Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients.
Recent evidence suggests that red cell distribution width (RDW) is associated with mortality in mixed cohorts of critically ill patients. Our goal was to investigate whether elevated RDW at initiation of critical care in the intensive care unit (ICU) is associated with 90-day mortality in surgical patients.



We performed a retrospective, single-center cohort study. Normal RDW was defined as 11.5%-14.5%. To investigate the association of admission RDW with 90-day mortality, we performed a logistic regression analysis, controlling for age, sex, race, body mass index, Nutrition Risk Screening 2002 score, Acute Physiology and Chronic Health Evaluation II score, hospital length of stay, as well as levels of creatinine, albumin, and mean corpuscular volume.



500 patients comprised the analytic cohort; 47% patients had elevated RDW and overall 90-day mortality was 28%. Logistic regression analysis demonstrated that patients with elevated RDW had a greater than two-fold increased odds of mortality (OR 2.28: 95%CI 1.20-4.33) compared to patients with normal RDW.



Elevated RDW at initiation of care is associated with increased odds of 90-day mortality in surgical ICU patients. These data support the need for prospective studies to determine whether RDW can improve risk stratification in surgical ICU patients.
Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114. Electronic address: totero@partners.org.
Tiffany M N
TM
Otero
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114; University of California, 252 Irvine Hall, Irvine, CA, 92697. Electronic address: canalesc@uci.edu.
Cecilia
C
Canales
Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115. Electronic address: dyeh2@mgh.harvard.edu.
D Dante
DD
Yeh
Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115. Electronic address: phou@bwh.harvard.edu.
Peter C
PC
Hou
Department of Nutrition and Food Services, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114. Electronic address: dmbelcher@partners.org.
Donna M
DM
Belcher
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115. Electronic address: squraishi@mgh.harvard.edu.
Sadeq A
SA
Quraishi
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D001900:Boston; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D004909:Erythrocyte Indices / Q000502:physiology*; D005260:Female; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
Critical care; ICU; Mortality; RDW; Red cell distribution width