الفهرس 
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Abstract
Red blood cell distribution width is a measure of the range of variation of red blood cell (RBC) volume that is reported as part of a standard complete blood count. Usually red blood cells are a standard size of about 6-8 μm in diameter. Higher RDW values indicate greater variation in size. Normal reference range of RDW in human red blood cells is 11.5-14.5%
RDW was measured as part of the routine CBC using a Siemens Advia 2120 Hematology Analyzer according to the formula:
RDW = (Coefficient of Variability of RBC ÷ mean MCV) × 100
Studies have revealed that RDW could be used as a predictor of mortality in critically ill patients. Although the mechanism of this relationship is not fully apparent, it seems that in critical illnesses, the acute systemic inflammatory response can alter both erythropoiesis and erythrocyte maturation. In different contexts including sepsis, cardiovascular disease, cancer, and chronic lower respiratory tract disease, RDW has shown to have association with increased risk of mortality. In patients admitted to PICU, RDW is associated with risk of death and is suggested as an independent prognostic marker. We aimed to study the association between RDW parameter in pediatric patients admitted to PICU with length of stay>48 hrs and mortality.
The aim of this work was to study red blood cell distribution width in critically ill children and to determine its relation to the prognosis.
The study included (100) critically ill children admitted into the pediatric intensive care unit (PICU) in pediatric department of Menoufia University Hospital of both sexes. Age of them was from one month to 16 years.
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All patients incorporated in this study were subjected to the following:
1) Informed consent:
An informed consent was taken from all participants’ guardians.
2) Detailed history taking
Full history of the patients, including personal, present, past, developmental, vaccination, and nutritional history. In addition, the family history.
3) Clinical examination:
Vital signs: pulse, temperature, blood pressure and respiratory rate.
Anthropometric parameters: weight, height, head circumference and body mass index.
General and local system examination (chest, heart, abdomen, CNS, musculoskeletal, urological, and hematological).
Clinical Scoring system for the patients, Pediatric index of mortality (PIM2)
*Routine laboratory Investigations:
CBC (including Red Blood Cell Distribution Width), CRP and Blood Culture if needed.
*Follow up of all patients till hospital discharge to determine the occurrence of morbidity (length of stay in PICU < 48 hours and sepsis) and mortality and their relation to the Red Cell Distribution Width levels.
Results of our study showed:
Patients were categorized into 4 groups based on their RDW results. The first group (group A) included 42 patients with RDW<13.4 %. The second group (group B) consisted of 20 patients with RDW of 13.4–14.3 %. The third
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group (group C) included 12 patients with RDW of 14.4–15.7 %. Lastly, the fourth group (group D) consisted of 26 patients with RDW ≥15.7 %.
We found a statistically insignificant difference between study groups as regard age. Also this was supported by correlation analysis which was conducted between age and RDW.
We found that sex distribution among all 4 study groups wasn’t a variable of statistical significance.
It was found that PIM2 risk score was significantly different between study groups that were divided based on RDW level, where PIM 2 was highest in group D with the highest RDW while it was lower in Groups B and A.
Platelet count was a variable of statistical significance between the 4 study groups. However on correlation analysis both parameter didn’t show a statistically significant correlation.
CRP was significantly different among study groups in which it was highest in group D with the highest RDW. Also elevated RDW was correlated positively with raised CRP at a level very close to statistical significance.
There was a surprising highly significant correlation as well as significant difference between study groups regarding SGOT level and RDW. Also SGPT was a variable of statistical significance between the 4 study groups.
Patients with the highest RDW were more likely to present with shock, which the highest prevalence of sock state was found in group D with the highest RDW.
Regarding sepsis and mortality, elevated RDW reflects anisocytosis and higher variability in size of circulating RBCs. Literature frequently stated
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that elevated RDW in pediatric patients admitted in PICU is associated with a higher risk for mortality in critically ill pediatric patients.
We found that incidence of sepsis and mortality rate were significantly different between study subgroups.
On ROC curve analysis, RDW showed significant results for predicting both mortality and sepsis. Although stronger results were obtained with mortality. RDW results although weren’t stronger than those of PIM2 but they were very close and nearly similar especially regarding mortality outcome.
Conclusion:
In conclusion, Based on the results of the current study, it can be concluded that RDW, a simple and readily available biomarker, was significantly higher in critically ill children admitted to pediatric ICU, and can be used as a pragmatic marker for prognosis of these children.
We found that higher RDW was significantly associated with higher mortality rate and incidence of sepsis in pediatric patients admitted to PICU.
PIM2 and CRP were high in the patients with high RDW and low in patients with low RDW. That mean that the more high the value of RDW,
the more mortality and morbidity of patients.