Association between red blood cell distribution width and mortality and severity among patients with COVID‐19: A systematic review and meta‐analysis

Abstract

Emerging evidence has underscored the potential usefulness of red blood cell distribution width (RDW) measurement in predicting the mortality and disease severity of COVID‐19. This study aimed to assess the association of the plasma RDW levels with adverse prognosis in COVID‐19 patients. A comprehensive literature search from inception to September 2020 was performed to harvest original studies reporting RDW on admission and clinical outcomes among patients hospitalized with COVID‐19. RDW levels were compared between cases (patients who died or developed more severe symptoms) and controls (patients who survived or developed less severe symptoms). A total of 14,866 subjects from 10 studies were included in the meta‐analysis. Higher levels of RDW were associated with adverse outcomes in COVID‐19 patients (mean differences = 0.72; 95% CI = 0.47–0.97; I2 = 89.51%). Deceased patients had higher levels of RDW compared to patients who survived (mean differences = 0.93; 95% CI = 0.63–1.23; I2 = 85.58%). Severely ill COVID‐19 patients showed higher levels of RDW, as opposed to patients classified to have milder symptoms (mean differences = 0.61; 95% CI = 0.28–0.94; I2 = 82.18%). Elevated RDW levels were associated with adverse outcomes in COVID‐19 patients. This finding warrants further research on whether RDW could be utilized as a simple and reliable biomarker for predicting COVID‐19 severity and whether RDW is mechanistically linked with COVID‐19 pathophysiology.

A new haematocytometric index: Predicting severity and mortality risk value in COVID-19 patients

“…that includes a total of 14,866 subjects from 10 studies was shown that elevated RDW levels were associated with poor outcomes in COVID-19 patients (mean differences = 0.72; 95% CI = 0.47–0.97; I 2 = 89.51%) and non-survived patients had higher levels of RDW compared to patients who survived from SARS-CoV-2 infection (mean differences = 0.93; 95% CI = 0.63–1.23; I 2 = 85.58%). In this meta-analysis, higher levels of RDW were associated with poor outcomes among COVID-19 patients [ 34 ].…”

Alterações Hematológicas Da Covid-19

“…Em uma revisão sistemática com 14.866 pacientes, Lee et al concluíram que pacientes com COVID-19 que morreram tinham níveis aumentados de RDW quando comparados com os sobreviventes, assim como aqueles que tiveram quadro grave da doença em comparação com os de quadro leve. 32 Taneri et al também acharam concentrações mais altas em casos graves da doença, e conforme o estudo observacional de Bergamaschi et al, o RDW foi um fator independente preditor de mortalidade, sendo o único parâmetro com valor prognóstico encontrado. 5 Os mecanismos envolvidos na fisiopatologia relacionada aos achados da série vermelha em pacientes infectados com o SARS-CoV-2 ainda não estão completamente elucidados.…”

“…5 Quanto ao RDW, sugere-se que o estado hiperinflamatório da COVID-19 pode alterar a resposta da medula óssea à eritropoietina, de modo a alterar a estrutura das hemácias, aumentando a sua fragilidade e variabilidade de tamanho. 32 Em suma, ainda há divergências entre diferentes trabalhos quanto à prevalência de anemia e seu impacto no quadro dos pacientes com COVID-19. Alguns estudos não encontraram resultados significativos, enquanto outros apontam para uma alta prevalência de anemia leve.…”

“…5 Tanto a ferritina quanto o RDW foram sugeridos como preditores efetivos de mortalidade e gravidade da doença, possivelmente úteis à prática clínica no futuro. 31,32…”

Ancho de distribución eritrocitaria como marcador asociado a riesgo de mortalidad en niños en cuidados intensivos

“…El impacto biológico de las enfermedades graves con variabilidad del ADE continúa en estudio, especialmente en el contexto de sepsis grave y shock séptico, donde las mediciones seriadas del ADE podrían utilizarse como factor pronóstico [20][21][22][23][24]. Así mismo, se viene investigando en COVID-19, donde podría utilizarse como un biomarcador simple y confiable para predecir la gravedad y clasificar el riesgo [25][26][27][28][29][30], y en pacientes con neumonía asociada a ventilador, donde junto al índice neutrófilo-linfocito ha demostrado correlación con mortalidad [31].…”