High red blood cell distribution width as a marker of hospital mortality after ICU discharge: a cohort study
Author
Fernandez, Rafael
Cano Hernandez, Silvia
Catalan, Ignacio
Rubio Sanchiz, Olga
Subirà Cuyàs, Carles
Masclans, Jaume
Rognoni, Gina
Ventura, Lara
Macharete, Caroline
Winfield, Len
Alcoverro, Josep Mª.
Publication date
2018-11-16ISSN
2052-0492
Abstract
Background: High red blood cell distribution width (RDW) is associated with worse outcome in diverse scenarios, including in critical illness. The Sabadell score (SS) predicts in-hospital survival after ICU discharge. We aimed to determine RDW’s association with survival after ICU discharge and whether RDW can improve the accuracy of the SS. Design: Retrospective cohort study. Setting: general ICU at a university hospital. Patients: We included all patients discharged to wards from January 2010 to October 2016. Methods: We analyzed associations between RDW and variables recorded on admission (age, comorbidities, severity score), during the ICU stay (treatments, complications, length of stay (LOS)), and at ICU discharge (SS). The primary outcome was hospital mortality. Statistical analysis included multivariable logistic regression and receiver operating characteristic curve (ROC) analyses. Results: We discharged 3366 patients to wards; median ward LOS was 7 [4–13] days; ward mortality was 5.2%. Mean RDW at ICU discharge was 15.4 ± 2.5%. Ward mortality was higher at each quartile of RDW (0.7%, 2.9%, 7.5%, 10.3%; area under ROC 0.81). A logistic regression model with Sabadell score obtained an excellent accuracy for ward mortality (area under ROC 0.863), and the addition of RDW slightly improved accuracy (AUROC 0.890, p < 0.05). Recursive partitioning demonstrated higher mortality in patients with high RDW at each SS level (1.6% vs. 0.3% in SS0, 9.7% vs. 1.1% in SS1, 21.9% vs. 9.7% in SS2), but not in SS3. Conclusion: High RDW is a marker of severity at ICU discharge and improves the accuracy of Sabadell score in predicting ward mortality except in the more extreme SS3.
Document Type
Article
Document version
Accepted version
Language
English
Subject (CDU)
61 - Medical sciences
Keywords
Mortalitat
Marcadors bioquímics
Cèl·lules sanguínies
Mortalidad
Marcadores bioquímicos
Células sanguíneas
Mortality
Biomarkers
Blood cells
Pages
7
Publisher
Springer Nature
Collection
6;
Is part of
Journal of Intensive Care
Citation
Fernandez, Rafael; Cano, Silvia; Catalan, Ignacio [et al.]. High red blood cell distribution width as a marker of hospital mortality after ICU discharge: a cohort study. Journal of Intensive Care, 2018, vol. 6, p. 1-7. Disponible en: <https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0343-3#Ack1>. Fecha de acceso: 22 dic. 2019. DOI: 10.1186/s40560-018-0343-3.
This item appears in the following Collection(s)
- Ciències de la Salut [738]
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