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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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Autores principales: Hunziker, Sabina, Celi, Leo A, Lee, Joon, Howell, Michael D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580634/
https://www.ncbi.nlm.nih.gov/pubmed/22607685
http://dx.doi.org/10.1186/cc11351
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author Hunziker, Sabina
Celi, Leo A
Lee, Joon
Howell, Michael D
author_facet Hunziker, Sabina
Celi, Leo A
Lee, Joon
Howell, Michael D
author_sort Hunziker, Sabina
collection PubMed
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.
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spelling pubmed-35806342013-02-26 Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients Hunziker, Sabina Celi, Leo A Lee, Joon Howell, Michael D Crit Care Research 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. BioMed Central 2012 2012-05-18 /pmc/articles/PMC3580634/ /pubmed/22607685 http://dx.doi.org/10.1186/cc11351 Text en Copyright ©2012 Hunziker et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Hunziker, Sabina
Celi, Leo A
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
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580634/
https://www.ncbi.nlm.nih.gov/pubmed/22607685
http://dx.doi.org/10.1186/cc11351
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