Diabetes, Metabolic Syndrome and Obesity (Aug 2022)

Influence of Red Blood Cell Distribution Width on All-Cause Death in Critical Diabetic Patients with Acute Kidney Injury

  • Mo M,
  • Huang Z,
  • Huo D,
  • Pan L,
  • Xia N,
  • Liao Y,
  • Yang Z

Journal volume & issue
Vol. Volume 15
pp. 2301 – 2309

Abstract

Read online

Manqiu Mo,1 Zichun Huang,2 Dongmei Huo,3 Ling Pan,3 Ning Xia,1 Yunhua Liao,3,* Zhenhua Yang3,* 1Geriatric Department of Endocrinology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China; 2Department of Cardiovascular Thoracic Surgery, the Third Affiliated Hospital of Guangxi Medical University: Nanning Second People’s Hospital, Nanning, 530031, People’s Republic of China; 3Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhenhua Yang; Yunhua Liao, Department of Nephrology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021, Guangxi, People’s Republic of China, Email 593456108@qq.com; yunhualiao1962@163.comObjective: To explore the relationship between red blood cell distribution width (RDW) and all-cause death in critical diabetic patients with acute kidney injury (AKI).Methods: The clinical data of critical diabetic patients with AKI in MIMIC-III database were analyzed retrospectively. According to the survival status of 28-day after AKI and levels of RDW, patients were divided into survival and death groups, high RDW (RDW > 15.3%) and low RDW groups (RDW ≤ 15.3%). Kaplan–Meier curves were used to compare the survival rates of diabetic patients with AKI in different RDW and AKI stages, and Cox regression analysis was used to evaluate the risk factors of 28-day all-cause death in critical diabetic patients with AKI.Results: A total of 5200 patients with critical diabetic patients with AKI were included in this study with the male to female ratio of 1.53:1. The mean follow-up time was 24.97 ± 7.14 days, and the 28-day all-cause mortality was 17.9% (931/5200). Age, RDW, blood urea nitrogen, serum creatinine, lactic acid, proportion of AKI stage, sepsis and respiratory failure in the death group were higher than those in the survival group, while mean arterial pressure (MAP) and red blood cell count were lower than those in the survival group. Kaplan–Meier analysis showed that the 28-day survival rate of the high RDW group was significantly lower than that of the low RDW group (log-rank χ2 = 9.970, P = 0.002). Multivariate Cox regression analysis showed that advanced age (HR = 1.042, 95% CI = 1.021– 1.063), decreased MAP (HR = 0.984, 95% CI = 0.969– 0.998), stage 3 AKI (HR = 3.318, 95% CI = 1.598– 6.890) and increased RDW (HR = 1.255, 95% CI = 1.123– 1.403) were independent risk factors of 28-day all-cause death in critical diabetic patients with AKI (P < 0.05).Conclusion: High level of RDW is an important risk factor of all-cause death in critical diabetic patients with AKI, and it may be used as a valuable index to classify the mortality.Keywords: diabetes, acute kidney injury, all-cause death, red cell distribution width, critical

Keywords