Red Blood Cell Distribution Width (RDW) as a predictor of septic shock in children

Background: Septic shock is a prevalent PICU condition requiring prompt intervention. Using the PELOD II score, which has multiple characteristics to examine, it is challenging to predict prognosis in healthcare-limited settings. A link has recently been shown between red blood cell distribution width (RDW) and mortality risk in critically ill patients, albeit the exact mechanism is unknown.Methods: This retrospective observational study examined RDW values in pediatric septic or non-septic shock patients. This study examined patient clinical features, RDW hematological markers (RDW-CV, RDW-SD, and RDW/albumin ratio), and the area under the curve to determine the cut-off for the hematological marker, sensitivity, and specificity.Results: Sixty-one pediatric patients met the inclusion criteria (33 with septic shock and 28 with non-septic shock). The red cell distribution width coefficient variation (RDW-CV) (p=0,058), red cell distribution width standard deviation (RDW-SD) (p=0,05), and RDW Albumin Ratio (RAR) (p=0,014) were shown to be significantly different between the septic shock and non-septic shock groups. The cut-off value for RDW-CV was 15.3% (53.6% sensitivity and 97% specificity), 47.4 fl for RDW-SD (64.3% sensitivity and 84.8% specificity), and 5.65 for RDW/albumin ratio (71.4% sensitivity and 84.8% specificity). RDW-CV odd ratio was 36.9 (95% confidence interval (CI) 4.41-308.96, p 0.001), RDW-SD odd ratio was 10.08 (95% confidence interval (CI) 2.95-34.34, p 0,001), and RDW/albumin ratio was 14.00 (95% confidence interval (CI) 3.98-49.16, p 0,001). Conclusion: Increased RDW can be one marker in pediatric patients with septic shock. Increased levels of RDW/albumin ratio are significantly associated with the incidence of septic shock. Through the (ROC) area under the curve, the RDW/albumin ratio has better capabilities compared to other predictor markers.