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STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department
Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evalu...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998434/ https://www.ncbi.nlm.nih.gov/pubmed/27310948 http://dx.doi.org/10.1097/MD.0000000000003692 |
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author | Chen, Chun-Kuei Lin, Shen-Che Wu, Chin-Chieh Chen, Li-Min Tzeng, I-Shiang Chen, Kuan-Fu |
author_facet | Chen, Chun-Kuei Lin, Shen-Che Wu, Chin-Chieh Chen, Li-Min Tzeng, I-Shiang Chen, Kuan-Fu |
author_sort | Chen, Chun-Kuei |
collection | PubMed |
description | Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65)). Of 6973 consecutive adult patients with a clinical diagnosis of sepsis and 2 sets of blood culture ordered by physicians, 477 (6.8%) died. The mortality group had higher RDW levels than the survival group (15.7% vs 13.8%). After dividing RDW into quartiles, the patients in the highest RDW quartile (RDW >15.6%; mortality, 16.7%) had more than twice the risk of in-hospital mortality compared with patients in the second highest quartile (RDW >14% and <15.6%; mortality, 7.3%), whereas the mortality rate in the lowest RDW quartile (<13.1%) was only 1.6%. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.75 (95% confidence interval, 0.72–0.77), which is significantly higher than the areas under the curve of clinical prediction rules (SIRS, MEDS, and CURB65). After integrating RDW into these scores, all scores performed better in predicting mortality (0.73, 0.72, and 0.77, for SIRS, MEDS, and CURB65, respectively). RDW could be an independent predictor of mortality among septic patients. Clinicians could classify the septic patients into different risk groups according to RDW quartiles. For more accurate mortality prediction, RDW could be a potential parameter to be incorporated into clinical prediction rules. |
format | Online Article Text |
id | pubmed-4998434 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-49984342016-09-02 STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department Chen, Chun-Kuei Lin, Shen-Che Wu, Chin-Chieh Chen, Li-Min Tzeng, I-Shiang Chen, Kuan-Fu Medicine (Baltimore) 3900 Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65)). Of 6973 consecutive adult patients with a clinical diagnosis of sepsis and 2 sets of blood culture ordered by physicians, 477 (6.8%) died. The mortality group had higher RDW levels than the survival group (15.7% vs 13.8%). After dividing RDW into quartiles, the patients in the highest RDW quartile (RDW >15.6%; mortality, 16.7%) had more than twice the risk of in-hospital mortality compared with patients in the second highest quartile (RDW >14% and <15.6%; mortality, 7.3%), whereas the mortality rate in the lowest RDW quartile (<13.1%) was only 1.6%. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.75 (95% confidence interval, 0.72–0.77), which is significantly higher than the areas under the curve of clinical prediction rules (SIRS, MEDS, and CURB65). After integrating RDW into these scores, all scores performed better in predicting mortality (0.73, 0.72, and 0.77, for SIRS, MEDS, and CURB65, respectively). RDW could be an independent predictor of mortality among septic patients. Clinicians could classify the septic patients into different risk groups according to RDW quartiles. For more accurate mortality prediction, RDW could be a potential parameter to be incorporated into clinical prediction rules. Wolters Kluwer Health 2016-06-17 /pmc/articles/PMC4998434/ /pubmed/27310948 http://dx.doi.org/10.1097/MD.0000000000003692 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0 |
spellingShingle | 3900 Chen, Chun-Kuei Lin, Shen-Che Wu, Chin-Chieh Chen, Li-Min Tzeng, I-Shiang Chen, Kuan-Fu STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
title | STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
title_full | STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
title_fullStr | STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
title_full_unstemmed | STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
title_short | STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
title_sort | stard-compliant article: the utility of red cell distribution width to predict mortality for septic patients visiting the emergency department |
topic | 3900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998434/ https://www.ncbi.nlm.nih.gov/pubmed/27310948 http://dx.doi.org/10.1097/MD.0000000000003692 |
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