Admission Red Blood Cell Distribution Width and Mean Platelet Volume as Predictors of Mortality in the Pediatric Intensive Care Unit: A Five-Year Single-Center Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Eligibility Criteria
2.2.1. Inclusion Criteria
2.2.2. Exclusion Criteria
2.3. Data Collection
2.4. Outcome
2.5. Study Size Estimation
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ARDS | Acute respiratory distress syndrome |
aRR | Adjusted relative risk |
AuROC | Area under the receiver operating characteristic |
BMI | Body mass index |
BUN | Blood urea nitrogen |
CBC | Complete blood count |
CRP | C-reactive protein |
CRRT | Continuous renal replacement therapy |
DAGs | Directed acyclic graphs |
ESR | Erythrocyte sedimentation rate |
fL | flamtoliter |
HR | Hazard ratio |
ICU | Intensive care unit |
IQR | Interquartile range |
LOS | Length of stay |
MCV | Mean corpuscular volume |
MOD | Multi-organ dysfunction |
MPV | Mean platelet volume |
MV | Mechanical ventilation |
NPV | Negative predictive value |
PCR | Polymerase chain reaction |
PCT | Platelet-crit |
PDW | Platelet distribution width |
PELOD-2 | Pediatric Logistic Organ Dysfunction-2 |
PICU | Pediatric intensive care unit |
PIM-2 | Pediatric Index of Mortality 2 |
PPV | Positive predictive value |
RBC | Red blood cell |
RDW | Red blood cell distribution width |
ROC | Receiver operating characteristic |
RR | Relative risk |
SD | Standard deviation |
TNF-α | Tumor necrosis factor-α |
WBC | White blood cell |
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Characteristics | Total (n = 580) | Non-Survivors (n= 57) | Survivors (n= 523) | p-Value |
---|---|---|---|---|
Age (years) | 5.9 (4.7, 10.4) | 5.8 (4.7, 8.8) | 6 (4.8, 10.4) | 0.689 |
Male, n (%) | 321 (55.3) | 38 (66.7) | 283 (54.1) | 0.070 |
Body mass index (kg/m2) | 15.2 (13.5, 17.4) | 15.1 (12.9, 17.8) | 15.2 (13.6, 17.4) | 0.614 |
Comorbidities | ||||
Seizure/epilepsy, n (%) | 49 (8.4) | 5 (8.7) | 44 (8.4) | 0.926 |
Chronic lung disease, n (%) | 43 (7.4) | 8 (14.0) | 35 (6.7) | 0.045 |
Cardiac arrythmia, n (%) | 27 (4.6) | 3 (5.3) | 24 (4.6) | 0.819 |
Asthma, n (%) | 12 (2.1) | 0 (0) | 12 (2.3) | 0.248 |
Neuromuscular disease, n (%) | 1 (0.2) | 0 (0) | 1 (0.2) | 0.741 |
Solid tumor, n (%) | 22 (3.8) | 0 (0) | 22 (4.2) | 0.114 |
Systemic lupus erythematosus, n (%) | 10 (1.7) | 2 (3.5) | 8 (1.5) | 0.276 |
Reason for intensive care unit admission | ||||
Respiratory failure and acute respiratory distress syndrome, n (%) | 418 (72.1) | 51 (89.5) | 367 (70.2) | 0.002 |
Congestive heart failure, n (%) | 130 (22.4) | 20 (35.1) | 110 (21.0) | 0.016 |
Sepsis/Septic shock, n (%) | 99 (17.1) | 15 (26.3) | 84 (16.1) | 0.051 |
Post-operative care, n (%) | 113 (19.5) | 7 (12.3) | 106 (20.3) | 0.148 |
Neurologic condition/alteration of consciousness, n (%) | 27 (4.6) | 3 (5.3) | 24 (4.6) | 0.819 |
Others, n (%) | 62 (10.7) | 7 (12.3) | 55 (10.5) | 0.682 |
Illness severity | ||||
Multi-organ failure, n (%) | 259 (44.6) | 46 (80.7) | 213 (40.7) | <0.001 |
Pediatric Index of Mortality 2 score | 2.9 (1.0, 6.6) | 4.1 (1.5, 9.2) | 2.8 (1.0, 6.3) | 0.021 |
Management | ||||
Mechanical ventilation, n (%) | 432 (74.5) | 54 (94.7) | 378 (72.3) | <0.001 |
Vasoactive drugs, n (%) | 217 (37.4) | 45 (78.9) | 172 (32.9) | <0.001 |
Continuous renal replacement therapy, n (%) | 25 (4.3) | 7 (12.3) | 18 (3.4) | 0.002 |
Laboratory Parameters | Total (n = 580) | Non-Survivors (n = 57) | Survivors (n = 523) | p-Value |
---|---|---|---|---|
Hemoglobin (g/dL) | 11.2 ± 2.8 | 11.2 ± 3.4 | 11.6 ± 2.7 | 0.862 |
Hematocrit (%) | 34.1 ± 8.7 | 34.7 ± 11.1 | 33.9 ± 8.4 | 0.559 |
White blood cell count (×103 cell/mm3) * | 12.0 (8.8, 16.6) | 12.1 (7.7, 19.5) | 12.0 (9.0, 16.5) | 0.994 |
Absolute neutrophil count | 7883.8 (4776.6, 11,733.8) | 8020.2 (3689.6, 13,156.6) | 7882.5 (4833.2, 11,707.5) | 0.878 |
