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ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 66-73

Red blood cell distribution width as a prognostic factor in mechanically ventilated patients with severe sepsis in comparison with Sequential Organ Failure Assessment score


Critical Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Correspondence Address:
Mohab S Mohamed
Critical Care Department, Faculty of Medicine, Alexandria University, Alexandria
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2356-9115.189784

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Background Sepsis is a major health concern worldwide. Within the last decade, several trials and protocols have focused on this condition, aiming to establish better measures for its management and prevention of potential complications. Higher values of red blood cell distribution width (RDW) have been found to be associated with sepsis severity and early mortality function and activation. Patients and methods A sample of 50 patients with severe sepsis who were admitted to Alexandria University Hospital were selected. The patients were divided into two groups: group A and group B. Group A patients met the inclusion and exclusion criteria with high RDW and group B patients met the inclusion and exclusion criteria with normal RDW. Both groups were compared with Sequential Organ Failure Assessment (SOFA) score as a prognostic marker. RDW was measured every other day. Patients were followed up until death or discharge from the ICU for a total of 28 days. Results A total of 50 adult patients with severe sepsis were enrolled in the study, comprising 12 women (48.0%) and 13 men (52.0%) in group A and 11 women (44.0%) and 14 men (56.0%) in group B. Chest infection was the most common source of sepsis in both group A (36%) and group B (44%). High RDW was associated with prolonged duration of mechanical ventilation (MV) of 13.60±4.76 days, compared with 9.96±3.91 days for normal RDW. High RDW was associated with prolonged ICU stay of 20.0±4.43 days compared with 14.20±3.34 days for normal RDW. High RDW was associated with poor outcome (68% mortality) compared with normal RDW (40% mortality). There was a positive correlation between high RDW with SOFA on day 0 (P=0.002), day 2 (P≤0.001), day 4 (P<0.001), day 6 (P≤0.001), day 14 (P≤0.001), day 20 (P≤0.001), and on average (P=0.001), and in normal RDW on day 0 (P=0.045), day 2 (P=0.033), day 4 (P=0.003), day 6 (P=0.008), day 14 (P=0.042), day 20 (P=0.005), and on average (P=0.010). There was a negative correlation between high RDW and platelet count on day 0 (P=0.0001), day 2 (P=0.002), day 4 (P=0.002), day 6 (P=0.005), and on average (P=0.001), as well as in normal RDW on day 0 (P=0.008), day 2 (P=0.010), day 4 (P=0.029), day 6 (P=0.015), and on average (P=0.012). Conclusion RDW at admission is an important biomarker in severe sepsis with increased mortality, prolonged duration of MV, and prolonged ICU stay in patients with high RDW at admission. There was positive correlation between RDW and SOFA on days 0, 2, 4, 6, 14, 20, and on average and negative correlation between RDW and platelet on days 0, 2, 4, 6, and on average.


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