title: Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis.
abstract: BACKGROUND
  Sepsis is a pro-inflammatory state caused by systemic infection. As sepsis progresses, multiple organ systems become affected with subsequent increase in mortality. Elevated red cell distribution width (RDW) has been seen with changes of other inflammatory markers and thus could potentially serve as a means of assessing sepsis severity. In this study, we examine the association of RDW with APACHE II score and in-hospital mortality.
  We conducted a retrospective study involving a cohort of patients with sepsis. The study period spanned 2 years with a cohort of 349 patients. Data were collected to determine if RDW is associated with APACHE II scores and in-hospital mortality in this cohort.
  
  
  RESULTS
  RDW correlated weakly (r s = 0.27), but significantly (P < 0.0001) with APACHE II scores; coefficient of determination (r (2) = 0.09). The odds ratios for the association of RDW with APACHE II were calculated over the RDW range 12-20% at a dichotomized level of APACHE II, i.e., <15 and ≥15. At a RDW ≥16%, multivariate analysis including all potential confounders indicated that RDW was independently associated with an APACHE II score of ≥15. Similarly, mortality was associated with RDW ≥16%.
  
  
  CONCLUSIONS
  A prognostic biomarker for sepsis in the form of a routine blood test may be of considerable clinical utility. The results of our study suggest that RDW may have value in differentiating between more severe and less severe cases of sepsis. Future studies with larger samples are needed to confirm these findings.
authors.affiliation: Pulmonary Division, St. Joseph's Regional Medical Center, Paterson, NJ, USA ; Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, USA.
authors.forename: Nader A
authors.initials: NA
authors.lastname: Mahmood
authors.affiliation: Pulmonary Division, St. Joseph's Regional Medical Center, Paterson, NJ, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Mathew
authors.affiliation: Pulmonary Division, St. Joseph's Regional Medical Center, Paterson, NJ, USA.
authors.forename: Balwinder
authors.initials: B
authors.lastname: Kang
authors.affiliation: Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, USA.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeBari
authors.affiliation: Pulmonary Division, St. Joseph's Regional Medical Center, Paterson, NJ, USA ; Seton Hall University, School of Health and Medical Sciences, South Orange, NJ, USA.
authors.forename: Muhammad Anees
authors.initials: MA
authors.lastname: Khan
keywords: APACHE II score; biomarkers; mortality; red blood cell distribution width; sepsis