The red cell distribution width can be associated with sepsis in patients older than two-year-old

Year 2020, Volume: 21 Issue: 1, 35 - 42, 16.01.2020

Fatih Aygün

https://doi.org/10.18229/kocatepetip.500360

Abstract

OBJECTIVE: Sepsis is an important cause of mortality and morbidity in critically ill patients. Early diagnosis of sepsis is important for treatment and prognosis. C-reactive protein (CRP) and procalcitonin (PCT) are the most commonly used biomarkers for diagnosis of sepsis. However, PCT can lead to significant increase of hospital costs and cannot be routinely performed in every center. With this point of view, we aimed to investigate the importance of the routine hemogram parameters like red cell distribution width (RDW) and mean platelet volume (MPV) in the diagnosis of sepsis.

MATERIAL AND METHODS: The medical records of 173 patients over 2 years of age who were admitted to Okmeydanı Training and Research Hospital, Pediatric Intensive Care Unit, between October 2016 and March 2018 were reviewed retrospectively. Demographic data of patients and the initial laboratory values were recorded. Patients were divided into two groups according to development of sepsis or not. The prognostic and laboratory differences between the groups were compared. Receiver operating characteristic (ROC) curves were used for sepsis biomarkers.

RESULTS: Thirty-eight (16.8%) of the patients were admitted with either sepsis and septic shock. A statistically significant relationship was determined between sepsis and CRP (p <0.001), PCT (p <0.001), platelet count (p <0.001) and RDW (p = 0.005). There was no significant relationship between MPV and sepsis (p = 0.592). The PCT was found to have the most sensitive association with sepsis in ROC curve analysis (AUC: 0.828). The cut-off value was 2.95 ng / dl, while PCT showed 72.7% sensitivity and 68.8% specificity. Subsequently, platelet (AUC: 0.808), CRP (AUC: 0.695) and RDW (AUC: 0.619) had significant association for diagnosis of sepsis. We demonstrated increase in the rate of mechanical ventilation(p=0.014) and red blood cell transfusion(p=0.009), also prolongation in the duration of hospitalization in intensive care unit (p=0.044), if the RDW is higher than %16.

CONCLUSIONS: This study suggests that RDW and MPV can also be used as acute phase reactant in sepsis and inflammation not only in differentiation of anaemia and thrombocytopenia. Also, RDW>%16 can be considered as a marker that increase mechanical ventilation and red blood cell transfusion beside prolonging duration of hospitalization in intensive care unit.

Keywords

Red blood distrubition width, pediatric intensive care unit, prognosis

Eritrosit dağılım genişliği iki yaşından büyük hastalarda sepsis ile ilişkili olabilir

Abstract

AMAÇ: Sepsis, yoğun bakım hastalarında önemli mortalite ve morbidite nedenidir. Sepsisin erken tanısı, tedavi ve prognoz için önemlidir. Sepsis için en yaygın kullanılan biyobelirteçler C-reaktif protein (CRP) ve prokalsitonindir (PKT). Bununla birlikte, rutin olarak istendiğinde özellikle PKT belirgin hastane maliyeti oluşturmaktadır ve her merkezde bakılamamaktadır. Bu düşünce ile rutin hemogram parametrelerinden olan eritrosit dağılım genişliği (RDW) ve ortalama trombosit volümünün (OTH) sepsis tanısındaki değerliliğini incelemeyi amaçladık.

GEREÇ VE YÖNTEM: Ekim 2016 ile Mart 2018 tarihleri arasında Okmeydanı Eğitim ve Araştırma Hastanesine yatırılan 2 yaş üstü 173 hastanın tıbbi kayıtları geriye dönük olarak incelendi. Çalışmaya alınan tüm hastaların demografik bilgileri ve yatışı sonrası ilk laboratuvar değerleri kaydedildi. Hastalar başvuru tanısına göre sepsisi olanlar ve olmayanlar olarak iki gruba ayrıldı. Gruplar arasındaki prognostik ve laboratuvar farklılıklar karşılaştırıldı. Sepsis biyobelirteçleri için receiver operating characteristic (ROC) eğrileri kullanıldı.

