Korean J Crit Care Med.  2014 Nov;29(4):313-319. 10.4266/kjccm.2014.29.4.313.

Change in Red Cell Distribution Width as Predictor of Death and Neurologic Outcome in Patients Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest

• Kim S
• Cho J
• Lim Y
• Kim J
• Yang H
• Lee G

• KMID: 2227739
• DOI: http://doi.org/10.4266/kjccm.2014.29.4.313

Abstract

BACKGROUND
The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated.
METHODS
Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%).
RESULTS
A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time.
CONCLUSIONS
RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.

Keyword

erythrocyte indices; mortality; out-of-hospital cardiac arrest; prognosis

MeSH Terms

Advanced Cardiac Life Support
Erythrocyte Indices*
Hematocrit
Humans
Hypothermia*
Length of Stay
Leukocyte Count
Mortality
Out-of-Hospital Cardiac Arrest*
Prognosis
Serum Albumin
Serum Albumin

Figure

• 

  Fig. 1. Study subject flow diagram. There were 2,239 patients admitted for OHCA from January 2009 to August 2013. 280 patients achieved ROSC. 62 patients were excluded because they were not treated with TH, they died within 24 hours, or they were younger than 15 years. A total of 218 patients were included in the final analysis. 122 (56%) patients survived at one month, while 96 (44%) patients died. OHCA: out-of-hospital cardiac arrest; DOA: death on arrival; CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation; TH: therapeutic hypothermia.

• 

  Fig. 2. Probability of one-month mortality and 6 months neurologic outcome according to RDW changes for 72 hours after ROSC. (A) This graph shows one-month mortality according to RDW changes for 72 hours after ROSC. Increased or decreased RDW changes in both directions seem to increase mortality. (B) This graph shows the 6-month neurologic outcome according to RDW changes for 72 hours after ROSC. Increased or decreased RDW changes in both directions seem to increase incidence of poor neurologic outcome. RDW: red cell distribution width; ROSC: return of spontaneous circulation.

Reference

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