Red blood cell distribution width at admission and the short-term mortality of patients with severe burn injury: a meta-analysis

Abstract

OBJECTIVE: Red blood cell distribution width (RDW) is a marker of inflammation and oxidative stress, and its elevation has been associated with poor outcomes in critically ill patients. This meta-analysis aimed to evaluate the association between RDW at admission and short-term mortality in patients with severe burn injury. METHODS: We systematically searched PubMed, Embase, and Web of Science up to August 2024, following PRISMA 2020 and Cochrane guidelines. Cohort studies of adult severe burn patients who reported RDW at admission and short-term mortality were included. Meta-analyses were performed using random-effects models, with mean difference (MD) and relative risk (RR) calculated for RDW and mortality outcomes, respectively. Subgroup and sensitivity analyses were conducted to assess heterogeneity. RESULTS: Nine cohort studies involving 5268 patients were included. Overall, RDW at admission was higher in nonsurvivors compared to survivors [MD: 0.95%, 95% confidence interval (CI): 0.52-1.38, p < 0.001, I2 = 57%]. In addition, a high RDW was associated with an increased risk of short-term mortality (RR: 1.76, 95% CI: 1.41-2.19, p < 0.001, I2 = 77%). Sensitivity analyses by excluding one dataset at a time confirmed the robustness of these findings. Subgroup analyses revealed no significant differences based on clinical settings, patient age, sex, follow-up duration, or study quality. CONCLUSIONS: RDW at admission is a significant predictor of short-term mortality in patients with severe burn injury. This finding highlights the potential role of RDW as a simple and effective marker for risk stratification in these patients.