Absolute lymphocyte count | 2590.9 (1551.4, 4187.5) | 2333.4 (1210.7, 3695.1) | 2592.8 (1580.6, 4218.4) | 0.265 |
Platelet count (×103 cell/mm3) * | 285 (181, 400) | 196 (86, 340) | 292 (194, 408) | <0.001 |
Red blood cell distribution width (%) | 15.7 ± 2.8 | 18.2 ± 3.6 | 15.5 ± 2.5 | <0.001 |
Mean corpuscular volume (fL) | 78.2 ± 9.1 | 81.1 ± 7.9 | 77.9 ± 9.2 | 0.014 |
Red blood cell count (×103 cell/mm3) | 4.4 ± 1.2 | 4.3 ± 1.4 | 4.4 ± 1.1 | 0.633 |
Nucleated red blood cell (%) * | 0 (0, 0.1) | 0.1 (0, 1.7) | 0 (0, 0.1) | <0.001 |
Mean platelet volume (fL) | 9.9 ±1.0 | 10.4 ± 1.2 | 9.8 ± 0.9 | <0.001 |
Platelet distribution width (PDW) | 10.8 ± 2.4 | 12.5 ± 3.0 | 10.7 ± 2.2 | <0.001 |
Erythrocyte sedimentation rate (mm/h) * | 24 (9, 41) | 33 (16, 53) | 24 (9, 39) | 0.297 |
C-reactive protein (mg/L) * | 15.5 (4.6, 62.5) | 36.6 (7.9, 113) | 15.1 (4.2, 62.4) | 0.323 |
Lactate (mmol/L) * | 2.2 (1.3, 3.7) | 3.4 (2.1, 4.5) | 2.1 (1.3, 3.4) | 0.004 |
Procalcitonin (ng/mL) * | 0.8 (0.2, 5.9) | 1.3 (0.4, 18.0) | 0.7 (0.2, 4.9) | 0.087 |
Blood urea nitrogen (mg/dL) * | 10 (6, 16) | 13 (7, 27) | 9 (6, 15) | 0.002 |
Creatinine (mg/dL) * | 0.3 (0.2, 0.5) | 0.5 (0.3, 0.8) | 0.3 (0.2, 0.4) | <0.001 |
Albumin (g/dL) | 3.6 ± 0.7 | 3.4 ± 0.7 | 3.6 ± 0.7 | 0.084 |
Aspartate transaminase (U/L) * | 41 (28, 79) | 56.5 (36, 169) | 40 (27, 73.5) | <0.001 |
Alanine transaminase (U/L) * | 23.5 (14, 46) | 31.5 (19, 86) | 23 (14, 43) | 0.010 |
Total bilirubin (mg/dL) * | 0.4 (0.2, 0.9) | 0.7 (0.3, 1.9) | 0.4 (0.2, 0.8) | 0.023 |
Direct bilirubin (mg/dL) * | 0.2 (0.1, 0.5) | 0.3 (0.1, 0.8) | 0.2 (0.1, 0.4) | 0.011 |
Parameters | Univariable Analysis | Multivariable Analysis | ||
---|---|---|---|---|
Unadjusted RR (95% CI) | p-Value | Adjusted RR (95% CI) | p-Value | |
RDW (%) | 1.25 (1.19–1.33) | <0.001 | 1.19 (1.13–1.25) | <0.001 |
RDW ≥ 15% * | 3.82 (2.02–7.23) | <0.001 | 2.73 (1.45–5.13) | 0.002 |
MPV (fL) | 1.54 (1.25–1.89) | <0.001 | 1.34 (1.10–1.64) | 0.003 |
MPV ≥ 10 fL * | 3.04 (1.79–5.15) | <0.001 | 2.38 (1.43–3.93) | 0.001 |
Parameters | Non-Survivors (n = 57) | Survivors (n = 523) | Sensitivity | Specificity | PPV | NPV | AuROC |
---|---|---|---|---|---|---|---|
RDW ≥ 15% | 46 (80.7) | 257 (49.1) | 80.7% | 50.9% | 15.2% | 96.0% | 0.66 (0.60–0.71) |
MPV ≥ 10 fL | 38 (66.7) | 192 (36.7) | 66.7% | 63.3% | 16.5% | 94.6% | 0.65 (0.58–0.71) |
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Sunkonkit, K.; Chai-adisaksopha, C.; Natesirinilkul, R.; Phinyo, P.; Trongtrakul, K. Admission Red Blood Cell Distribution Width and Mean Platelet Volume as Predictors of Mortality in the Pediatric Intensive Care Unit: A Five-Year Single-Center Retrospective Study. J. Clin. Med. 2025, 14, 3839. https://doi.org/10.3390/jcm14113839
Sunkonkit K, Chai-adisaksopha C, Natesirinilkul R, Phinyo P, Trongtrakul K. Admission Red Blood Cell Distribution Width and Mean Platelet Volume as Predictors of Mortality in the Pediatric Intensive Care Unit: A Five-Year Single-Center Retrospective Study. Journal of Clinical Medicine. 2025; 14(11):3839. https://doi.org/10.3390/jcm14113839
Chicago/Turabian StyleSunkonkit, Kanokkarn, Chatree Chai-adisaksopha, Rungrote Natesirinilkul, Phichayut Phinyo, and Konlawij Trongtrakul. 2025. "Admission Red Blood Cell Distribution Width and Mean Platelet Volume as Predictors of Mortality in the Pediatric Intensive Care Unit: A Five-Year Single-Center Retrospective Study" Journal of Clinical Medicine 14, no. 11: 3839. https://doi.org/10.3390/jcm14113839
APA StyleSunkonkit, K., Chai-adisaksopha, C., Natesirinilkul, R., Phinyo, P., & Trongtrakul, K. (2025). Admission Red Blood Cell Distribution Width and Mean Platelet Volume as Predictors of Mortality in the Pediatric Intensive Care Unit: A Five-Year Single-Center Retrospective Study. Journal of Clinical Medicine, 14(11), 3839. https://doi.org/10.3390/jcm14113839