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Review
. 2021 Sep 15;13(4):307-314.
doi: 10.1055/s-0041-1735876. eCollection 2024 Dec.

A Meta-analysis of the Utility of Red Cell Distribution Width as a Biomarker to Predict Outcomes in Pediatric Illness (PROSPERO CRD42020208777)

Devin Murphy  1 , Etan Orgel  2   3 , Wouter Koek  1 , Melissa Frei-Jones  1   4 , Christopher Denton  2   3 , Deepak Kamat  1
Affiliations
Review

A Meta-analysis of the Utility of Red Cell Distribution Width as a Biomarker to Predict Outcomes in Pediatric Illness (PROSPERO CRD42020208777)

Devin Murphy et al. J Pediatr Intensive Care. .

Abstract

Red cell distribution width (RDW) is an average of the variation in red blood cell (RBC) sizes reported on a complete blood count. An elevated RDW indicates a pathological process that is affecting erythropoiesis. Studies showed that as the severity of disease process increases, the RDW often increases as well. Particularly in resource-limited countries, RDW has been studied as an outcome predictor for conditions in a variety of disciplines and is offered as an adjunct monitoring tool that is cost effective, readily available, and indicative of pathological processes amenable to intervention. Particularly in pediatric critical care settings, RDW has been shown to be a reliable tool for surveillance of disease states such as sepsis. Despite the increased attention of RDW as a marker for disease outcome, collective evaluation on the utility of RDW as a marker for outcome in pediatric critical care settings is lacking. We offer a systematic review and meta-analysis of published studies to assess the ability of RDW to predict illness severity and mortality among pediatric critical care patients. Among eight studies of over 4,800 patients, we found over a two-fold increase in odds for mortality in critically ill children whose RDW was above 15.7%. This is the first systematic review of RDW being used to predict mortality in critically ill children and findings of this study may prompt early intervention in the pediatric critical care setting.

Keywords: RDW; critical care; hematology; mortality; pediatric.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Study selection.
Fig. 2
Fig. 2
Funnel plot to assess publication bias among studies that assessed red cell distribution width and mortality.
Fig. 3
Fig. 3
Forest plot showing the results of eight studies examining the association between mortality and RDW values above cut-off (median: 15.7). The figure shows the log odds ratio with corresponding 95% confidence intervals in the individual studies as well as the summary estimate based on a random-effects model. The values were then back-transformed to odds ratios. E.g., the antilog of 0.88 is e^0.88 = 2.41. RDW, red cell distribution width.
See this image and copyright information in PMC

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