The effect of red cell distrubition width on acute kidney injury in patient with metastatic lung cancer hospitalized in intensive care unit

Introduction: Lung cancer has the highest mortatity rate among the cancers worldwide. İndications for intensive care unit (ICU) hospitalization for these patients can be related to cancer itself, cancer therapy or comorbid disease. Acute kidney injury (AKI) and infections are the leading cause of mortality in these patient group. Red cell distribution width (RDW) is an important index showing distribution of the size of the erythrocytes in circulation. İt is known that high RDW levels in lung cancer patients adversely affect the survival of these patients and can be useful for predicting the risk of death in this patient population. We investigated the effect of RDW on acute kidney injury in this population in the light of current literature. Materials and methods: 143 patients with diagnosis of metastatic lung cancer which were hospitalized in medical intensive care unit and oncology intensive care unit at dicle university faculty of medicine research hospital between 2010 and 2014 were included to this study. the study was designed as retrospectively. The demographic characteristics, etiology, comorbid conditions and laboratory findings were recorded from the patient files. Length of stay in ICU was recorded. Creatinine, RDW, Hg, MCV, CRP, albümin levels were recorded at the time of admission and after 48 hours. Patients were divided into two groups according to RDW levels ( RDW >16.8 and RDW ≤ 16,8). Group1( RDW>16,8) and group 2(RDW≤ 16,8) were consisted of 62 patients and 81 patients respectively. Groups were compared according to development of AKI, mortality and length of stay in the ICU. Results: 122 male (%85,3) and 21 female (%14,7) were included to this study.mean RDW values of the patients was 16,53±1.91 and RDW was higher than 16,8 in 43,4% of patients. AKI was developed in 60,1% of patients. mean age (p<0.001), serum creatinine (p<0.001), AKI (p=0.012), CRP (p<0.001), mortality (p<0.001) were statsitically significantly higher in group 1 compared to group 2. The length of stay in ICU (p=0.006) and albümin levels (p<0.001) were statatistically significantly lower in group 1 compared to group 2. There were statistically significant positive correlation between RDW and serum creatinine (p<0.001) and CRP(p<0.001). there were statistically significantly negative correlation between RDW and the length of stay in ICU( p:0.011), albümin (p<0.001) and hemoglobin (p:0.048). mortality ratios were statistically significantly higher in patinets with RDW >16,8 (p<0.001) and patients with AKI (P<0.001). Conclusion: We think that RDW can be an important parameter to predict AKI development in metastatic lung cancer patients who hospitalized in ICU. We found that AKI, mortality and length of stay in the ICU were higher in patients with high RDW levels. Key words: lung cancer, Red cell distribution width, acute kidney injury