Elevated Red Blood Cell Distribution Width Is Associated with Poor Prognosis in Fractured Patients Admitted to Intensive Care Units

• Published in: Orthopaedic surgery Vol. 15; no. 2; pp. 525 - 533
• Main Authors: Sun, Kaibo, Zhou, Yannan, Wu, Yuangang, Zeng, Yi, Xu, Jiawen, Shen, Bin
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.02.2023; John Wiley & Sons, Inc; Wiley
• Subjects: Anemia; Blood; Clinical; Diabetes; Erythrocytes; Ethnicity; Fracture Patients; Fractures; Heart failure; Hospitalization; Hospitals; Humans; Hypertension; Intensive care; Intensive Care Units; Laboratories; Liver diseases; Mortality; Multivariate analysis; Nomograms; Osteoporosis; Patients; Prognosis; Red Blood Cell Distribution Width; Regression analysis; Retrospective Studies; Rheumatoid arthritis; ROC Curve; Surgery; Surgical outcomes; Trauma; Variables; Vital signs; Prognosis; Red Blood Cell Distribution Width; Mortality; Fracture Patients
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13614

Objectives Red blood cell distribution width (RDW) with prognosis in various infectious diseases. For fractured patients admitted to the intensive care units (ICU), an accurate and fast appraisal is essential. To investigate the association between RDW and prognosis in fractured patients admitted to the ICU utilizing the MIMIC‐III database. Methods A retrospective cohort from the MIMIC III database from 2001 and 2012 was constructed. RDW and other information were collected with in‐hospital mortality as the primary outcome and 90‐day mortality and hospital and intensive care unit (ICU) length of stay (LOS) as secondary outcomes. Univariate and multivariate logistic regression models with propensity score inverse probability of treatment weighting (IPTW) were used to investigate the prognostic value of RDW. A nomogram was built with significant prognostic factors to predict in‐hospital mortality, and the performance of the nomogram was evaluated and compared with other severity assessment scores. Subgroup analysis was also conducted. Results A total of 2721 fracture patients admitted to the ICU were identified. After IPTW, the group with higher RDW was significantly associated with elevated in‐hospital mortality (odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.19–2.37), 90‐day mortality (OR: 1.39, 95% CI: 1.04–1.86), prolonged hospital LOS (OR: 1.25, 95% CI: 1.03–1.50), and ICU LOS significantly (OR: 1.26, 95% CI: 1.05–1.53) in the multivariate logistics model. The nomogram showed optimal discriminative ability and predictive accuracy with an area under the receiver operating characteristic curve of 0.77. Conclusion RDW independently predicted in‐hospital mortality, 90‐day mortality, and hospital and ICU LOS in fractured patients admitted to ICU. The nomogram including RDW could also be a promising tool with potential clinical benefits. Elevated RDW was linked to the poor prognosis for critically ill fracture patients. The higher RDW was associated with the increased risk of in‐hospital mortality and 90‐day mortality, as well as prolonged ICU and hospital LOS. RDW: Red blood cell distribution width; ICU: Intensive care unit; LOS: length of stay.