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VOLUME 24 , ISSUE 2 ( February, 2020 ) > List of Articles

Original Article

Red Cell Distribution Width as a Severity Marker on the Outcome of Patients with Acute Kidney Injury on Renal Replacement Therapy

Sunil Nanjarapalle, Aloka Samantaray, Sivakumar Vishnubhotla

Keywords : Acute kidney injury, Disease severity, Hospital mortality

Citation Information : Nanjarapalle S, Samantaray A, Vishnubhotla S. Red Cell Distribution Width as a Severity Marker on the Outcome of Patients with Acute Kidney Injury on Renal Replacement Therapy. Indian J Crit Care Med 2020; 24 (2):95-98.

DOI: 10.5005/jp-journals-10071-23342

License: CC BY-NC 4.0

Published Online: 17-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Background: Acute kidney injury (AKI) requiring dialysis is associated with high mortality and morbidity. Red blood cell distribution width (RDW) has been shown as a predictor of mortality in different subsets of patients admitted to intensive care unit (ICU). This study compares the predictive ability of RDW and other severity illness prognostic models on 30 days mortality in adult patients admitted to ICUs with AKI necessitating dialysis. Materials and methods: Thirty patients were evaluated using five different prognostic scoring models. Sequential organ failure assessment (SOFA) score, acute tubular necrosis-individual severity index (ATN-ISI), version II of acute physiology and chronic health evaluation (APACHE II), vasoactive-inotropic score (VIS), version II of simplified acute physiology score (SAPS II), and RDW as a marker were used to prognosticate the severity of illness. The scores were calculated using the values of clinical and laboratory parameters at the time of admission. Results: The prognostic abilities of the scores were compared for their discriminatory power using receiver-operating characteristic (ROC) curves. The area under the ROC curve (AROC) of RDW was 0.904, SOFA score was 0.828, ATN-ISI was 0.743, SAPS was 0.857, and APACHE II score was 0.828. Vasoactive-inotropic score has the lowest discriminatory power with AROC of 0.487. Red blood cell distribution width has a strong and significant correlation with APACHE II and SOFA scores and a weak relation with ATN-ISI score and SAPS II. Conclusion: Red blood cell distribution width has a better predictive ability than other disease severity scoring systems to predict mortality in an adult AKI patient admitted to ICU with need for renal replacement therapy (RRT).


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  1. Kasuno K, Shirakawa K, Yoshida H, Mori K, Kimura H, Takahashi N, et al. Renal redox dysregulation in AKI: application for oxidative stress marker of AKI. Am J Physiol Renal Physiol 2014;307(12):F1342–F1351. DOI: 10.1152/ajprenal.00381.2013.
  2. Feng Y, Liu Y, Wang L, Cai X, Wang D, Wu K, et al. Sustained oxidative stress causes late acute renal failure via duplex regulation on p38 MAPK and Akt phosphorylation in severely burned rats. PLoS One 2013;8(1):e54593. DOI: 10.1371/journal.pone.0054593.
  3. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009;133(4):628–632. DOI: 10.1043/1543-2165-133.4.628.
  4. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013;31(3):545–548. DOI: 10.1016/j.ajem.2012.10.017.
  5. Bhadade R, De'Souza R, Harde MJ, Mehta KS, Bhargava P. A prospective study of acute kidney injury according to KDIGO definition and its mortality predictors. J Assoc Physicians India 2016;64(12):22–28.
  6. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11(2):R31. DOI: 10.1186/cc5713.
  7. Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010;11(2):234–238. DOI: 10.1097/PCC.0b013e3181b806fc.
  8. Mukhoedova TV, Lomivorotov VN, Kolesnikov SV, Litasova EE, Malov AA, Borisov AS. Prediction of the outcomes of renal replacement therapy for acute renal failure after cardiosurgical interventions. Anesteziol Reanimatol 2005;2:53–58.
  9. Allegretti AS, Steele DJ, David-Kasdan JA, Bajwa E, Niles JL, Bhan I. Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study. Crit Care 2013;17(3):R109. DOI: 10.1186/cc12780.
  10. Prasanth TS, Remya KA, Resmi NR, Philipose R, Vijayakumar K. Acute renal failure renal replacement therapy & outcome. Urol Nephrol Open Access J 2015;2(5):00056. DOI: 10.15406/unoaj.2015.02.00056.
  11. Oh HJ, Park JT, Kim JK, Yoo DE, Kim SJ, Han SH, et al. Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy. Nephrol Dial Transplant 2012;27(2):589–594. DOI: 10.1093/ndt/gfr307.
  12. Skarupskienė I, Adukauskienė D, Kuzminskienė J, Rimkutė L, Balčiuvienė V, Žiginskienė E, et al. Mortality prediction in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery. Medicina (Kaunas) 2017;53(4):217–223. DOI: 10.1016/j.medici.2017.06.003.
  13. Malov AA, Borisov AS, Lomivorotov VV, Efremov SM, Ponomarev DN, Mukhoedova TV, et al. Mortality prediction in patients with dialysis-dependent acute kidney injury after cardiac surgery with cardiopulmonary bypass. Heart Lung Circ 2014;23(4):325–331. DOI: 10.1016/j.hlc.2013.10.082.
  14. Lima EQ, Dirce MT, Castro I, Yu L. Mortality risk factors and validation of severity scoring systems in critically ill patients with acute renal failure. Ren Fail 2005;27(5):547–556. DOI: 10.1080/08860220500198771.
  15. Jandial A, Kumar S, Bhalla A, Sharma N, Varma N, Varma S. Elevated red cell distribution width as a prognostic marker in severe sepsis: a prospective observational study. Indian J Crit Care Med 2017;21(9):552–562. DOI: 10.4103/ijccm.IJCCM_208_17.
  16. Cheung YN, Shum HP, Chan KC, Yan WW. Preoperative red cell distribution width: not a useful prognostic indicator for 30-day mortality in patients who undergo major- or ultra-major noncardiac surgery. Indian J Crit Care Med 2016;20(11):647–652. DOI: 10.4103/0972-5229.194008.
  17. Sun XP, Chen WM, Sun ZJ, Ding XS, Gao XY, Liang SW, et al. Impact of red blood cell distribution width on long-term mortality in patients with ST-elevation myocardial infarction. Cardiology 2014;128(4): 343–348. DOI: 10.1159/000359994.
  18. Hu Y, Liu H, Fu S, Wan J, Li X. Red blood cell distribution width is an independent predictor of AKI and mortality in patients in the coronary care unit. Kidney Blood Press Res 2017;42(6):1193–1204. DOI: 10.1159/000485866.
  19. Nguyen HV, Havalad V, Aponte-Patel L, Murata AY, Wang DY, Rusanov A, et al. Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: a substudy of a randomized clinical trial. J Thorac Cardiovasc Surg 2013;146(2):296–301. DOI: 10.1016/j.jtcvs.2012.07.020.
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