BACKGROUND Sepsis is a potential life threatening dysregulated immune response to an infection, which can result in multi-organ failure and death. Unfortunately, good prognostic markers are lacking in patients with suspected infection to identify those at risk. Red blood cell distribution width (RDW) is a common and inexpensive hematologic laboratory measurement associated with adverse prognosis in multiple diseases. The aim of this study was to determine the prognostic value of RDW for mortality and early clinical deterioration in patients with a suspected infection in the emergency department. METHODS In this single center prospective observational cohort study, consecutive patients with suspected infection presenting for internal medicine in the emergency department between September 2016 and March 2018 were included. For prognostic validation of bedside sepsis scores and RDW receiver operating characteristics were generated. Association between RDW and mortality and ICU admission was analyzed univariate and in a multivariate logistic regression model. RESULTS 1046 patients were included. In multivariate analyses, RDW was significantly associated with 30-day mortality (OR 1.15, 95% CI: 1.04-1.28) and early clinical deterioration (OR 1.09, 95% CI: 1.00-1.18). For 30-day mortality RDW had an AUROC of 0.66 (95% CI 0.59-0.72). Optimal cut-off value for RDW 2 was 12.95%. For early clinical deterioration RDW had an AUROC of 0.59 (95% CI 0.54-0.63) with an optimal cut-off value of 14.48%. CONCLUSIONS RDW was found to be a significant independent prognostic factor of 30-day mortality and early clinical deterioration in patients with suspected infection.. Therefore it can be a used as an extra marker besides bedside sepsis scores in identifying patients at risk for worse outcome in patients with suspected infection.

中文翻译：

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急诊科怀疑感染的患者的红细胞分布宽度的预后价值。

背景技术败血症是一种潜在的威胁生命的感染，免疫反应失调，可能导致多器官衰竭和死亡。不幸的是，怀疑感染的患者缺乏良好的预后指标，无法识别有风险的患者。红细胞分布宽度（RDW）是与多种疾病的不良预后相关的常见且廉价的血液学实验室测量。这项研究的目的是确定RDW对急诊科怀疑感染患者的死亡率和早期临床恶化的预后价值。方法在该单中心前瞻性观察队列研究中，纳入了2016年9月至2018年3月在急诊科就诊内科的连续疑似感染患者。为了对床边败血症评分和RDW接收者的操作特征进行预后验证。RDW与死亡率和ICU入院率之间的相关性通过单因素和多因素Logistic回归模型进行了分析。结果纳入1046例患者。在多变量分析中，RDW与30天死亡率（OR 1.15，95％CI：1.04-1.28）和早期临床恶化（OR 1.09，95％CI：1.00-1.18）显着相关。对于30天的死亡率，RDW的AUROC为0.66（95％CI为0.59-0.72）。RDW 2的最佳截止值为12.95％。对于早期临床恶化，RDW的AUROC为0.59（95％CI 0.54-0.63），最佳临界值为14.48％。结论RDW是可疑感染患者30天死亡率和早期临床恶化的重要独立预后因素。