title: Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients.
abstract: OBJECTIVE
  Organ transplant is an effective treatment for patients with end-stage renal and hepatic failure. Increased use has introduced more emergency department admissions of infectious origin after transplant. Because infections usually manifest with simple complaints and fever, emergency physicians need laboratory tests and radiologic imaging procedures to quickly detect the presence and source of infection. Our aim was to analyze fever-related emergency admissions of renal and hepatic graft recipients and determine whether admitted patients had increased red blood cell distribution width and mean platelet volume levels.
  
  
  METHODS
  We reviewed the medical records of renal and hepatic graft patients who presented to our emergency department with fever during a 4-year period. Our analyses included 150 patients in which complete blood count and C-reactive protein results were available and the source of infection was determined. We compared results with a control group of 150 transplant patients without any infectious findings.
  
  
  RESULTS
  In the 150 solid-organ graft recipients who presented to our emergency department with fever, significant differences were observed versus control patients with respect to white blood cell count, neutrophil-to-lymphocyte ratio, red blood cell distribution width, mean platelet volume, and C-reactive protein levels (P < .05). We determined that C-reactive protein levels, red blood cell distribution width, mean platelet volume, and lymphocyte count were independent indicators of infection on multiple logistic regression analyses. We also determined that red blood cell distribution width had a specificity of 94% and a sensitivity of 26%.
  
  
  CONCLUSIONS
  We found a significantly higher red blood cell distribution width in emergency admissions of infectious origin of renal and hepatic graft recipients than in the control group (P < .001), suggesting that this measurement is a suitable marker of infection for the emergency setting by virtue of rapid availability of test results and lack of extra costs.
authors.affiliation: From the Department of Emergency, Faculty of Medicine, Baskent University, Ankara, Turkey.
authors.forename: Afsin Emre
authors.initials: AE
authors.lastname: Kayipmaz
authors.forename: Meliha
authors.initials: M
authors.lastname: Findik
authors.forename: Cemil
authors.initials: C
authors.lastname: Kavalci
authors.forename: Aydincan
authors.initials: A
authors.lastname: Akdur
authors.forename: Gokhan
authors.initials: G
authors.lastname: Moray
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003141:Communicable Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D004636:Emergency Service, Hospital; D004909:Erythrocyte Indices; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008499:Medical Records; D010359:Patient Readmission; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein