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Usefulness of serial measurement of the red blood cell distribution width to predict 28-day mortality in patients with trauma

 Taeyoung Kong  ;  Jong Eun Park  ;  Yoo Seok Park  ;  Hye Sun Lee  ;  Je Sung You  ;  Hyun Soo Chung  ;  Incheol Park  ;  Sung Phil Chung 
 AMERICAN JOURNAL OF EMERGENCY MEDICINE, Vol.35(12) : 1819-1827, 2017 
Journal Title
Issue Date
Critical Pathways ; Erythrocyte Indices ; Female ; Hospital Mortality/trends ; Hospitalization/statistics & numerical data* ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Shock, Hemorrhagic/blood* ; Shock, Hemorrhagic/etiology ; Shock, Hemorrhagic/mortality ; Time Factors ; Wounds and Injuries/blood* ; Wounds and Injuries/complications ; Wounds and Injuries/mortality
Admission ; Emergency department ; Hemorrhagic shock ; Mortality ; Red blood cell distribution width ; Trauma
BACKGROUND: This is the first study to evaluate the association between the serially measured RDW values and clinical severity in patients surviving >24 h after sustaining trauma. We evaluated the serial measurement and cut-off values of RDW to determine its significance as a prognostic marker of early mortality in patients with suspected severe trauma.

METHODS: This study retrospectively analyzed prospective data of eligible adult patients who were admitted to the ED with suspected severe trauma. The RDW was determined on each day of hospitalization. The primary outcome was all-cause mortality within 28-days of ED admission.

RESULTS: We included 305 patients who met our inclusion criteria. The multivariate Cox regression model demonstrated that higher RDW values on day 1 (hazard ratio [HR], 1.558; 95% confidence interval [CI], 1.09-2.227; p=0.015) and day 2 (HR, 1.549; 95% CI, 1.046-2.294; p=0.029) were strong independent predictors of short-term mortality among patients with suspected severe trauma. Considering the clinical course of severe trauma patients, the RDW is an important ancillary test for determining severity. Specifically, we found that RDW values >14.4% on day 1 (HR, 4.227; 95% CI: 1.672-10.942; p<0.001) and >14.7% on day 2 (HR, 6.041; 95% CI: 2.361-15.458; p<0.001) increased the hazard 28-day all-cause mortality.

CONCLUSION: An increased RDW value is an independent predictor of 28-day mortality in patients with suspected severe trauma. The RDW, routinely obtained as part of the complete blood count without added cost or time, can be serially measured as indicator of severity after trauma.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kong, Tae Young(공태영) ORCID logo https://orcid.org/0000-0002-4182-7245
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
Park, Jong Eun(박종은)
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
Chung, Hyun Soo(정현수) ORCID logo https://orcid.org/0000-0001-6110-1495
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