RESUMEN
Objective To investigate the correlation between red cell volume distribution width (RDW) and the mortality rate of acute respiratory distress syndrome (ARDS) patients after renal transplantation. Methods Clinical data of 106 ARDS patients undergoing renal transplantation were retrospectively analyzed. According to RDW, all patients were assigned into the normal (≤15.0%, n=68) and increasing RDW groups (>15.0%, n=38). Baseline data and the incidence of adverse events were statistically compared between two groups. Kaplan-Meier survival curve was adopted to compare the 50 d-mortality rate between two groups. Cox's proportional hazards regression model was utilized to identify the risk factors of the mortality of ARDS patients. Results Among 106 patients, the 50 d-mortality rate was calculated as 43.4% (46/106). The sequential organ failure assessment (SOFA) score, serum creatinine, hemoglobin and platelet count significantly differed between two groups (all P<0.05). In the increasing RDW group, the 50 d-mortality rate and the incidence of infectious shock were significantly higher than those in the normal RDW group (both P<0.05). Kaplan-Meier survival curve demonstrated that the 50 d-mortality rate significantly differed between two groups (P<0.01). Cox's proportional hazards regression model univariate analysis revealed that hemoglobin level<100 g/L, serum creatinine>133 μmol/L, platelet count<100×109/L, severe ARDS and RDW>15.0% were the potential risk factors of the 50 d-mortality rate in ARDS patients (all P<0.05). Multivariate analysis demonstrated that severe ARDS [odd ratio (OR)=12.77, 95%confidence interval (CI) 11.63-15.39, P<0.001] and RDW>15.0% (OR=2.01, 95%CI 1.02-3.94, P<0.043) were the independent risk factors of the 50 d-mortality rate in ARDS patients. Conclusions RDW elevation is correlated with the severity of disease and 50 d-mortality rate in ARDS patients following renal transplantation. RDW can serve as a clinical parameter to predict the prognosis of ARDS patients after renal transplantation.
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New automated blood cell analyzers, Coulter Counter Model S-Plus series provide an index of red cell volume distribution width (RDW) or heterogeneity and a histogram display of red cell volume distribution. We evaluated the clinical significance of RDW by determining the normal range of RDW in healthy adults, children, and newborns and the change of RDW in pediatric patients with various hematologic diseases. The normal ranges of RDW in adults, children and newborns were 12.3 +/- 0.8, 13.0 +/- 1.0, and 17.1 +/- 1.7% respectively. Increases in RDW were observed in patients with iron deficiency and in those receiving iron therapy, as in those with early iron deficiency. Patients with chronic disease, acute hemorrhage, and aplastic anemia with no transfusion in the previous four months had normal RDW. In contrast patients with immune hemolytic anemia, hereditary spherocytosis mechanical hemolytic anemia, acute leukemia, chronic myelocytic leukemia, and chronic hepatobiliary disease had high RDW, as did those with solid tumor and malignant lymphoma during chemotherapy. Among patients with acute leukemia during chemotherapy, RDW was more increased if accompained by macrocytosis than by normocytosis. It was found that the RDW was proportional to the % reticulocyte. We tried to classify anemia, based on RDW and mean corpuscular volume (MCV) and to guide the diagnosis from the peripheral blood analysis in pediatric patients. The distinction of iron deficiency anemia from the anemia of chronic disease and the detection of early iron deficiency was improved. A change in RDW according to storage time at room temperature was not observed. From this study, RDW could be used as a sensitive parameter of red cell anisocytosis. Thus we recommend the use of these new variables the initial classification of anemia in pediatric patients.