Investigating the Relationship between Red Cell Width Distribution (RDW) and Outcome in Ventilator-Associated Pneumonia: A Prospective Cross-Sectional Study
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Abstract
Background: Ventilator-associated pneumonia (VAP) is a consequence of mechanical ventilation, which can be fatal. Several markers are available to predict outcomes related to VAP. Choosing a predictor that is inexpensive, affordable, and accurate is advantageous. This study aimed to examine red cell distribution width (RDW) as a predictor of mortality in patients with VAP.
Methods: This prospective cohort study was conducted among 49 patients in the intensive care unit (ICU) of Valiasr Hospital in Tehran. A researcher-made checklist was used to collect RDW and other marker data, as well as mortality outcomes and length of stay (LOS) in the ICU. The Pearson correlation coefficient in the SPSS software and the regression model in the Eviews software were used to examine the relationship between markers and different outcomes.
Results: Of a total of 49 patients (57.1% male; mean age = 54 ± 16), the length of ICU stays ranged from 7 to 14 days. According to the Pearson correlation coefficient, a significant association between RDW and mortality (P =.009) was noted. But no significant relationship between RDW and length of stay in the ICU (P =.81) was noted. Additionally, the regression model showed a positive relationship between RDW and white blood cells (WBC), lactate, and sequential organ failure assessment (SOFA).
Conclusion: Our study showed a positive but weak correlation between RDW and ICU mortality in patients with VAP. Due to its availability and low cost of measurement, RDW is an appropriate option for predicting mortality risk in patients who are admitted to the ICU and develop VAP.
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[8] Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, Bandinelli S, Phillips CS, Yu B, Connelly S, Shlipak MG, Chaves PH, Launer LJ, Ershler WB, Harris TB, Longo DL, Guralnik JM. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):258-65.
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[10] Allen LA, Felker GM, Mehra MR, Chiong JR, Dunlap SH, Ghali JK, Lenihan DJ, Oren RM, Wagoner LE, Schwartz TA, Adams KF Jr. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010 Mar;16(3):230-8.
[11] Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009 Apr;133(4):628-32.
[12] Golafshan H, Hajizamani S, Khedmati ME. Clinical applications of RDW (Red Cells Distribution Width). Journal of Laboratory & Diagnosis. 2016;8(31):5-10.
[13] Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009 Oct;158(4):659-66.
[14] Hu Z, Sun Y, Wang Q, Han Z, Huang Y, Liu X, Ding C, Hu C, Qin Q, Deng A. Red blood cell distribution width is a potential prognostic index for liver disease. Clin Chem Lab Med. 2013 Jul;51(7):1403-8.
[15] Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016 Oct;4(20):399.
[16] Komiya, K., Ishii, H., & Kadota, J. (2014). Healthcare-associated Pneumonia and Aspiration Pneumonia. Aging and disease, 6(1), 27–37.
[17] Ye Z, Smith C, Kullo IJ. Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease. Am J Cardiol. 2011; 107(8):1241-5.
[18] Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red cell distribution width and all-cause mortality in critically ill patients. Crit Care Med. 2011; 39(8):1913-21.
[19] Hu ZD, Chen Y, Zhang L, Sun Y, Huang YL, Wang QQ, Xu YL, Chen SX, Qin Q, Deng AM. Red blood cell distribution width is a potential index to assess the disease activity of systemic lupus erythematosus. Clin Chim Acta. 2013; 425:202-5.
[20] Zhang Z, Xu X, Ni H, Deng H. Red cell distribution width is associated with hospital mortality in unselected critically ill patients. J Thorac Dis. 2013; 5(6):730-6.
[21] Wang B, Lu H, Gong Y, Ying B, Cheng B. The Association between Red Blood Cell Distribution Width and Mortality in Critically Ill Patients with Acute Kidney Injury. Biomed Res Int. 2018; 2018:9658216
[22] van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL Jr. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail. 2010 Feb;12(2):129-36.
[23] Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone trial (VEST). Circulation. 2001 Apr 24;103(16):2055-9.
[24] Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Ann Med. 2011 Feb;43(1):40-6.
[25] Ju XF, Wang F, Wang L, Wu X, Jiang TT, You DL, Yang BH, Xia JJ, Hu SY. Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock. Chin Med J (Engl). 2017 May 20;130(10):1189-1195.
[26] Meynaar IA, Knook AH, Coolen S, Le H, Bos MM, van der Dijs F, von Lindern M, Steyerberg EW. Red cell distribution width as predictor for mortality in critically ill patients. Neth J Med. 2013 Nov;71(9):488-93.
[27] Hussain Khan Z , Sasaa M A, Mohammadi M , Alipour A , Hajipour A . Mortality Related to Intubation in Adult General ICUs: A Systematic Review and Meta-Analysis, Arch Neurosci. Online ahead of Print; 7(3):e89993.
[28] Hussain Khan, Z., Maki Aldulaimi, A., Varpaei, H., Mohammadi, M. Various Aspects of Non-Invasive Ventilation in COVID-19 Patients: A Narrative Review. Iranian Journal of Medical Sciences, 2022;
[29] Mohammadi M, Khafaee Pour Khamseh A, Varpaei H A. The Need for Pre-vaccination Screening. Int J Infect.In Press(In Press):e119476.
[2] Nadi E, Nekoie B, Mobaien A, Moghimbeigi A, Nekoie A. Evaluation of the Etiology of Nosocomial Pneumonia in the ICUs of the Teaching Hospitals of Hamadan University of Medical Sciences. Avicenna J Clin Med. 2011; 18 (1):26-32.
