The Role of Red Cell Distribution Width (RDW) in Predicting Outcomes in Pediatric Patients with Ventilator-Associated Pneumonia (VAP)

Background: Ventilator-associated pneumonia (VAP) significantly contributes to morbidity and mortality in critically ill pediatric patients. Identifying biomarkers for risk stratification is essential for improving outcomes. Red cell distribution width (RDW), a parameter reflecting red blood cell size variability, has shown promise in predicting adverse outcomes in adult critical care, but its role in pediatric VAP remains underexplored.Objective: This study aims to evaluate the prognostic utility of RDW in predicting mortality and other outcomes in mechanically ventilated pediatric patients diagnosed with VAP.Methods: A prospective observational study was conducted over 20 months in a Pediatric Intensive Care Unit (PICU) in Egypt. Sixty pediatric patients requiring mechanical ventilation for more than 24 hours were included. VAP diagnosis was based on clinical, radiological, and microbiological criteria. RDW levels were measured at admission, and outcomes such as mortality, duration of mechanical ventilation, and PICU stay were recorded. Data were analyzed using multivariate logistic regression.Results: Among the 60 patients, 21 (35%) developed VAP, with a significantly higher mortality rate compared to non-VAP patients (76.2% vs. 17.9%, p < 0.001). RDW levels were markedly elevated in VAP patients (mean: 18.6 ± 2.7%) compared to non-VAP patients (mean:15.9±2.5%,p < 0.01). An RDW cutoff >16.9% predicted mortality with 85.7% sensitivity and 88% specificity (AUC: 0.87, p < 0.001). Multivariate analysis identified RDW >16.9% (OR:3.9,95% CI:1.9–5.8, p<0.001) as independent predictors of mortality.Conclusion: Elevated RDW is a significant predictor of mortality in pediatric patients with VAP. Its integration into clinical risk stratification models may enhance prognostic accuracy and inform management strategies.