Red cell distribution width is an independent predictor of mortality in necrotizing fasciitis - 04/10/14

Doi : 10.1016/j.ajem.2014.08.001

Chia-Lung Weng, MD , Cheng-Hsien Wang, MD , I-Chuan Chen, MD , Kuang-Yu Hsiao, MD , Kung-Pin Chang, MD , Shih-Yun Wu, MD , Hong-Mo Shih, MD ^{^⁎}
Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University College of Medicine, Taiwan (ROC)

^⁎Corresponding author. Chang Gung Memorial Hospital, Chiayi No. 6, W Sec, Jiapu Rd, Puzi City, Chiayi County 613, Taiwan (ROC). Tel.: +886 5 3621000x2805; fax: +886 5 362 3002.

Abstract

Introduction

Necrotizing fasciitis (NF) is a rapidly progressing and potentially lethal infectious disease of the soft tissue. An elevated red blood cell distribution width (RDW) is associated with increased risk of death in patients with heart disease and infectious disease. We retrospectively assessed the association of elevated RDW with in-hospital mortality due to NF.

Methods

All patients had diagnoses of NF and were admitted to the emergency department of a single institution in Taiwan over a 4-year period. Demographics, comorbidities, clinical presentations, and laboratory parameters were retrospectively reviewed. Red blood cell distribution width was categorized as elevated (>14.5%) or not elevated. Multivariate regression analysis was used to identify risk factors associated with mortality.

Results

A total of 98 patients were enrolled, and the mortality rate was 23%. Univariate analysis indicated that advanced age, initial hypotension, low hemoglobin level, and elevated RDW (69.6% vs 20%, OR = 9.14, P < .001) were significantly associated with mortality. Multivariate analysis indicated that RDW was a significant and independent predictor of mortality in enrolled patients.