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Background <p>RBC distribution width is a key variable in complete blood counts, associated with immature RBC release into circulation due to various processes, including systemic inflammation. RDW correlates with elevated acute inflammatory markers like ESR, CRP, and interleukin-6, and is a biomarker in conditions like kidney disease and multiple myelomas. It independently predicts disease severity in critically ill adults and is associated with morbidity, mortality and length of stay in pediatric intensive care unit, though its potential as an early biomarker for detecting pediatric patients with multiple organ dysfunction (MODS) remains unknown.</p> Methods <p>The study retrospectively reviewed PICU patients admitted to Aga Khan University Hospital from September 2018 to December 2022, excluding those admitted for less than 48&#xa0;h for elective procedures, received recent RBC transfusions, or were anemic. RDW &gt; 14.0% was considered elevated. MODS, defined as dysfunction in two or more organs, was the primary outcome. Data included demographics, PRISM III scores, laboratory values (RDW, BUN, creatinine, CRP, etc.), and clinical outcomes. Patients were stratified into three RDW groups: &lt;13.4%, 13.4–14.3%, and &gt; 14.4%. Analysis focused on associations between RDW levels and MODS within the first 7 days of PICU admission.</p> Results <p>The study included 680 patients. Higher RDW was associated with younger age and higher PRISM III scores, but not with sex. RDW Group III had longer hospital stays, higher mortality, and higher incidence of MODS, but not significant. Hemoglobin and MCHC levels were lower in Group III, whereas BUN and creatinine levels showed no significant differences across groups. The OR for MODS was highest for Group II.</p> Conclusions <p>This retrospective study evaluated the prognostic value of RDW in predicting length of stay, mortality, and early identification of MODS within seven days. Among 680 pediatric patients, higher RDW levels were associated with increased mortality, longer LOS, and higher rates of sepsis and MODS, though these findings lacked statistical significance. Elevated RDW was linked to inflammation and critical illness severity but did not correlate well with pediatric severity scores or MODS trends. Future multicenter studies are recommended to explore RDW’s utility in predicting early organ dysfunction and critical illness outcomes.</p>

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Red blood cell distribution width (RDW) as a predictor of multiple organ dysfunction in pediatric critical care: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Syed M. Dayyan Hassan,
  • Abdul Hadi Shahid,
  • Zuhaib Ali,
  • Muneeb Ahmed,
  • Hasheem Mohammad,
  • Syeda Farwa Fatima,
  • Shalni Golani,
  • Fatima Jamshaid,
  • Najeeb Rahman,
  • Naveed ur Rehman Siddiqui

摘要

Background

RBC distribution width is a key variable in complete blood counts, associated with immature RBC release into circulation due to various processes, including systemic inflammation. RDW correlates with elevated acute inflammatory markers like ESR, CRP, and interleukin-6, and is a biomarker in conditions like kidney disease and multiple myelomas. It independently predicts disease severity in critically ill adults and is associated with morbidity, mortality and length of stay in pediatric intensive care unit, though its potential as an early biomarker for detecting pediatric patients with multiple organ dysfunction (MODS) remains unknown.

Methods

The study retrospectively reviewed PICU patients admitted to Aga Khan University Hospital from September 2018 to December 2022, excluding those admitted for less than 48 h for elective procedures, received recent RBC transfusions, or were anemic. RDW > 14.0% was considered elevated. MODS, defined as dysfunction in two or more organs, was the primary outcome. Data included demographics, PRISM III scores, laboratory values (RDW, BUN, creatinine, CRP, etc.), and clinical outcomes. Patients were stratified into three RDW groups: <13.4%, 13.4–14.3%, and > 14.4%. Analysis focused on associations between RDW levels and MODS within the first 7 days of PICU admission.

Results

The study included 680 patients. Higher RDW was associated with younger age and higher PRISM III scores, but not with sex. RDW Group III had longer hospital stays, higher mortality, and higher incidence of MODS, but not significant. Hemoglobin and MCHC levels were lower in Group III, whereas BUN and creatinine levels showed no significant differences across groups. The OR for MODS was highest for Group II.

Conclusions

This retrospective study evaluated the prognostic value of RDW in predicting length of stay, mortality, and early identification of MODS within seven days. Among 680 pediatric patients, higher RDW levels were associated with increased mortality, longer LOS, and higher rates of sepsis and MODS, though these findings lacked statistical significance. Elevated RDW was linked to inflammation and critical illness severity but did not correlate well with pediatric severity scores or MODS trends. Future multicenter studies are recommended to explore RDW’s utility in predicting early organ dysfunction and critical illness outcomes.