Association between red blood cell distribution width and mortality of COVID-19 patients

Lorente, Leonardo; Martı́n, Marı́a; Argüeso, Mónica; Solé‐Violán, Jordi; Pérez, A. González; Ramos, José Alberto Marcos y; Ramos-Gómez, Luis; López, Sergio Luis González; Franco, Andrés; González-Rivero, Agustín F.; Gonzalez, Veronica D.; Alcoba-Flórez, Julia; Rodríguez, Miguel Ángel Palomero; Riaño-Ruiz, Marta; Campo, Juan Guillermo O; González, Lourdes; Cantera, Tamara; Ortiz-López, Raquel; Ojeda, Nazario; Rodríguez‐Pérez, Aurelio; Domínguez, C.; Jiménez, Alejandro

doi:10.1016/j.accpm.2020.10.013

Cited by 47 publications

(63 citation statements)

References 37 publications

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“…After a full-text review of the remaining 12 articles, one further study was excluded because of missing information. Thus, 11 studies were included in the meta-analysis [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Their characteristics are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…A total of 4901 COVID-19 patients were studied, 4247 (50% males, mean age 52 years) with low severity or who survived and 654 (57% males, mean age 66 years) with high severity or who died. Two studies were prospective [ 34 , 36 ], while the remaining nine were retrospective [ 30 , 31 , 32 , 33 , 35 , 37 , 38 , 39 , 40 ]. Six studies were performed in Asia [ 30 , 33 , 35 , 38 , 39 , 40 ], three in Europe [ 32 , 36 , 37 ], and two in America [ 31 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies were prospective [ 34 , 36 ], while the remaining nine were retrospective [ 30 , 31 , 32 , 33 , 35 , 37 , 38 , 39 , 40 ]. Six studies were performed in Asia [ 30 , 33 , 35 , 38 , 39 , 40 ], three in Europe [ 32 , 36 , 37 ], and two in America [ 31 , 34 ]. End points included disease severity based on current clinical guidelines in six studies [ 30 , 33 , 34 , 35 , 39 , 40 ], survival in three [ 31 , 36 , 37 ], and transfer to ICU in two [ 32 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, the difference was not statistically significant in four studies [ 32 , 35 , 37 , 40 ]. In the remaining study, the RDW values were mildly, non-significantly, higher in patients with mild disease or survivor status (mean difference, −0.06) [ 36 ]. The pooled results confirmed that the RDW values were significantly higher in patients with severe disease or non-survivor status (SMD 0.56, 95% CI 0.31 to 0.81, p < 0.001) ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

Zinellu

Mangoni

2021

JCM

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The identification of biomarkers predicting disease severity and outcomes is the focus of intense research in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 infection). Ideally, such biomarkers should be easily derivable from routine tests. We conducted a systematic review and meta-analysis of the predictive role of the red blood cell distribution width (RDW), a routine hematological test, in patients with SARS-CoV-2 infection. We searched the electronic databases PubMed, Web of Science and Scopus, from January 2020 to November 2020, for studies reporting data on the RDW and coronavirus disease 2019 (COVID-19) severity, defined as severe illness or admission to the intensive care unit (ICU), and mortality. Eleven studies in 4901 COVID-19 patients were selected for the meta-analysis. Pooled results showed that the RDW values were significantly higher in patients with severe disease and non-survivors (standard mean difference, SMD = 0.56, 95% CI 0.31 to 0.81, p < 0.001). Heterogeneity between studies was extreme (I2 = 80.6%; p < 0.001). In sensitivity analysis, the effect size was not modified when each study was in turn removed (effect size range, between 0.47 and 0.63). The Begg’s (p = 0.53) and Egger’s tests (p = 0.52) showed no evidence of publication bias. No significant correlations were observed between SMD and age, gender, whole blood count, end point, study geographic area, or design. Our meta-analysis showed that higher RDW values are significantly associated with COVID-19 severity and mortality. This routine parameter might assist with early risk stratification in patients with SARS-CoV-2 infection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

Zinellu

Mangoni

2021

JCM

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“…In patients with pneumonia, specifically, RDW was associated with both short-and longterm mortality in multiple studies (12)(13)(14)(15). Recently RDW has also been suggested to be of prognostic value in patients with COVID-19 (16)(17)(18)(19)(20). Most notably, Foy et al found a significantly increased mortality risk in patients with elevated RDW at the time of hospital admission with a hazard ratio of 2.01 when using a cut-off of 14.5% (21).…”

