Red blood cell distribution width in bronchial asthma and pneumonia patients in intensive care unit at Benghazi Children Hospital, 2020-2021

Background: The red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. Any process that releases reticulocytes in the circulation will result in an increase in RDW. RDW is a routine laboratory measure associated with poor outcomes in adult critical illness.  The aims of study: We performed a retrospective study to describe the association between RDW with morbidity and mortality in children with bronchial asthma and clinically diagnosed pneumonia and we determined the utility of RDW as an early pragmatic biomarker for outcome in those children admitted to ICU of Benghazi children hospital. Materials and methods:  Retrospective study to all patients admitted to Benghazi children hospital with bronchial asthma and clinically diagnosed pneumonia between January 2021 and January 2022 were considered eligible for inclusion with some exclusions. We collected demographics, laboratory values, hospitalization characteristics and outcomes. We calculated the relative change in RDW from admission (A-RDW) to the last RDW(R-RDW) which either repeated days later or before mortality. Results: Over a13-month period, 100 patients had RDW measure done in the first day of PICU admission. The mean age of the patients was  years, equal gender distribution by 50% of both. All patients were Libyans. Causes of admissions were Bronchial asthma (35%), Pneumonia (46%) and Bronchial asthma superimposed by pneumonia (19%).  We noted a severe respiratory distress in most of cases according to PRESS score (68.3%).Reported complications of this study were sepsis (13%), association of more than one complications (13%), pleural effusion (1%), empyema (1%) and respiratory failure (4%). Regarding the route of oxygen therapy was by mask in 100% of patients on admission and 13% 0f these patients connected to MV. The A-RDW mean was 13.44% and R-RDW 14.219%. There were significant correlations between RDW on admission and severity of respiratory distress, length of hospital stay and outcome of patients. 87% of our patients were discharged in good general condition. Conclusions and recommendations: We conclude that there is a reliable correlation between RDW and respiratory diseases, and elevated RDW is a significant predictors of mortality, complication and prolonged staying in hospital. We recommend further studies to evaluate the correlation between RDW and other diseases in pediatric age group, correlation between RDW and inflammatory markers and also we recommend further study to evaluate prolonged complication with RDW readings.