[3] Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002; 165(7):867-903.
[4] American Association of Critical-Care Nurses. AACN practice alert: ventilator-associated pneumonia. AACN Advanced Critical Care. 2005; 16(1):105-9.
[5] Ana Bonell, Ryan Azarrafiy, Vu Thi Lan Huong, Thanh Le Viet, Vu Dinh Phu, Vu Quoc Dat, et al. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clinical Infectious Diseases. 2019; 68(3):511-518.
[6] Karakuzu Z, Iscimen R, Akalin H, Girgin NK, Kahveci F, Sinirtas M. Prognostic risk factors in ventilator-associated pneumonia. Med Sci Monit. 2018; 24:1321.
[7] Craven DE, Steger KA. Ventilator-associated bacterial pneumonia: challenges in diagnosis, treatment, and prevention. New Horiz. 1998 May; 6(2 Suppl):S30-45.(5 gha)
[8] Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, Bandinelli S, Phillips CS, Yu B, Connelly S, Shlipak MG, Chaves PH, Launer LJ, Ershler WB, Harris TB, Longo DL, Guralnik JM. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):258-65.
[9] McPherson RA, Pincus MR. Henry’s clinical diagnosis and management by laboratory methods. 24th ed. Philadelphia, PA: Elsevier - Health Sciences Division; 2021.
[10] Allen LA, Felker GM, Mehra MR, Chiong JR, Dunlap SH, Ghali JK, Lenihan DJ, Oren RM, Wagoner LE, Schwartz TA, Adams KF Jr. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010 Mar;16(3):230-8.
[11] Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009 Apr;133(4):628-32.
[12] Golafshan H, Hajizamani S, Khedmati ME. Clinical applications of RDW (Red Cells Distribution Width). Journal of Laboratory & Diagnosis. 2016;8(31):5-10.
[13] Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009 Oct;158(4):659-66.
[14] Hu Z, Sun Y, Wang Q, Han Z, Huang Y, Liu X, Ding C, Hu C, Qin Q, Deng A. Red blood cell distribution width is a potential prognostic index for liver disease. Clin Chem Lab Med. 2013 Jul;51(7):1403-8.
[15] Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016 Oct;4(20):399.
[16] Komiya, K., Ishii, H., & Kadota, J. (2014). Healthcare-associated Pneumonia and Aspiration Pneumonia. Aging and disease, 6(1), 27–37.
[17] Ye Z, Smith C, Kullo IJ. Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease. Am J Cardiol. 2011; 107(8):1241-5.
[18] Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red cell distribution width and all-cause mortality in critically ill patients. Crit Care Med. 2011; 39(8):1913-21.
[19] Hu ZD, Chen Y, Zhang L, Sun Y, Huang YL, Wang QQ, Xu YL, Chen SX, Qin Q, Deng AM. Red blood cell distribution width is a potential index to assess the disease activity of systemic lupus erythematosus. Clin Chim Acta. 2013; 425:202-5.
[20] Zhang Z, Xu X, Ni H, Deng H. Red cell distribution width is associated with hospital mortality in unselected critically ill patients. J Thorac Dis. 2013; 5(6):730-6.
[21] Wang B, Lu H, Gong Y, Ying B, Cheng B. The Association between Red Blood Cell Distribution Width and Mortality in Critically Ill Patients with Acute Kidney Injury. Biomed Res Int. 2018; 2018:9658216
[22] van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL Jr. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail. 2010 Feb;12(2):129-36.
[23] Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone trial (VEST). Circulation. 2001 Apr 24;103(16):2055-9.
[24] Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Ann Med. 2011 Feb;43(1):40-6.
[25] Ju XF, Wang F, Wang L, Wu X, Jiang TT, You DL, Yang BH, Xia JJ, Hu SY. Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock. Chin Med J (Engl). 2017 May 20;130(10):1189-1195.
[26] Meynaar IA, Knook AH, Coolen S, Le H, Bos MM, van der Dijs F, von Lindern M, Steyerberg EW. Red cell distribution width as predictor for mortality in critically ill patients. Neth J Med. 2013 Nov;71(9):488-93.
[27] Hussain Khan Z , Sasaa M A, Mohammadi M , Alipour A , Hajipour A . Mortality Related to Intubation in Adult General ICUs: A Systematic Review and Meta-Analysis, Arch Neurosci. Online ahead of Print; 7(3):e89993.
[28] Hussain Khan, Z., Maki Aldulaimi, A., Varpaei, H., Mohammadi, M. Various Aspects of Non-Invasive Ventilation in COVID-19 Patients: A Narrative Review. Iranian Journal of Medical Sciences, 2022;
[29] Mohammadi M, Khafaee Pour Khamseh A, Varpaei H A. The Need for Pre-vaccination Screening. Int J Infect.In Press(In Press):e119476.
| Files | ||
| Issue | Vol 9 No Supp. 2 (2023): Supplement 2 |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i6.14443 | |
| Keywords | ||
| Ventilator associated pneumonia Red Cell Distribution Width Mortality intensive care unit critical care mechanical ventilation | ||
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How to Cite
1.
Ramezani S, Varpaei HA, Mohammadi M, Rahmani H, Ramezani M. Investigating the Relationship between Red Cell Width Distribution (RDW) and Outcome in Ventilator-Associated Pneumonia: A Prospective Cross-Sectional Study. Arch Anesth & Crit Care. 2023;9(Supp. 2):474-478.