Section: Introductionmentioning

confidence: 99%

Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience

et al. 2021

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Background: Coronavirus disease (COVID-19) was first described at the end of 2019 in China and has since spread across the globe. Red cell distribution width (RDW) is a potent prognostic marker in several medical conditions and has recently been suggested to be of prognostic value in COVID-19.Methods: This retrospective, observational study of consecutive patients with COVID-19 was conducted from March 12, 2020 to December 4, 2020 in the Wilhelminenhospital, Vienna, Austria. RDWlevels on admission were collected and tested for their predictive value of 28-day mortality.Results: A total of 423 eligible patients with COVID-19 were included in the final analyses and 15.4% died within 28 days (n = 65). Median levels of RDWwere significantly higher in non-survivors compared to survivors [14.6% (IQR, 13.7–16.3) vs. 13.4% (IQR, 12.7– 14.4), P < 0.001]. Increased RDW was a significant predictor of 28-day mortality [crude odds ratio (OR) 1.717, 95% confidence interval (CI) 1.462–2.017; P = < 0.001], independent of clinical confounders, comorbidities and established prognostic markers of COVID-19 (adjusted OR of the final model 1.368, 95% CI 1.126–1.662; P = 0.002). This association remained consistent upon sub-group analysis. Our study data also demonstrate that RDW levels upon admission for COVID-19 were similar to previously recorded, non-COVID-19 associated RDW levels [14.2% (IQR, 13.3–15.7) vs. 14.0% [IQR, 13.2–15.1]; P = 0.187].Conclusions: In this population, RDWwas a significant, independent prognostic marker of short-term mortality in patients with COVID-19.

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Relationship between initial red cell distribution width and ΔRDW and mortality in cardiac arrest patients

Zhong,

Zhang,

et al. 2023

ESC Heart Failure

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AimsThere has been a lack of research examining the relationship between red cell distribution width (RDW) and the prognosis of cardiac arrest (CA) patients. The prognostic value of the changes in RDW during intensive care unit (ICU) hospitalization for CA patients has not been investigated. This study aims to investigate the correlation between RDW measures at ICU admission and RDW changes during ICU hospitalization and the prognosis of CA patients and then develop a nomogram that predicts the risk of mortality of these patients.Methods and resultsA retrospective cohort study is used to collect clinical characteristics of CA patients (>18 years) that are on their first admission to ICU with RDW data measured from the Medical Information Mart for Intensive Care IV Version 2.0 database. Patients are randomly divided into a development cohort (75%) and a validation cohort (25%). The primary outcome is 30 and 360 day all‐cause mortality. ΔRDW is defined as the RDW on ICU discharge minus RDW on ICU admission. A multivariate Cox regression model is applied to test whether the RDW represents an independent risk factor that affects the all‐cause mortality of these patients. Meanwhile, the dose–response relationship between the RDW and the mortality is described by restricted cubic spine (RCS). A prediction model is constructed using a nomogram, which is then assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). A total of 1278 adult CA patients are included in this study. We found that non‐survivors have a higher level of RDW and ΔRDW compared with survivors, and the mortality rate is higher in the high RDW group than in the normal RDW group. The Kaplan–Meier survival curve indicates that patients in the normal RDW group had a higher cumulative survival rate at 30 and 360 days than those in the high RDW group (log‐rank test, χ2 = 36.710, χ2 = 54.960, both P values <0.05). The multivariate Cox regression analysis shows that elevated RDW at ICU admission (>15.50%) is an independent predictor of 30 [hazard ratio = 1.451, 95% confidence interval (CI) = 1.181–1.782, P < 0.001] and 360 day (hazard ratio = 1.393, 95% CI = 1.160–1.671, P < 0.001) all‐cause mortality among CA patients, and an increase in RDW during ICU hospitalization (ΔRDW ≥ 0.4%) can serve as an independent predictor of mortality among these patients. A non‐linear relationship between the RDW measured at ICU admission and the increased risk of mortality rate of these patients is shown by the RCS. This study established and validated a nomogram based on six variables, anion gap, first‐day Sequential Organ Failure Assessment score, cerebrovascular disease, malignant tumour, norepinephrine use, and RDW, to predict mortality risk in CA patients. The consistency indices of 30 and 360 day mortality of CA patients in the validation cohort are 0.721 and 0.725, respectively. The nomogram proved to be well calibrated in the validation cohort. DCA curves indicated that the nomogram provided a higher net benefit over a wide, reasonable range of threshold probabilities for predicting mortality in CA patients and could be adapted for clinical decision‐making.ConclusionsElevated RDW levels on ICU admission and rising RDW during ICU hospitalization are powerful predictors of all‐cause mortality for CA patients at 30 and 360 days, and they can be used as potential clinical biomarkers to predict the bad prognosis of these patients. The newly developed nomogram, which includes RDW, demonstrates high efficacy in predicting the mortality of CA patients.

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Association between red blood cell distribution width and mortality of COVID-19 patients

Abstract: Highlights Non-surviving showed higher RDW than surviving patients There is an association between RDW and mortality RDW could be used as mortality biomarker

Cited by 47 publications

References 37 publications

Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience

Relationship between initial red cell distribution width and ΔRDW and mortality in cardiac arrest patients

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