High red blood cell distribution width as a marker of hospital mortality after ICU discharge: a cohort study.

Autor: Fernandez R; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Cano S; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Catalan I; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Rubio O; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Subira C; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Masclans J; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Rognoni G; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Ventura L; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Macharete C; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Winfield L; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain., Alcoverro JM; Intensive Care Department, Hospital Sant Joan de Deu - Fundacio Althaia, Dr. Joan Soler 1, 08243 Manresa, Spain.; 2Universitat Internacional de Catalunya, Barcelona, Spain.; 3CIBERES, Madrid, Spain.
Jazyk: angličtina
Zdroj: Journal of intensive care [J Intensive Care] 2018 Nov 16; Vol. 6, pp. 74. Date of Electronic Publication: 2018 Nov 16 (Print Publication: 2018).
DOI: 10.1186/s40560-018-0343-3
Abstrakt: 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.
Competing Interests: This study was approved by the ethical committee of the Unió Catalana d’Hospitals, and informed consent was waived.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Databáze: MEDLINE
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