• Víctor Moreno-Torres, Ana Royuela, Elena Múñez-Rubio, Ángela Gutierrez-Rojas, Patricia Mills-Sánchez, Alfonso Ortega, Sandra Tejado-Bravo, Javier García-Sanz, Alejandro Muñoz-Serrano, Jorge Calderón-Parra, Ana Fernández-Cruz, and Antonio Ramos-Martínez.
• Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain. Electronic address: victor.moreno.torres.1988@gmail.com.
• J Crit Care. 2022 Oct 1; 71: 154069154069.

PurposeTo evaluate Red blood cell distribution width (RDW) as a sepsis prognostic biomarker.Methods203 septic patients admitted to the ICU. Analysis of RDW dynamics, hospital mortality discrimination ability and the added value when incorporated to the SOFA, LODS, SAPS-II and APACHE-II scores using the AUC-ROC.ResultsNon-survivors presented higher RDW values during the first week after ICU admission (p = 0.048). Only SOFA and RDW were independently associated with mortality when adjusted by Charlson, immunosuppression, nosocomial infection, NEWS2, SAPS-II, septic shock and haemoglobin (p < 0.05). After adjustment, AUC-ROC was 0.827, 0.822, 0.824, 0.834 and 0.812 for each model including admission, 24, 48 and 72-h and 7-days RDW, respectively. When added to the scores, 24-h RDW and admission RDW improved their discrimination ability (SOFA AUC-ROC = 0.772 vs 0.812 SOFA + admission RDW, p = 0.041; LODS AUC-ROC = 0.687 vs 0.710, p = 0.002; SAPS-II AUC-ROC = 0.734 vs 0.785, p = 0.021; APACHE-II AUC-ROC = 0.672 vs 0.755, p = 0.003). Admission RDW with SOFA presented the better discrimination ability for mortality.ConclusionRDW is an independent prognostic marker of death in septic patients admitted in the ICU that improves SOFA, LODS, APACHE-II and SAPS-II discrimination ability. This parameter could be incorporated to the prognostic scores as a marker of systemic dysfunction and dysregulated inflammatory response.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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