Evaluation of Dynamic Variation in Red Cell Distribution Width as a Septic Marker in Comparison with Procalcitonin Levels and Clinical Scores in Patients with Sepsis or Septic Shock: A Prospective Observational Study
DOI:
https://doi.org/10.3889/oamjms.2023.11097Keywords:
Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment Score, red cell distribution width, procalcitonin, sepsis, septic shockAbstract
BACKGROUND: Sepsis is a dysregulated host response to infection resulting in potentially life-threatening organ dysfunction. Elevation in red cell distribution width (RDW), a simple routinely done investigation, could be a prognostic marker in these patients.
AIM: We performed this prospective observational study to assess role of dynamic variation of RDW in predicting 30-day mortality in patients with sepsis or septic shock presenting and getting admitted in intensive care unit (ICU) in Fayoum, Egypt.
METHODS: Between January 2019 and January 2021, 150 patients with sepsis or septic shock at admission were prospectively evaluated for association between RDW value on admission, on day 4, on day 7, and 30-day mortality. To find out factors associated independently with 30-day mortality, we applied multivariate logistic regression analysis and used the analysis to develop nanogram for prediction of mortality on admission.
RESULTS: Among 150 patients, 89 (59.3%) were male. Mean age of the patients was 59.6 ± 12.28 years. Regarding RDW on admission (RDW-0), the mean was 14.1 ± 1.9 while on day 4 (RDW-4), the mean was 14.5 ± 1.97, and on day 7 (RDW-7), the mean was 14.4 ± 2.03. Seventy-four (49.3%) patients died during the period of 30 days follow-up. Multiple logistic regression models for the parameters associated with the mortality outcome at admission were done, for age, higher age was associated with higher probability of mortality, OR = 1.07 (95% CI: 1.02, 1.13). Male sex was associated with lower probability of mortality as compared to females, OR = 0.02 (95% CI: 0.06, 0.80). Higher acute physiologic assessment and chronic health evaluation (APACHE) II score, RDW value, and procalcitonin level, all were associated with higher mortality probability. For APACHE II score, higher level was associated with higher odds of mortality, OR = 1.16. For RDW value on admission, higher value was associated with higher odds of mortality, OR = 1.66. For procalcitonin level at admission, higher level was associated with higher odds of mortality, OR = 1.54. Odds for mortality for those who showed any increase in RDW in day 4 as compared to day 0 are higher as compared to those who showed a decrease or no change in RDW, OR = 2.8, p-value = 0.007.
CONCLUSIONS: We found that an increase in RDW value on admission and on day 4 is significantly associated with mortality. And that, an increase in RDW value from day 0 to day 4 is also significantly associated with mortality Therefore, a combination of baseline RDW value and an increase in serial RDW values can be a promising independent prognostic marker in patients with sepsis or septic shock.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3); 2022.
Shankar-Hari M, Harrison DA, Rubenfeld GD, Rowan K.
Epidemiology of sepsis and septic shock in critical care units: Comparison between sepsis-2 and sepsis-3 populations using a national critical care database. Br J Anaesth. 2017;119(4):626-36. https://doi.org/10.1093/bja/aex234 PMid:29121281 DOI: https://doi.org/10.1093/bja/aex234
Kim CH, Park JT, Kim EJ, Han JH, Han JS, Choi JY, et al. An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock. Crit Care 2013;17(6):R282. https://doi.org/10.1186/cc13145 PMid:24321201 DOI: https://doi.org/10.1186/cc13145
Hong N, Oh J, Kang SM, Kim SY, Won H, Youn JC, et al. Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta 2012;413(11-12):992-7. https://doi.org/10.1016/j.cca.2012.02.024 PMid:22406179 DOI: https://doi.org/10.1016/j.cca.2012.02.024
Majercik S, Fox J, Knight S, Horne BD. Red cell distribution width is predictive of mortality in trauma patients. J Trauma Acute Care Surg 2013;74(4):1021-6. https://doi.org/10.1097/TA.0b013e3182826f02 PMid:23511140 DOI: https://doi.org/10.1097/TA.0b013e3182826f02
Sen HS, Abakay O, Tanrikulu AC, Sezgi C, Taylan M, Abakay A, et al. Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr. 2014;126(11-12):347-54. https://doi.org/10.1007/s00508-014-0537-1 PMid:24664312 DOI: https://doi.org/10.1007/s00508-014-0537-1
Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: Data from the charm program and the duke databank. J Am Coll Cardiol. 2007;50(1):40-7. https://doi.org/10.1016/j.jacc.2007.02.067 PMid:17601544 DOI: https://doi.org/10.1016/j.jacc.2007.02.067
Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15-21. https://doi.org/10.1097/01ccm.0000194535.82812.ba PMid:16374151 DOI: https://doi.org/10.1097/01.CCM.0000194535.82812.BA
Martin GS. Sepsis, severe sepsis and septic shock: Changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther. 2012;10(6):701-6. https://doi.org/10.1586/eri.12.50 PMid:22734959 DOI: https://doi.org/10.1586/eri.12.50
