الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Red cell distribution width (RDW) measures variability in red blood cell size. and is a simple, low cost, and widely available measure routinely reported as part of a complete blood count (CBC).
Several recent studies suggest that RDW may also be useful as a biomarker of disease severity and clinical outcomes in critically ill patients. An increased RDW is an independent predictor of all-cause mortality in sepsis, congestive heart failure. and has been shown to improve acute physiology scoring for risk prediction in critically ill adults.
Any disease involving red blood cell (RBC) destruction or production can increase variability in RBC size and lead to RDW elevation. In critical illness, the acute systemic inflammatory response resulting from a multitude of underlying etiologies can alter both erythropoiesis and erythrocyte maturation. The resulting acute rise in RDW may therefore reflect the degree of the underlying inflammatory state and provide useful prognostic information about intensity of resource utilization and risk of mortality. Similarly, sustained RDW elevation may also be seen in cases of protracted inflammation, as in adults with chronic illnesses.
The aim of this work was to determine the utility of RDW as an early pragmatic biomarker for outcome in pediatric critical illness.
110 critically ill patients admitted to pediatric intensive care unit (PICU) were enrolled in this study and divided as follows:
• group I: (n=57) surviving group.
• group II: (n=43) non-surviving group.
The medical records of all patients were reviewed for a CBC, including RDW, measured within 24 hours of PICU admission, and all cases were subjected to:
1- Full history taking.
2- Thorough clinical examination.
3- Investigations including: CBC including RDW.
Results revealed that:
1- We found that the age of studied patients was between 0.1-13 years with mean age was 2.2 year. The frequency of males was slightly higher than the frequency of females. The most frequent admitted categories at PICU was respiratory system, followed by CNS, GIT, sepsis, cardiac, endocrine and then surgical.
2- The LOS in the PICU of the studied patients was ranged from 1 day to 14 days. In our PICU, the mortality rate of the studied patients was 43%. The median RDW for all patients was 14.7% and PIM2 score ranged from 0.6% to 97%.
3- According to mortality, there were insignificant differences between both groups regarding age and gender. As regarding PICU LOS there was significant increase in patient with mortality compared with patient without mortality.
4- There was significant increase in PIM-2, RDW and the frequency of anemia compared with others without mortality, while there was significant decrease in Hb and MCV levels, all are Risk factors for mortality.
5- RDW showed insignificant positive correlation with PIM-2, age, Hb and MCV while showed significant moderate correlation with PICU LOS, so RDW is a good indicator of severity.
6- RDW showed insignificant positive correlation with PIM-2, MCV and PICU LOS and showed insignificant negative correlation with age and Hb.
7- The most predicting factors of mortality were RDW, Anemia, PIM-2, PICU LOS in the studied patients.
8- The optimal cutoff value of PIM-2 to predict mortality rate in the studied patients was >5.8% with a very high sensitivity 97.67% and specificity 98.25%, and the optimal cutoff value of RDW to predict mortality rate in the studied patients was >14.7% with a high sensitivity 81.4% and specificity 85.96%.
In conclusion, RDW is a predictor of mortality in critically ill PICU patients. Taking into consideration the fact that RDW is routinely measured in complete blood count with no additional cost, this can serve as an “inexpensive prognostic marker” in critically ill patients.