL), increase hematologic comorbidity (9%), cardiac disease (53%), septic shock (87.5%), stage 3 AKI (78%), need for Renal Replacement Therapy (44%); higher SOFA score (12); and longer hospital stay (21 days) compared to those with lower baseline RDW levels. Optimal cut-off value for RDW was 15.1%. At this level, sensitivity and specificity were 82.14 and 97.71%, respectively. On bivariate analysis, factors associated with increase in-hospital mortality were higher RDW, age, WBC, serum creatinine, SOFA score, and presence of AKI stages >1 and septic shock. With adjustment for other factors, only RDW and SOFA remained as the significant predictors, with every point increase resulting to 97.5% and 68.4% rise in odds of death, respectively. In the final multivariate Cox’s regression (after adjusting for all other factors such as RDW, age, and other factors in the initial model), only RDW and SOFA score are significant. For every unit increase in RDW, the hazard for mortality increases by approximately 15% (aHR 1.15, 95% CI 1.06 to 1.25, p = 0.001), after adjusting for age, sex and co-morbidities. For every unit increase in SOFA scores, the hazard for mortality increases by approximately 43% (aHR 1.431, 95% CI 1.25 to 1.64, p < 0.001). This model explained 28.47% in the variance of time to mortality and was statistically significant at p<0.00. The current study found that an elevated RDW is an independent predictor of in hospital mortality among patients with sepsis induced AKI. Patients with RDW of > 15.1 are approximately twice more likely to die among patients with sepsis induced AKI. This finding suggests that RDW may aid in risk stratification and can represent an inexpensive marker to predict mortality among sepsis induced AKI.

Association between Red Cell Distribution Width and Left Atrial Thrombus in Patients with Valvular Atrial Fibrillation

Background: Red cell distribution width (RDW) is a quantitative measure of variability in the size of circulating erythrocytes and previously shown to provide information concerning the prothrombotic status or adverse outcome of cardiovascular disease. Left atrial thrombus (LAT) is commonly detected in patients with valvular atrial fibrillation (VAF) due to rheumatic mitral valve stenosis (RMVS) but there is very limited data regarding the predictive value of RDW for the development of LAT in these patients.&#x0D; Aim: To determine the association between RDW and LAT in VAF patients.&#x0D; Methods: A total of 58 patients were included in a retrospective observational study between January 2016 to December 2016 in patients who admitted to Dr. Moewardi General Hospital, due to symptomatic VAF. Blood examination and transthoracic echocardiography were performed to all patients. LAT was defined as a fixed or mobile echogenic mass within left atrium (LA) and left atrial appendage (LAA). The RDW was compared between a patient with LAT or without LAT.&#x0D; Results: There were 28 patients (mean age: 46.2±13.3 years) in LAT(+) group and 30 patients (mean age: 45.6±11.5 years) in LAT(-) group. RDW was significantly higher in LAT(+) group (14.4±1.8% vs. 13.3±1.5%, p=0.010). The RDW was independent predictor of LAT by multivariate analysis (OR 1.619; p=0.020; 95% CI: 1.079-2.429). The cut-off RDW value for LAT was &gt;13.5% with a sensitivity of 73.3% and a specificity of 64.3% (area under curve=0.700; 95% CI: 0.562-0.838; p=0.009). The prevalence of LAT was significantly higher in patient with an RDW &gt;13.5% than in those with an RDW &lt;13.5 % (64.3% and 35.7%, p=0.002), with prevalence ratio 5.91.&#x0D; Conclusion: This study shows that a higher level of RDW has an association with the presence of LAT and an independent risk factor of LAT formation in patients with VAF.

Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience.

Background: Coronavirus disease (COVID-19) was first described at the end of 2019 in China and has since spread across the globe. Red cell distribution width (RDW) is a potent prognostic marker in several medical conditions and has recently been suggested to be of prognostic value in COVID-19.Methods: This retrospective, observational study of consecutive patients with COVID-19 was conducted from March 12, 2020 to December 4, 2020 in the Wilhelminenhospital, Vienna, Austria. RDWlevels on admission were collected and tested for their predictive value of 28-day mortality.Results: A total of 423 eligible patients with COVID-19 were included in the final analyses and 15.4% died within 28 days (n = 65). Median levels of RDWwere significantly higher in non-survivors compared to survivors [14.6% (IQR, 13.7–16.3) vs. 13.4% (IQR, 12.7– 14.4), P < 0.001]. Increased RDW was a significant predictor of 28-day mortality [crude odds ratio (OR) 1.717, 95% confidence interval (CI) 1.462–2.017; P = < 0.001], independent of clinical confounders, comorbidities and established prognostic markers of COVID-19 (adjusted OR of the final model 1.368, 95% CI 1.126–1.662; P = 0.002). This association remained consistent upon sub-group analysis. Our study data also demonstrate that RDW levels upon admission for COVID-19 were similar to previously recorded, non-COVID-19 associated RDW levels [14.2% (IQR, 13.3–15.7) vs. 14.0% [IQR, 13.2–15.1]; P = 0.187].Conclusions: In this population, RDWwas a significant, independent prognostic marker of short-term mortality in patients with COVID-19.

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

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.