Association between red blood cell distribution width and mortality in diabetic ketoacidosis

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Abstract

Background

No epidemiological studies have assessed the impact of red blood cell distribution width (RDW) on the prognosis of diabetic ketoacidosis (DKA) patients in the intensive care unit (ICU). Thus, we investigated whether RDW was associated with mortality in DKA patients.

Material and method

We analyzed data from MIMIC-III. RDW was measured at ICU admission. The relationship between RDW and mortality of DKA was determined using a multivariate Cox regression analysis. The primary outcome of the study was 365-day mortality from the date of ICU admission. We also conducted a subgroup analysis to further confirm the consistency of associations.

Results

In total, 495 critically ill DKA patients were eligible for analysis. In the univariable Cox regression model for 365-day all-cause mortality, RDW was a predictor of all-cause mortality in DKA patients (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.19–1.43). After adjusting for confounders, RDW was still a particularly strong predictor (HR: 1.23, 95% CI: 1.05–1.45). The same relationship was also observed for 90-day all-cause mortality (HR: 1.29, 95% CI: 1.02–1.65).

Conclusions

High RDW was associated with risk of all-cause mortality in DKA patients in the ICU. RDW was an independent prognostic factor for these patients.

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Most cited references 36

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A nuclear factor induced by hypoxia via de novo protein synthesis binds to the human erythropoietin gene enhancer at a site required for transcriptional activation.

G. L. Semenza, G. L. Wang (1992)

We have identified a 50-nucleotide enhancer from the human erythropoietin gene 3'-flanking sequence which can mediate a sevenfold transcriptional induction in response to hypoxia when cloned 3' to a simian virus 40 promoter-chloramphenicol acetyltransferase reporter gene and transiently expressed in Hep3B cells. Nucleotides (nt) 1 to 33 of this sequence mediate sevenfold induction of reporter gene expression when present in two tandem copies compared with threefold induction when present in a single copy, suggesting that nt 34 to 50 bind a factor which amplifies the induction signal. DNase I footprinting demonstrated binding of a constitutive nuclear factor to nt 26 to 48. Mutagenesis studies revealed that nt 4 to 12 and 19 to 23 are essential for induction, as substitutions at either site eliminated hypoxia-induced expression. Electrophoretic mobility shift assays identified a nuclear factor which bound to a probe spanning nt 1 to 18 but not to a probe containing a mutation which eliminated enhancer function. Factor binding was induced by hypoxia, and its induction was sensitive to cycloheximide treatment. We have thus defined a functionally tripartite, 50-nt hypoxia-inducible enhancer which binds several nuclear factors, one of which is induced by hypoxia via de novo protein synthesis.

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Univariate description and bivariate statistical inference: the first step delving into data.

Zhongheng Zhang (2016)

In observational studies, the first step is usually to explore data distribution and the baseline differences between groups. Data description includes their central tendency (e.g., mean, median, and mode) and dispersion (e.g., standard deviation, range, interquartile range). There are varieties of bivariate statistical inference methods such as Student's t-test, Mann-Whitney U test and Chi-square test, for normal, skews and categorical data, respectively. The article shows how to perform these analyses with R codes. Furthermore, I believe that the automation of the whole workflow is of paramount importance in that (I) it allows for others to repeat your results; (II) you can easily find out how you performed analysis during revision; (III) it spares data input by hand and is less error-prone; and (IV) when you correct your original dataset, the final result can be automatically corrected by executing the codes. Therefore, the process of making a publication quality table incorporating all abovementioned statistics and P values is provided, allowing readers to customize these codes to their own needs.

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Red cell distribution width and all-cause mortality in critically ill patients.

Hsiang-Hua Chang, Fiona Gibbons, Karthik Mahadevappa … (2011)

Red cell distribution width is a predictor of mortality in the general population. The prevalence of increased red cell distribution width and its significance in the intensive care unit are unknown. The objective of this study was to investigate the association between red cell distribution width at the initiation of critical care and all cause mortality. Multicenter observational study. Two tertiary academic hospitals in Boston, MA. A total of 51,413 patients, aged ≥ 18 yrs, who received critical care between 1997 and 2007. None. The exposure of interest was red cell distribution width as a predictor of mortality in the general population. The prevalence of increased red cell distribution width and its significance in the intensive care unit are unknown and categorized a priori in quintiles as ≤ 13.3%, 13.3% to 14.0%, 14.0% to 14.7%, 14.7% to 15.8%, and >15.8%. Logistic regression examined death by days 30, 90, and 365 postcritical care initiation, inhospital mortality, and bloodstream infection. Adjusted odds ratios were estimated by multivariable logistic regression models. Adjustment included age, sex, race, Deyo-Charlson index, coronary artery bypass grafting, myocardial infarction, congestive heart failure, hematocrit, white blood cell count, mean corpuscular volume, blood urea nitrogen, red blood cell transfusion, sepsis, and creatinine. Red cell distribution width was a particularly strong predictor of all-cause mortality 30 days after critical care initiation with a significant risk gradient across red cell distribution width quintiles after multivariable adjustment: red cell distribution width 13.3% to 14.0% (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.08-1.30; p 15.8% (OR, 2.61; 95% CI, 2.37-2.86; p 15.8% quintiles, respectively, compared with those with red cell distribution width ≤ 13.3%. Estimating the receiver operating characteristic area under the curve shows that red cell distribution width has moderate discriminative power for 30-day mortality (area under the curve = 0.67). Red cell distribution width is a robust predictor of the risk of all-cause patient mortality and bloodstream infection in the critically ill. Red cell distribution width is commonly measured, inexpensive, and widely available and may reflect overall inflammation, oxidative stress, or arterial underfilling in the critically ill.

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Author and article information

Journal

Journal ID (nlm-ta): J Int Med Res

Journal ID (iso-abbrev): J. Int. Med. Res

Journal ID (publisher-id): IMR

Journal ID (hwp): spimr

Title: The Journal of International Medical Research

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0300-0605

ISSN (Electronic): 1473-2300

Publication date (Electronic): 31 March 2020

Publication date Collection: March 2020

Volume: 48

Issue: 3

Electronic Location Identifier: 0300060520911494

Affiliations

[1 ]Department of Endocrinology and Vascular Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China

[2 ]Department of Emergency, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China

Author notes

[*]Lielie Zhu, Department of Emergency, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China. Email: w15258686889@ 123456163.com

Author information

Lielie Zhu https://orcid.org/0000-0002-6639-751X

Article

Publisher ID: 10.1177_0300060520911494

DOI: 10.1177/0300060520911494

PMC ID: 7132821

PubMed ID: 32228354

SO-VID: ea29fbc8-37d4-4cf8-819c-97dff09edc39

License:

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 3 August 2019

Date accepted : 14 February 2020

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Keywords: red blood cell distribution width,diabetic ketoacidosis,intensive care units,mortality,diabetes mellitus,chronic renal disease

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Keywords: red blood cell distribution width, diabetic ketoacidosis, intensive care units, mortality, diabetes mellitus, chronic renal disease

Association between red blood cell distribution width and mortality in diabetic ketoacidosis

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Most cited references 36

A nuclear factor induced by hypoxia via de novo protein synthesis binds to the human erythropoietin gene enhancer at a site required for transcriptional activation.

Univariate description and bivariate statistical inference: the first step delving into data.

Red cell distribution width and all-cause mortality in critically ill patients.

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