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Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia.doc

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Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia

Braunetal.CriticalCare2011,15:R194 /content/15/4/R194 RESEARCH OpenAccess Elevatedredcelldistributionwidthpredictspoor outcomeinyoungpatientswithcommunity acquiredpneumonia EyalBraun1,2?,ErelDomany2?,YaelKenig1,YoavMazor1,2,BadiraFMakhoul1,2 andZaherSAzzam1,2,3* Abstract Introduction:Communityacquiredpneumonia(CAP)isamajorcauseofmorbidityandmortality.Whilethereis muchdataaboutriskfactorsforsevereoutcomeinthegeneralpopulation,thereislessfocusonyoungergroup ofpatients.Therefore,weaimedtodetectsimpleprognosticfactorsforseveremorbidityandmortalityinyoung patientswithCAP. Methods:Patientsof60yearsoldoryounger,whowerediagnosedwithCAP(definedaspneumoniaidentified48 hoursorlessfromhospitalization)betweenMarch1,2005andDecember31,2008wereretrospectivelyanalyzed forriskfactorsforcomplicatedhospitalizationand90-daymortality. Results:Thecohortincluded637patients.90-daymortalityratewas6.6%andthemedianlengthofstaywas5 days.Inunivariateanalysis,malepatientsandthosewithco-morbidconditionstendedtohavecomplicated disease.Inmultivariateanalysis,variablesassociatedwithcomplicatedhospitalizationincludedpostchestradiation state,priorneurologicdamage,bloodureanitrogen(BUN)10.7mmol/Landredcelldistributionwidth(RDW) 14.5%;whereas,variablesassociatedwithanincreasedriskof90-daymortalityincludedage≥51years,prior neurologicdamage,immunosuppression,andthecombinationofabnormalwhitebloodcells(WBC)andelevated RDW.ComplicatedhospitalizationandmortalityrateweresignificantlyhigheramongpatientswithincreasedRDW regardlessofthewhitebloodcellcount.ElevatedRDWwasassociatedwithasignificantincreaseincomplicated hospitalizationand90-daymortalityratesirrespectivetohemoglobinlevels. Conclusions:InyoungpatientswithCAP,elevatedRDWlevelsareassociatedwithsignificantlyhigherratesof mortalityandseveremorbidity.RDWasaprognosticmarkerwasunrelatedwithhemoglobinlevels. Trialregistration:ClinicalTrials.GovNCKeywords:Pneumonia,RedBloodCellWidth,Mortality,Prognosis,ComplicatedHospitalization Introduction Muc