Is elevated Red cell distribution width a prognostic predictor in adult patients with community acquired Pneumonia?

Abstract

BackgroundCommunity acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards.MethodsThe cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization.ResultsThe cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels.ConclusionsElevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score.

Prognostic Value of Red Blood Cell Distribution Width in Non-Cardiovascular Critically or Acutely Patients: A Systematic Review

“…The adjusted OR rose from1.12 to 1.40. RDW was reported as a binary variable in 2 studies [28, 33], and we found that the increased RDW levels were associated with a higher risk of death (OR, 2.12; 95%CI, 1.82–2.46) with low heterogeneity ( I 2 = 0, P = 0.49). And 4 studies provided data on AUC from 0.63 to 0.76 of RDW in prediction mortality [23, 25, 31, 33].…”

“…In addition, because of the studies by Purtle et al and Bazick et al were conducted in the same hospitals and derived from the same study periods [2, 12] and the risk of data duplication was inevitable, thus the study by Purtle et al was excluded [12]. A similar situation also occurred in the studies by Braun et al [26, 28], and his early study was excluded [26]. There was no additional studies were obtained through reviewing the bibliographies of relevant reviews or systematic reviews and there was no discrepancy between two reviewers.…”

Role of Red Blood Cell Distribution Width as a Prognostic Marker in Patients With Severe Sepsis and Septic Shock

“…(8) In one study done by Eyal Braun et al in 2014, where 3815 patients of community acquired pneumonia were studied, they found 16.9% (32.69% in our study) mortality in patients with RDW <=15% and 21.7% (59.18% in our study) mortality in patients with RDW >15%. (9) In another study done by Nader A Mahmood et al in 2014 RDW ≥16% was independently associated with an APACHE II score of ≥15. This suggests that septic patients with an RDW ≥16% may have a higher severity of illness.…”

Assessment of red blood cell distribution width as a prognostic marker in chronic lymphocytic leukemia

“…Specifically, it is associated with high rate of morbidity and mortality in the case of patients with chronic heart failure [22, 23, 24]. Likewise, it is a marker of poor prognosis for patients with infectious diseases [25, 26]. However, there are relatively few reports focusing on RDW in the area of oncology.…”