Daniel Dankl1, Richard Rezar2, Behrooz Mamandipoor3, Zhichao Zhou4, Sarah Wernly5,6, Bernhard Wernly5,6, Venet Osmani3. 1. Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria. 2. Department of Cardiology and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria. 3. Fondazione Bruno Kessler Research Institute, Trento, Italy. 4. Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 5. Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria. 6. Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria.
Abstract
BACKGROUND: Mortality in sepsis remains high. Studies on small cohorts have shown that red cell distribution width (RDW) is associated with mortality. The aim of this study was to validate these findings in a large multicenter cohort. METHODS: We conducted this retrospective analysis of the multicenter eICU Collaborative Research Database in 16,423 septic patients. We split the cohort in patients with low (≤15%; n = 7,129) and high (>15%; n = 9,294) RDW. Univariable and multivariable multilevel logistic regressions were used to fit regression models for the binary primary outcome of hospital mortality and the secondary outcome intensive care unit (ICU) mortality with hospital unit as random effect. Optimal cutoffs were calculated using the Youden index. RESULTS: Patients with high RDW were more often older than 65 years (57% vs. 50%; p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) IV scores (69 vs. 60 pts.; p < 0.001). Both hospital (adjusted odds ratios [aOR] 1.18; 95% CI: 1.16-1.20; p < 0.001) and ICU mortality (aOR 1.16; 95% CI: 1.14-1.18; p < 0.001) were associated with RDW as a continuous variable. Patients with high RDW had a higher hospital mortality (20 vs. 9%; aOR 2.63; 95% CI: 2.38-2.90; p < 0.001). This finding persisted after multivariable adjustment (aOR 2.14; 95% CI: 1.93-2.37; p < 0.001) in a multilevel logistic regression analysis. The optimal RDW cutoff for the prediction of hospital mortality was 16%. CONCLUSION: We found an association of RDW with mortality in septic patients and propose an optimal cutoff value for risk stratification. In a combined model with lactate, RDW shows equivalent diagnostic performance to Sequential Organ Failure Assessment (SOFA) score and APACHE IV score.
BACKGROUND: Mortality in sepsis remains high. Studies on small cohorts have shown that red cell distribution width (RDW) is associated with mortality. The aim of this study was to validate these findings in a large multicenter cohort. METHODS: We conducted this retrospective analysis of the multicenter eICU Collaborative Research Database in 16,423 septic patients. We split the cohort in patients with low (≤15%; n = 7,129) and high (>15%; n = 9,294) RDW. Univariable and multivariable multilevel logistic regressions were used to fit regression models for the binary primary outcome of hospital mortality and the secondary outcome intensive care unit (ICU) mortality with hospital unit as random effect. Optimal cutoffs were calculated using the Youden index. RESULTS: Patients with high RDW were more often older than 65 years (57% vs. 50%; p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) IV scores (69 vs. 60 pts.; p < 0.001). Both hospital (adjusted odds ratios [aOR] 1.18; 95% CI: 1.16-1.20; p < 0.001) and ICU mortality (aOR 1.16; 95% CI: 1.14-1.18; p < 0.001) were associated with RDW as a continuous variable. Patients with high RDW had a higher hospital mortality (20 vs. 9%; aOR 2.63; 95% CI: 2.38-2.90; p < 0.001). This finding persisted after multivariable adjustment (aOR 2.14; 95% CI: 1.93-2.37; p < 0.001) in a multilevel logistic regression analysis. The optimal RDW cutoff for the prediction of hospital mortality was 16%. CONCLUSION: We found an association of RDW with mortality in septic patients and propose an optimal cutoff value for risk stratification. In a combined model with lactate, RDW shows equivalent diagnostic performance to Sequential Organ Failure Assessment (SOFA) score and APACHE IV score.
Authors: Marta Salvatori; Francesc Formiga; Rafael Moreno-Gónzalez; David Chivite; Margherita Migone De Amicis; Maria Domenica Cappellini; Xavier Corbella Journal: Kardiol Pol Date: 2019-04-29 Impact factor: 3.108
Authors: Alberto Fogagnolo; Savino Spadaro; Fabio S Taccone; Riccardo Ragazzi; Anna Romanello; Alberto Fanni; Elisabetta Marangoni; Federico Franchi; Sabino Scolletta; Carlo A Volta Journal: Minerva Anestesiol Date: 2019-04-16 Impact factor: 3.051
Authors: Lonneke A van Vught; Peter M C Klein Klouwenberg; Cristian Spitoni; Brendon P Scicluna; Maryse A Wiewel; Janneke Horn; Marcus J Schultz; Peter Nürnberg; Marc J M Bonten; Olaf L Cremer; Tom van der Poll Journal: JAMA Date: 2016-04-12 Impact factor: 56.272
Authors: Tom J Pollard; Alistair E W Johnson; Jesse D Raffa; Leo A Celi; Roger G Mark; Omar Badawi Journal: Sci Data Date: 2018-09-11 Impact factor: 6.444