Association between preoperative RDW and in-hospital death in trauma patients: A multicenter retrospective cohort study
Xiaojuan Xiong, Mi Zhou, Peng Hu, Chang Liu, Yunqin Ren, Qingxiang MaoObjective
Red cell distribution width (RDW) is an emerging prognostic marker in trauma. This study aims to investigate the association between preoperative RDW and in-hospital mortality in surgical trauma patients.
Methods
This retrospective cohort study enrolled 34,848 surgical trauma patients sourced from three Chinese medical centers and the MIMIC-IV 2.2 database. Receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative ability of preoperative (at-admission) RDW for in-hospital mortality and to determine an optimal cutoff value for patient stratification. Propensity score matching (PSM) was performed with a caliper value of 0.01, balancing 18 covariates between the two groups, including demographic characteristics, vital signs, injury severity scores, comorbidities. After PSM, 7,697 pairs were matched. Binary logistic regression was applied to assess the relationship between RDW and in-hospital mortality.
Results
In-hospital mortality was 3.02% (1,051/34,848). Preoperative RDW showed moderate discrimination for in-hospital mortality, with an area under the curve (AUC) of 0.777 (95% CI 0.763–0.792). Before PSM, in-hospital mortality was significantly higher in the Pre-RDW > 14.25% group compared to the Pre-RDW ≤ 14.25% group (7.58% vs. 1.11%,
Conclusions
Elevated preoperative RDW is independently associated with in-hospital mortality in trauma patients, and RDW > 14.25% indicates a significantly higher risk of in-hospital death.