The significance of RDW and LDH in pediatric critical illness

The LDH level, which can be easily assessed, was described to be independently associated with in-hospital mortality. Also, independent of illness severity in critically ill children, red cells distribution width (RDW)was associated with mortality and morbidity. To evaluate whether LDH and RDW can predict critical illness in critically sick children and whether they are related to death or not. Study conducted on 56 patients who were treated in the pediatric intensive care units of university children hospital and other group of 56 apparently healthy children coming for routine follow up. All patients were subjected to the following laboratory work-up: complete blood picture, including red blood cell distribution width (RDW), lactate dehydrogenase level, and arterial blood gases. Additionally, Illness severity was assessed using the pediatric Sequential Organ Failure Assessment (pSOFA). Study yielded Mean ± SD of RDW in critically ill patients on admission and after 72 h was (16.26 ± 2.94%), (16.99 ± 2.42%)respectively, which was significantly higher than Mean ± SD of RDW incontrol group on initial testingand after 72 h (14.10 ± 1.13%) (14.07 ± 1.07%)(P = 0.000) respectively.Besides, median(IQR) LDH in critically ill patients on admission and after 72 h was 384(280.5–567.5) u/l, 466.5 (357–669.5)u/l respectively, which was significantly higher than median (IQR) LDH of control group on initial testing and after 72 hours113.5 (97–137)u/l, 114 (98–137.5)u/l respectively. Additionally, a cutoff value of > 15.5% of RDW was found to predict critical illness among patients with 53.57% sensitivity, and 92.86% specificity. RDW in conjunction with other clinical criteria and scorings could serve as simple marker to differentiate critical from non-critical children. LDH could be used as predictor for death in critically ill children.