SYSTEMATIC REVIEW article
Front. Pediatr.
Sec. Pediatric Critical Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1646179
Red blood cell distribution width as a predictor of mortality in critically ill pediatric patients: A systematic review and meta-analysis
Provisionally accepted
- Shengzhou People’s Hospital, Shaoxing, China
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Objective: Red blood cell distribution width (RDW) has been found to predict outcomes in critically ill adult patients. However, its utility in pediatric patients remains unexplored. We reviewed published evidence and conducted a meta-analysis to assess whether RDW can be used to predict mortality in the pediatric intensive care unit (PICU). Methods: All observational studies assessing the association between RDW and PICU mortality available on the databases of PubMed, Embase, Scopus, and Web of Science up to 4th November 2024 were included. A detailed review of study outcomes was conducted with a meta-analysis. Results: Seven studies were included. 6327 pediatric patients were included in these studies. On qualitative analysis, five of the seven studies found a statistically significant association between high RDW and PICU mortality. Four studies used RDW as a continuous variable, while three studies reported specific RDW cut-offs. Meta-analysis showed that an incremental increase in RDW was associated with a statistically significant increased risk of mortality (OR: 1.24 95% CI: 1.07, 1.44 I2=32%). Pooled analysis of studies using RDW as a categorical variable showed that higher values of RDW were associated with significantly higher risk of mortality (OR: 1.73 95% CI: 1.02, 2.92 I2=77%). Conclusions: RDW could be a potential predictor of mortality in the PICU. Results need to be interpreted with caution owing to the limited number of studies with variable study populations. Additional studies are needed to strengthen evidence.
Keywords: biomarker, death, Critically ill, Children, Survival
Received: 12 Jun 2025; Accepted: 27 Aug 2025.
Copyright: © 2025 Yu, Hu and Shen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yaping Shen, Shengzhou People’s Hospital, Shaoxing, China
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