Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis

Abstract

BackgroundRed cell distribution width (RDW), a routine component of the complete blood count (CBC), measures variation in the size of circulating erythrocytes. It has been associated with several clinical outcomes in cardiovascular disease. We sought to strengthen the association between RDW and mortality in patients admitted for acute coronary syndrome (ACS) by pooling together data from available studies.MethodsStudies that fulfilled the following were identified for analysis: 1) observational; 2) included patients admitted for ACS; 3) reported data on all-cause or cardiovascular (CV) mortality in association with a low or high RDW; and 4) used logistic regression analysis to control for confounders. Using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until January 9, 2017. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Our primary outcome of interest was all-cause or CV mortality. We also investigated the impact of RDW on major adverse cardiovascular events (MACEs) for the studies that reported these outcomes. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk.ResultsWe identified 13 trials involving 10,410 patients, showing that in ACS, a low RDW is associated with a statistically significant lower all-cause or CV mortality (RR 0.35, (95% CI 0.30 to 0.40), P < 0.00001, I2 = 53%), a finding that was consistent both in the short- and long-term.ConclusionsA low RDW is also associated with lower risk for MACEs after an ACS (RR 0.56, (95% CI 0.51 to 0.61), P < 0.00001, I2 = 91%). A low RDW during an ACS is associated with lower all-cause or CV mortality and lower risk of subsequent MACEs, providing us with a convenient and inexpensive risk stratification tool in ACS patients.

Preoperative red cell distribution width predicts postoperative cognitive dysfunction after coronary artery bypass grafting

“…The inflammatory state and oxidative stress change the morphology, deforming force, and half-life of red blood cells, increase RDW in vivo, and cause changes in hemodynamic state [27]. RDW clinically influences the severity and prognosis of stroke, acute coronary syndrome, and other diseases [28,29]. Our study displays that preoperative RDW is associated with cognitive decline in CHD patients undergoing CABG.…”

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

“…Elevated RDW level is also known as anisocytosis. Several studies in recent years have shown that RDW can be used as a potent predictor of morbidity and mortality in a variety of settings, particularly in many cardiovascular problems, such as coronary heart disease, pulmonary arterial hypertension, and HF . The role of RDW in HF is unclear, but its value in HF has been demonstrated to be independent of anemia .…”

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

“…Red blood cell distribution width (RDW) is a parameter of the haemogram used in the differential diagnosis of anaemia and involves the variability in form and size of red blood cells in the subject [17] . An association between high RDW and mortality has been found in patients with coronary disease [18] , liver disease [19] , pancreatitis [20] and ischemic stroke [21] , [22] . This association has also been found in septic patients [23] , [24] , [25] .…”