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ORIGINAL ARTICLE • Einstein (São Paulo) 20 • 2022 • https://doi.org/10.31744/einstein_journal/2022AO6828 copy

Relation between red blood cell distribution width and acute kidney injury in patients with sepsis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The objective of the present study is to evaluate the association of red blood cell distribution width with acute kidney injury in sepsis.

Methods

This is a retrospective study of 849 critically ill patients with sepsis in intensive care unit. Demographic data, renal function, inflammation, complete blood count, and acid-base parameters were compared between acute kidney injury and non-acute kidney injury groups. Therefore, a multivariate analysis was performed to observe independent predictive factors.

Results

Comparatively, higher levels of C-reactive protein, lactate, red blood cell distribution width, and Simplified Acute Physiology Score 3 were found in the acute kidney injury group. The study showed a higher frequency of women, hemoglobin (Hgb) concentration, platelets, bicarbonate and PaO₂/FiO₂ ratio in the non-acute kidney injury group. In addition, there was an independent association of comorbidity-chronic kidney disease [OR 3.549, 95%CI: 1.627-7.743; p<0.001], urea [OR 1.047, 95%CI: 1.036-1.058; p<0.001] and RDW [OR 1.158, 95%CI: 1.045-1.283; p=0.005] with acute kidney injury in sepsis patients.

Conclusion

As an elective risk factor, red blood cell distribution width was independently associated with sepsis-related acute kidney injury. Thus, red blood cell distribution width acts like a predictive factor for sepsis-induced acute kidney injury in intensive care unit admission.

Acute kidney injury; Erythrocyte indices; Sepsis; Renal replacement therapy

Parameters	AKI Group (n=294) (%)	Non-AKI Group (n=555) (%)	p value
Sex
Women	83 (28.2)	298 (53.7)	<0.001
Men	211 (71.8)	257 (46.3)	<0.001
Age (years)	76±15	69±19	<0.001
Comorbidity
Diabetes melittus	109 (37.1)	131 (23.6)	<0.001
Hypertension	148 (50.3)	199 (35.9)	<0.001
CKD	75 (25.5)	15 (2.7)	<0.001
Smoker	59 (20.1)	100 (18)	0.47
MAP (mmHg)	78±21	86±19	<0.001
Creatinine (mg/dL)	1.9±0.7	1.1±0.4	<0.001
Urea (mg/dL)	82.6±42.9	44.6±17.8	<0.001
Sodium (mEq/L)	135±13	135±7	0.69
Potassium (mEq/L)	4.2±0.7	3.9±1.8	0.03
CRP (mg/L)	119.6±5.9	96.±4.3	0.001
Glycemia (mg/dL)	141±62	133±54	0.07
Total bilirubin (mg/dL)	1.5±0.9	0.9±0.4	0.03
Hgb (g/dL)	11.7±2.4	12.5±2.2	<0.001
MCV (fL)	90.9±9.5	91.1±6.4	0.94
RDW (%)	15.6±2.2	14.4±1.9	<0.001
WBC (10³/µL)	12.7±8.8	12.4±8.6	0.81
Platelets (10³/µL)	190.3±5.5	216±4.3	<0.001
pH	7.39±0.09	7.44±0.07	<0.001
pO₂ (mmHg)	99.6±32.1	94.2±27.5	0.02
pCO₂ (mmHg)	32.3±8.8	34.1±9.5	0.02
Arterial HCO₃ (mEq/L)	20.4±5.1	23.1±4.7	0.001
Arterial lactate (mg/dL)	22.4±3.9	19.1±4.7	0.02
PaO2/FiO₂	306±116	357±108	<0.001
SAPS 3	57.1±12.7	50.4±11.1	<0.001

AKI versus non-AKI	OR	95%CI for OR		p value
AKI versus non-AKI	OR	Lower	Upper	p value
Urea (mg/dL)	1.047	1.036	1.058	<0.001
Women	0.348	0.224	0.542	<0.001
Bicarbonate (mEq/L)	0.883	0.839	0.930	<0.001
CKD	3.549	1.627	7.743	0.001
RDW (%)	1.158	1.045	1.283	0.005
SAPS 3	1.017	0.996	1.039	0.11
PaO₂/FiO₂	0.999	0.997	1.000	0.13
pH	0.149	0.008	2.611	0.19
Arterial lactate (mg/dL)	0.990	0.997	1.000	0.21
Glycemia (mg/dL)	0.998	0.994	1.002	0.33
MAP (mmHg)	0.995	0.984	1.006	0.34
Potassium (mEq/L)	0.933	0.779	1.118	0.45
Age (years)	1.006	0.990	1.022	0.49
Platelets (10³/µL)	0.999	0.997	1.002	0.65
CRP (mg/L)	1.000	0.998	1.003	0.79
Hgb (g/dL)	0.999	0.896	1.113	0.98

Instituto Israelita de Ensino e Pesquisa Albert Einstein Avenida Albert Einstein, 627/701 , 05651-901 São Paulo - SP, Tel.: (55 11) 2151 0904 - São Paulo - SP - Brazil
E-mail: revista@einstein.br

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