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Research Snapshot Theater: Precision Medicine in Sepsis, Adult and Pediatric

Red Blood Cell Distribution Width: A Predictor of Multiple Organ Dysfunction in PICU

Sunday, March 22, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 18
Introduction: Red blood cell distribution width (RDW) — a routinely reported hematologic parameter that reflects erythrocyte size variability — is often elevated in systemic inflammation and critical illness. It correlates with inflammatory markers (e.g., C-reactive protein and interleukin-6) and predicts morbidity and mortality in adult ICU populations. Its utility as an early biomarker for multiple organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU), however, is unclear.


Methods: We conducted a retrospective cohort study of all PICU admissions at Aga Khan University Hospital from September 2018 to December 2022. Children < 18 years were eligible. Exclusion criteria were elective short-stay admissions ( < 48 h), prior red-cell transfusion, and pre-existing anemia. On admission, patients were stratified by RDW into three groups: < 13.4 %, 13.4–14.3 %, and >14.4 %. Outcomes included MODS (≥2 dysfunctional organ systems), in-hospital mortality, PRISM III score, length of stay, and selected laboratory parameters. An RDW >14.0 % was considered elevated.


Results: Of 2,874 PICU admissions, 680 met inclusion criteria. Patients in Group III (RDW > 14.4 %) were significantly younger (median age 3.0 years; P = .001) and had lower mean corpuscular hemoglobin concentration (P = .038). MODS occurred in 58.7 % of the cohort and was most frequent in Group III (60.7 %), although this difference was not statistically significant (P = .16). Group III also had the highest mortality (15.1 %) and the longest length of stay (4.6 ± 4.9 days). Elevated RDW was not independently associated with MODS (odds ratio 0.73, 95 % CI 0.46–1.15) or mortality.


Conclusions: Although elevated RDW appears to mirror underlying inflammation and disease severity in critically ill children, it was not a statistically significant predictor of MODS or mortality in this single-center cohort. Trends toward worse outcomes with higher RDW suggest that RDW lacks prognostic specificity when used in isolation. Multi-center prospective studies are needed to clarify RDW’s value as an early marker of organ dysfunction in pediatric critical care.