BULGULAR: Hastaların 38’i (% 16.8) sepsis ve septik şok ile başvurdu. Sepsis ile CRP (p<0.001), PKT (p<0.001), trombosit sayısı (p <0.001) ve RDW (p = 0.005) arasında istatistiksel anlamlı ilişki saptandı. OTH ile sepsis (p = 0.592) arasında anlamlı ilişki yoktu. ROC eğrisi analizinde sepsis ile en duyarlı ilişki PKT’de saptandı (AUC: 0.828). Kesme değeri 2.95 ng/dl iken PKT %72.7 duyarlılık ve %68.8 özgüllük gösterdi. Daha sonra sepsis tanısı için anlamlı ilişki sırasıyla trombosit (AUC:0.808), CRP (AUC:0.695) ve RDW (AUC:0.619) olarak saptandı. RDW>%16 ile mekanik ventilatör (p=0.014)ve eritrosit transfüzyonu (p=0.009) gereksiniminin arttığı, yoğun bakım yatış süresinin uzadığı gösterilmiştir (p=0.044).

SONUÇ: Bu çalışma ile RDW ve OTH’nin sadece anemi ve trombositopeni ayrımında kullanılmayacağını, aslında bir akut faz reaktanı gibi, sepsis ve inflamasyon ile ilişkili birer belirteç olduğu gösterilmiştir. Ayrıca RDW>%16 olması mekanik ventilatör ve eritrosit transfüzyonu gereksinimini artıran, yoğun bakım yatış süresini uzatan bir belirteç olarak gösterilmiştir.

Keywords

eritrosit dağılım genişliği, çocuk yoğun bakım ünitesi, prognoz, prokalsitonin

References

• 1. Fingar KR, Barrett ML, Elixhauser A, Stocks C, Steiner CA. Trends in Potentially Preventable Inpatient Hospital Admissions and Emergency Department Visits. Statistical Brief #1952. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015 May 15;191(10):1147-573. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805–1812.4. Malle E, Sodin-Semri S, Kovacevic A: Serum amyloid A. An acute phase protein involved in tumor pathogenesis. Cell Mol Life Sci 2009, 66:9-26.5. Meisner M. Procalcitonin (PCT). A New Innovative Infection Parameter. Biochemical and Clinical Aspects, 3rd edn. Stuttgart: Georg Thieme Verlag, 2000.6. Morgenthaler NG, Struck J, Chancerelle Y, Weglöhner W, Agay D, Bohuon C, et al. Production of procalcitonin (PCT) in non-thyroidal tissue after LPS injection. Horm.Metab. Res. 2003; 35: 290–5.7. Han YQ, Zhang L, Yan L, Li P, Ouyang PH, Lippi G, Hu ZD. Red blood cell distribution width predicts long-term outcomes in sepsis patients admitted to the intensive care unit Clin Chim Acta. 2018 Dec; 487:112-116.8. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011; 17:47-58.9. Han YY, Doughty LA, Kofos D, Sasser H, Carcillo JA. Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis. Pediatr Crit Care Med 2003; 4:21‑5.10. Guo SY, Zhou Y, Hu QF, Yao J, Wang H: Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis. Am J Med Sci 2015; 349:499-504.11. Self WH, Grijalva CG, Williams DJ, Woodworth A, Balk RA, Fakhran S, et. al. Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults with Community-Acquired Pneumonia Chest. 2016 Oct;150(4):819-828.12. Wang F, Pan W, Pan S, Ge J, Wang S, Chen M. Red cell distribution width as a novel predictor of mortality in ICU patients. Ann Med. 2010; 43:40-6.13. Forhecz Z, Gombos T, Borgulya G. Red cell distribution width in heart failure: Prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009; 158:659-66.14. Yildiz A, Yigit A, Benli AR. The prognostic role of platelet to lymphocyte ratio and mean platelet volume in critically ill patients. Eur Rev Med Pharmacol Sci 2018;22:2246-52.15. Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochemia Medica 2016; 26:178-93.16. Erdoğan S, Oto A, Boşnak M. The relation between mean platelet volume and mortality in critical pediatric patients. Turk J Pediatr. 2015 Nov-Dec;57(6):605-610.17. Akca S, Haji-Michael P, de Mendonc¸a A, Suter P, Levi M, Vincent JL. Time course of platelet counts in critically ill patients. Crit Care Med. 2002;30(4): 753-756.18. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;28(6): 1871-1876.19. Zhang S, Cui YL, Diao MY, Chen DC, Lin ZF. Use of Platelet Indices for Determining Illness Severity and Predicting Prognosis in Critically Ill Patients. Chin Med J (Engl). 2015 Aug 5;128(15):2012-8.