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

Öz

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.

Anahtar Kelimeler

• Red blood distrubition width,pediatric intensive care unit,prognosis

Eritrosit dağılım genişliği iki yaşından büyük hastalarda sepsis ile ilişkili olabilir

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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