Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients
Introduction: Recently, red cell distribution width (RDW), a measure of erythrocyte size variability, has been shown to be a prognostic marker in critical illness. The aim of this study was to investigate whether adding RDW has the potential to improve the prognostic performance of the simplified ac...
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| Format: | Article |
| Language: | English |
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BioMed Central Ltd.
2012
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| Online Access: | http://hdl.handle.net/1721.1/71857 https://orcid.org/0000-0001-8593-9321 |
| _version_ | 1826199602049581056 |
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| author | Hunzike, Sabina Celi, Leo Anthony G. Lee, Joon Howell, Michael D. |
| author2 | Harvard University--MIT Division of Health Sciences and Technology |
| author_facet | Harvard University--MIT Division of Health Sciences and Technology Hunzike, Sabina Celi, Leo Anthony G. Lee, Joon Howell, Michael D. |
| author_sort | Hunzike, Sabina |
| collection | MIT |
| description | Introduction: Recently, red cell distribution width (RDW), a measure of erythrocyte size variability, has been shown to be a prognostic marker in critical illness. The aim of this study was to investigate whether adding RDW has the potential to improve the prognostic performance of the simplified acute physiology score (SAPS) to predict short- and long-term mortality in an independent, large, and unselected population of intensive care unit (ICU) patients. Methods: This observational cohort study includes 17,922 ICU patients with available RDW measurements from different types of ICUs. We modeled the association between RDW and mortality by using multivariable logistic regression, adjusting for demographic factors, comorbidities, hematocrit, and severity of illness by using the SAPS. Results: ICU-, in-hospital-, and 1-year mortality rates in the 17,922 included patients were 7.6% (95% CI, 7.2 to 8.0), 11.2% (95% CI, 10.8 to 11.7), and 25.4% (95% CI, 24.8 to 26.1). RDW was significantly associated with in-hospital mortality (OR per 1% increase in RDW (95%CI)) (1.14 (1.08 to 1.19), P < 0.0001), ICU mortality (1.10 (1.06 to 1.15), P < 0.0001), and 1-year mortality (1.20 (95% CI, 1.14 to 1.26); P < 0.001). Adding RDW to SAPS significantly improved the AUC from 0.746 to 0.774 (P < 0.001) for in-hospital mortality and 0.793 to 0.805 (P < 0.001) for ICU mortality. Significant improvements in classification of SAPS were confirmed in reclassification analyses. Subgroups demonstrated robust results for gender, age categories, SAPS categories, anemia, hematocrit categories, and renal failure. Conclusions: RDW is a promising independent short- and long-term prognostic marker in ICU patients and significantly improves risk stratification of SAPS. Further research is needed the better to understand the pathophysiology underlying these effects. |
| first_indexed | 2024-09-23T11:22:32Z |
| format | Article |
| id | mit-1721.1/71857 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T11:22:32Z |
| publishDate | 2012 |
| publisher | BioMed Central Ltd. |
| record_format | dspace |
| spelling | mit-1721.1/718572022-09-27T19:06:30Z Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients Hunzike, Sabina Celi, Leo Anthony G. Lee, Joon Howell, Michael D. Harvard University--MIT Division of Health Sciences and Technology Celi, Leo Anthony G. Lee, Joon Introduction: Recently, red cell distribution width (RDW), a measure of erythrocyte size variability, has been shown to be a prognostic marker in critical illness. The aim of this study was to investigate whether adding RDW has the potential to improve the prognostic performance of the simplified acute physiology score (SAPS) to predict short- and long-term mortality in an independent, large, and unselected population of intensive care unit (ICU) patients. Methods: This observational cohort study includes 17,922 ICU patients with available RDW measurements from different types of ICUs. We modeled the association between RDW and mortality by using multivariable logistic regression, adjusting for demographic factors, comorbidities, hematocrit, and severity of illness by using the SAPS. Results: ICU-, in-hospital-, and 1-year mortality rates in the 17,922 included patients were 7.6% (95% CI, 7.2 to 8.0), 11.2% (95% CI, 10.8 to 11.7), and 25.4% (95% CI, 24.8 to 26.1). RDW was significantly associated with in-hospital mortality (OR per 1% increase in RDW (95%CI)) (1.14 (1.08 to 1.19), P < 0.0001), ICU mortality (1.10 (1.06 to 1.15), P < 0.0001), and 1-year mortality (1.20 (95% CI, 1.14 to 1.26); P < 0.001). Adding RDW to SAPS significantly improved the AUC from 0.746 to 0.774 (P < 0.001) for in-hospital mortality and 0.793 to 0.805 (P < 0.001) for ICU mortality. Significant improvements in classification of SAPS were confirmed in reclassification analyses. Subgroups demonstrated robust results for gender, age categories, SAPS categories, anemia, hematocrit categories, and renal failure. Conclusions: RDW is a promising independent short- and long-term prognostic marker in ICU patients and significantly improves risk stratification of SAPS. Further research is needed the better to understand the pathophysiology underlying these effects. Swiss National Science Foundation (SNF PBBSP3-128266) Universität Basel National Institute of Biomedical Imaging and Bioengineering (U.S.) (grant R01 EB001659) Robert Wood Johnson Foundation (Physician Faculty Scholars program, grant 66350) 2012-07-26T20:26:43Z 2012-07-26T20:26:43Z 2012-05 2012-04 2012-06-07T11:08:56Z Article http://purl.org/eprint/type/JournalArticle 1364-8535 1875-7081 http://hdl.handle.net/1721.1/71857 Hunziker, Sabina et al. “Red Cell Distribution Width Improves the Simplified Acute Physiology Score for Risk Prediction in Unselected Critically Ill Patients.” Critical Care 16.3 (2012): R89. Web. https://orcid.org/0000-0001-8593-9321 en http://dx.doi.org/10.1186/cc11351 Critical Care Creative Commons Attribution http://creativecommons.org/licenses/by/2.0 Sabina Hunziker et al.; licensee BioMed Central Ltd. application/pdf BioMed Central Ltd. BioMed Central Ltd |
| spellingShingle | Hunzike, Sabina Celi, Leo Anthony G. Lee, Joon Howell, Michael D. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| title | Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| title_full | Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| title_fullStr | Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| title_full_unstemmed | Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| title_short | Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| title_sort | red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients |
| url | http://hdl.handle.net/1721.1/71857 https://orcid.org/0000-0001-8593-9321 |
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