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Red blood cell distribution width as mortality biomarker in patients with traumatic brain injury

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Abstract

One study found higher red blood cell distribution width (RDW) on the admission of traumatic brain injury (TBI) in non-surviving patients; however, a regression analysis was not carried out to establish an association between RDW and TBI mortality. Thus, the objectives of this study were to determine whether there is an association between RDW and TBI mortality, and to describe the temporal profile of RDW during the first week. Isolated (< 10 points in non-cranial aspects of Injury Severity Score) and severe (< 9 points in Glasgow Coma Scale) TBI patients were included. RDW at days 1, 4, and 8 of TBI were determined. The end-point study was 30-day mortality. Ninety-seven surviving patients compared to the 38 non-surviving patients had higher RDW at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p < 0.001). The area under the curve (95% CI) for prediction of mortality by RDW at days 1, 4, and 8 was 0.81 (0.73–0.87; p < 0.001), 0.92 (0.85–0.96; p < 0.001) and 0.94 (0.88–0.98; p < 0.001). Regression analysis showed an association between RDW and mortality (odds ratio = 1.778; 95% CI 1.312–2.409; p < 0.001). The association found between RDW on admission and mortality is the main new finding of our study. Regarding the temporal profile of RDW, the fact that RDW during the first week of TBI may help in estimating prognosis is another interesting finding of our study.

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Funding

This study was supported by a Grant (OA18/011) from Fundación DISA a la Investigación Médica 2017 (Santa Cruz de Tenerife. Spain) and a Grant from Instituto de Salud Carlos III (PI-18-00500) (Madrid, Spain) and co-financed with Fondo Europeo de Desarrollo Regional (FEDER). Funding did not influence the study design, the collection, analysis and interpretation of data, the manuscript writing, and the decision to submit it for publication.

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Authors and Affiliations

  1. Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Leonardo Lorente

  2. Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, 38010, Santa Cruz de Tenerife, Spain

    María M. Martín & Candelaria Ruiz

  3. Department of Physiology, Faculty of Medicine, University of the La Laguna, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Pedro Abreu-González

  4. Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320, Santa Cruz de Tenerife, Tenerife, Spain

    Antonia Pérez-Cejas & Agustín F. González-Rivero

  5. Intensive Care Unit, Hospital General La Palma, Buenavista de rriba s/n, Breña Alta, 38713, La Palma, Spain

    Luis Ramos-Gómez

  6. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez nº17-19, 46004, Valencia, Spain

    Mónica Argueso

  7. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de La Ballena S/N, 35010, Las Palmas de Gran Canaria, Spain

    Jordi Solé-Violán

  8. Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, 35016, Las Palmas de Gran Canaria, Spain

    Juan J. Cáceres

  9. Research Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Alejandro Jiménez

  10. Department of Neurosurgery, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Victor García-Marín

Authors
  1. Leonardo Lorente
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  2. María M. Martín
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  3. Candelaria Ruiz
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  4. Pedro Abreu-González
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  5. Antonia Pérez-Cejas
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  6. Agustín F. González-Rivero
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  7. Luis Ramos-Gómez
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  8. Mónica Argueso
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  9. Jordi Solé-Violán
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  10. Juan J. Cáceres
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  11. Alejandro Jiménez
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  12. Victor García-Marín
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Contributions

LL was responsible for the conception, design, and coordination of the study, made substantial contributions to the acquisition of data, analysis and interpretation of data, and drafted the manuscript. MMM, CR, LRG, MA, JSV, JJC, and VGM have made substantial contributions to the acquisition of data and provided useful suggestions. PAG, APC, and AFGR determined blood concentrations. AJ has made substantial contributions to the analysis and interpretation of data. All authors read critically and approved the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Leonardo Lorente.

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The authors declare that they have no conflict of interest.

Ethical approval

Six Spanish hospitals participated in this observational and prospective study with the approval of the review board from all hospitals.

Informed consent

A family member of each patient signed the written informed consent for participation in the study.

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Lorente, L., Martín, M.M., Ruiz, C. et al. Red blood cell distribution width as mortality biomarker in patients with traumatic brain injury. Acta Neurol Belg 121, 715–720 (2021). https://doi.org/10.1007/s13760-020-01409-z

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  • DOI: https://doi.org/10.1007/s13760-020-01409-z

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