Red Blood Cell Distribution Width as a Pragmatic Marker for Outcome in Pediatric Critical Illness

Red cell distribution width (RDW) is a routine laboratory measure associated with poor outcomes in adult critical illness. We determined the utility of RDW as an early pragmatic biomarker for outcome in pediatric critical illness. We used multivariable logistic regression to test the association of...

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Bibliographic Details
Published in:PloS one 2015-06, Vol.10 (6), p.e0129258-e0129258
Main Authors: Ramby, Alexis L, Goodman, Denise M, Wald, Eric L, Weiss, Scott L
Format: Article
Language:English
Subjects:
Adolescent
Anemia
Bioindicators
Biomarkers
Biomarkers - metabolism
Blood
Blood transfusions
Child
Child, Preschool
Chronic illnesses
Clinical outcomes
Comparative analysis
Critical care
Critical Illness - mortality
Erythrocyte Indices - physiology
Erythrocytes
Erythrocytes - physiology
Female
Health aspects
Hematology
Hospital Mortality
Hospitalization
Hospitals
Humans
Infant
Intensive care
Intensive Care Units, Pediatric
Laboratories
Length of Stay
Logistic Models
Male
Medical records
Medicine
Mortality
Patients
Pediatric diseases
Pediatrics
Powder injection molding
Prognosis
Retrospective Studies
Risk
Risk Factors
Risk groups
ROC Curve
Sepsis
Severity of Illness Index
Shock, Septic - mortality
Shock, Septic - pathology
Studies
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Summary:Red cell distribution width (RDW) is a routine laboratory measure associated with poor outcomes in adult critical illness. We determined the utility of RDW as an early pragmatic biomarker for outcome in pediatric critical illness. We used multivariable logistic regression to test the association of RDW on the first day of pediatric intensive care unit (PICU) admission with prolonged PICU length of stay (LOS) >48 hours and mortality. The area under the receiver operating characteristic curve (AUROC) for RDW was compared to the Pediatric Index of Mortality (PIM)-2 score. Over a 13-month period, 596 unique patients had RDW measured on the first day of PICU admission. Sepsis was an effect modifier for LOS >48 hours but not mortality. In sepsis, RDW was not associated with LOS >48 hours. For patients without sepsis, each 1% increase in RDW was associated with 1.17 (95% CI 1.06, 1.30) increased odds of LOS >48 hours. In all patients, RDW was independently associated with PICU mortality (OR 1.25, 95% CI 1.09, 1.43). The AUROC for RDW to predict LOS >48 hours and mortality was 0.61 (95% CI 0.56, 0.66) and 0.65 (95% CI 0.55, 0.75), respectively. Although the AUROC for mortality was comparable to PIM-2 (0.75, 95% CI 0.66, 0.83; p = 0.18), RDW did not increase the discriminative utility when added to PIM-2. Despite the moderate AUROC, RDW 48 hours and 3.3% risk of mortality compared to patients with an RDW >15.7% (lower limit of upper quartile) who had 78% risk of LOS >48 hours and 12.9% risk of mortality (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0129258