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

Abstract

BackgroundRDW (red cell distribution width) has been reported to been associated with the prognosis of patients with cardiovascular diseases. However, RDW is often overlooked by clinicians in treating patients with non-cardiovascular diseases, especially in an emergency. The objective of this systematic review is to explore the prognostic value of RDW in non-cardiovascular emergencies.MethodsPubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched from their inception to December 31, 2015. We included studies examining the relationship between RDW and mortality rate by adjusting important covariables in non-cardiovascular emergencies. All included studies were divided into three groups. Group A: general critically ill patients; Group B: patients with infectious disease; Group C: other conditions. We extracted each study’ characteristics, outcomes, covariables, and other items independently.ResultsA total of 32 studies were eligible for inclusion in our meta-analysis. Six studies belonged to Group A, 9 studies belonged to Group B and 17 studies belonged to Group C. Among these included studies, RDW was assessed as a continuous variable (per 1% increase) in 16 studies, as a binary variable in 8 studies, and as a categorical variable in 8 studies. In addition, AUCs (area under the receiver operating characteristic curve) of RDW for predicting mortality were reported in 25 studies. All studies were published between 2011–2015. The qualities of included 32 studies were moderate or high.ConclusionThe present systematic review indicates that the increased RDW is significantly associated with a higher mortality rate in an non-cardiovascular emergency. The low cost and readily accessible of this laboratory variable may strengthen its usefulness in daily practice in the future.

Prognostic significance of red cell distribution width in hospitalized older patients with heart failure or infection

“…RDW showed no baseline difference in HF patients with different severities (Table ) and no in‐hospital variation in the selected patients with acutely decompensated HF. Worse primary outcome was found in older adults showing RDW ≥15% in both HF (Table ) and infection (Table ), as in the literature, indicating that RDW is a simple, stable and sensitive prognostic factor in these common diseases . As senile HF and infection are fatal, these findings are important in gerontology.…”

“…A large‐scale cohort is standard to study the association of RDW with HF . Second, HF management protocol and antibiotic treatment strategy depend on the discretions of the treating physicians, although the discretions were strictly based on the guidelines of the domestic medical societies . Third, this observational study did not contain a healthy control group.…”

“…Worse primary outcome was found in older adults showing RDW ≥15% in both HF (Table 4) and infection (Table 5), as in the literature, indicating that RDW is a simple, stable and sensitive prognostic factor in these common diseases. 24 As senile HF and infection are fatal, these findings are important in gerontology. Approximately half of HF patients die within 5 years after the initial diagnosis.…”

“…20,22,23 Second, HF management protocol and antibiotic treatment strategy depend on the discretions of the treating physicians, although the discretions were strictly based on the guidelines of the domestic medical societies. 13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Third, this observational study did not contain a healthy control group. RDW is sensitive but not specific for certain diseases.…”

Red cell distribution width associated with adverse cardiovascular outcomes in patients with chronic kidney disease

“…Recent studies have indicated that patients with higher RDW levels were associated with an increased risk of cardiovascular (CV) events and new-onset stroke [ 3 – 5 ]. Moreover, the level of RDW was positively correlated with mortality in patients with acute or critical illnesses, in those with chronic diseases, and in healthy cohorts [ 6 – 13 ]. Patel et al reported a 14% increased risk of death for each 1% increment in RDW in a community-based elderly population [ 10 ].…”