Karlsson S, Varpula M, Ruokonen E, Pettilä V, Parviainen I, Ala- Kokko TI, et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: The finnsepsis study. Intensive Care Med. 2007;33(3):435-43. https://doi.org/10.1007/s00134-006-0504-z PMid:17225161 DOI: https://doi.org/10.1007/s00134-006-0504-z
Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, et al. Variability of intensive care admission decisions for the very elderly. PLoS One. 2012;7(4):e34387. https://doi.org/10.1371/journal.pone.0034387 PMid:22509296 DOI: https://doi.org/10.1371/journal.pone.0034387
Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥80 years). Intensive Care Med. 2017;43(12):1820-8. https://doi.org/10.1007/s00134-017-4940-8 PMid:28936626 DOI: https://doi.org/10.1007/s00134-017-4940-8
Papathanassoglou E, Middleton N, Benbenishty J, Williams G, Christofi MD, Hegadoren K. Systematic review of gender-dependent outcomes in sepsis. Nurs Crit Care. 2017;22(5):284-92. https://doi.org/10.1111/nicc.12280 PMid:28295902 DOI: https://doi.org/10.1111/nicc.12280
Mohamed AK, Mehta AA, James P. Predictors of mortality of severe sepsis among adult patients in the medical intensive care unit. Lung India. 2017;34(4):330-5. https://doi.org/10.4103/lungindia.lungindia_54_16 PMid:28671163 DOI: https://doi.org/10.4103/lungindia.lungindia_54_16
Sadaka F, EthmaneAbouElMaali C, Cytron MA, Fowler K, Javaux VM, O’Brien J. Predicting mortality of patients with sepsis: A comparison of APACHE II and APACHE III scoring systems. J Clin Med Res. 2017;9(11):907-10. https://doi.org/10.14740/jocmr3083w PMid:29038667 DOI: https://doi.org/10.14740/jocmr3083w
Zanon F, Caovilla JJ, Michel RS, Cabeda EV, Ceretta DF, Luckemeyer GD, et al. Sepsis in the intensive care unit: Etiologies, prognostic factors and mortality. Rev Bras Ter Intensiva. 2008;20(2):128-34. PMid:25306999 DOI: https://doi.org/10.1590/S0103-507X2008000200003
Singh M, Palnati V, Ramakrishnan SR. Comparison of mortality prediction, of APACHE II, SAPS II and SOFA ICU scoring systems in patients with severe sepsis and septic shock in ICU of a tertiary care hospital. J Med Sci Clin Res. 2019;7(11):2455-0450. https://doi.org/10.18535/jmscr/v7i11.108 DOI: https://doi.org/10.18535/jmscr/v7i11.108
Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8. https://doi.org/10.1001/jama.286.14.1754 PMid:11594901 DOI: https://doi.org/10.1001/jama.286.14.1754
Rivera-Fernández R, Nap R, Vázquez-Mata G, Miranda DR. Analysis of physiologic alterations in intensive care unit patients and their relationship with mortality. J Crit Care. 2007;22(2):120-8. https://doi.org/10.1016/j.jcrc.2006.09.005 PMid:17548023 DOI: https://doi.org/10.1016/j.jcrc.2006.09.005
Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009;37(5):1649-54. https://doi.org/10.1097/CCM.0b013e31819def97 PMid:19325482 DOI: https://doi.org/10.1097/CCM.0b013e31819def97
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):762-74. https://doi.org/10.1001/jama.2016.0288. Erratum in: JAMA. 2016;315(20):2237. PMid:26903335 DOI: https://doi.org/10.1001/jama.2016.0288
Karakike E, Kyriazopoulou E, Tsangaris I, Routsi C, Vincent JL, Giamarellos-Bourboulis EJ. The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: Analysis through a derivation and a validation cohort. Crit Care. 2019;23(1):387. https://doi.org/10.1186/s13054-019-2665-5 PMid:31783881 DOI: https://doi.org/10.1186/s13054-019-2665-5
Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med. 2013;31(3):545-8. https://doi.org/10.1016/j.ajem.2012.10.017 PMid:23380094 DOI: https://doi.org/10.1016/j.ajem.2012.10.017
Kim YC, Song JE, Kim EJ, Choi H, Jeong WY, Jung IY, Jeong SJ, Ku NS, Choi JY, Song YG, Kim JM. A simple scoring system using the red blood cell distribution width, delta neutrophil index, and platelet count to predict mortality in patients with severe sepsis and septic shock. Journal of Intensive Care Medicine. 2019;34(2):133-9. PMid:24321201 DOI: https://doi.org/10.1177/0885066618787448
Mahmood NA, Mathew J, Kang B, DeBari VA, Khan MA. Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis. Int J Crit Illn Inj Sci. 2014;4(4):278-82. https://doi.org/10.4103/2229-5151.147518 PMid:25625057 DOI: https://doi.org/10.4103/2229-5151.147518
Lorente L, Martín MM, Abreu-González P, Solé-Violán J, Ferreres J, Labarta L, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients. PLoS One. 2014;9(8):e105436. https://doi.org/10.1371/journal.pone.0105436 PMid:25153089 DOI: https://doi.org/10.1371/journal.pone.0105436
Jandial A, Kumar S, Bhalla A, Sharma N, Varma N, Varma S. Elevated red cell distribution width as a prognostic marker in severe sepsis: A prospective observational study. Indian J Crit Care Med. 2017;21(9):552-62. https://doi.org/10.4103/ijccm.IJCCM_208_17 PMid:28970653 DOI: https://doi.org/10.4103/ijccm.IJCCM_208_17
Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: Is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003;237(3):319-34. https://doi.org/10.1097/01.SLA.0000055547.93484.87 PMid:12616115 DOI: https://doi.org/10.1097/01.SLA.0000055547.93484.87
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Mohamed Fawzy, Mahmoud Adel , Sherif Abdelsamie, Mohamed Elsherif, Gamal Hamed Ahmed Ibrahim, Walid Ahmed (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0
