Yan-Qiu Han1, Lei Zhang1, Li Yan2, Peng Li1, Pei-Heng Ouyang1, Giuseppe Lippi3, Zhi-De Hu4. 1. Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China. 2. Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China. 3. Section of Clinical Biochemistry, University of Verona, Verona, Italy. 4. Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China. Electronic address: hzdlj81@163.com.
Abstract
BACKGROUND: Although some underpowered studies have proven that increased red blood cell distribution width (RDW) may be associated with short-term prognosis of sepsis, the long-term prognostic value of RDW remains largely unknown. METHODS: This retrospective observational study was based on the Medical Information Mart for Intensive Care III (MIMIC III), a large critical care database. Baseline RDW and conventional disease severity scores were extracted along with data on 4-year mortality, of adult patients with severe sepsis upon first admission to the intensive care unit (ICU). The prognostic value of RDW was analyzed with Kapan-Meier cure, Cox model, receiver operating characteristic (ROC) curve analysis, net reclassification index (NRI) and integrated discriminatory index (IDI). RESULTS: A total of 4264 subjects were included. The area under ROC curve of RDW for predicting 4-year mortality was 0.64 (95% CI: 0.63-0.66). In multivariable Cox model, increased RDW was independently associated with all-cause mortality, irrespective of anemia. With conventional severity scores as reference, RDW had continuous NRI comprised between 0.18 and 0.20, and IDI comprised between 0.30 and 0.40. CONCLUSION: RDW values significantly predicts long-term all-cause mortality in critically ill patients with severe sepsis beyond conventional severity scores.
BACKGROUND: Although some underpowered studies have proven that increased red blood cell distribution width (RDW) may be associated with short-term prognosis of sepsis, the long-term prognostic value of RDW remains largely unknown. METHODS: This retrospective observational study was based on the Medical Information Mart for Intensive Care III (MIMIC III), a large critical care database. Baseline RDW and conventional disease severity scores were extracted along with data on 4-year mortality, of adult patients with severe sepsis upon first admission to the intensive care unit (ICU). The prognostic value of RDW was analyzed with Kapan-Meier cure, Cox model, receiver operating characteristic (ROC) curve analysis, net reclassification index (NRI) and integrated discriminatory index (IDI). RESULTS: A total of 4264 subjects were included. The area under ROC curve of RDW for predicting 4-year mortality was 0.64 (95% CI: 0.63-0.66). In multivariable Cox model, increased RDW was independently associated with all-cause mortality, irrespective of anemia. With conventional severity scores as reference, RDW had continuous NRI comprised between 0.18 and 0.20, and IDI comprised between 0.30 and 0.40. CONCLUSION: RDW values significantly predicts long-term all-cause mortality in critically illpatients with severe sepsis beyond conventional severity scores.
Authors: Yi Jiang; Feng-Quan Jiang; Fang Kong; Meng-Meng An; Bei-Bei Jin; Da Cao; Ping Gong Journal: Ann Intensive Care Date: 2019-06-10 Impact factor: 6.925