Red blood cell distribution width at emergency department admission increases the accuracy of the HEART score for predicting death in patients with chest pain

2016 ◽  
Vol 222 ◽  
pp. 999-1000 ◽  
Author(s):  
Gianni Turcato ◽  
Valentina Serafini ◽  
Alice Dilda ◽  
Beatrice Caruso ◽  
Massimo Zannoni ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Emergency Department Admission ◽  
Heart Score ◽  
Red Blood Cell Distribution

scholarly journals Red Blood Cell Distribution Width (RDW) Predicts COVID-19 Severity: A Prospective, Observational Study from the Cincinnati SARS-CoV-2 Emergency Department Cohort

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 618 ◽  
Author(s):  
Brandon Michael Henry ◽  
Justin Lee Benoit ◽  
Stefanie Benoit ◽  
Christina Pulvino ◽  
Brandon A. Berger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Severe Illness ◽  
Cell Distribution ◽  
Laboratory Assessment ◽  
Distribution Width ◽  
Red Blood Cell Distribution

Since previous evidence has demonstrated that red blood cell distribution width (RDW) may be a useful prognostic parameter in many critical illnesses and infectious diseases, we investigated the utility of RDW for monitoring patients with coronavirus disease 2019 (COVID-19). The study population consisted of 49 COVID-19 patients, including 16 (32.6%) with severe illness, 12 (24.5%) with severe acute kidney injury (AKI), and 8 (16.3%) requiring renal replacement therapy (RRT). The predictive value of blood tests, performed during emergency department evaluation, was then addressed. A progressive increase of RDW was observed with advancing COVID-19 severity. The area under the curve (AUC) of RDW was 0.73 for predicting severe illness, 0.80 for severe AKI, and 0.83 for RRT, respectively. In multivariate analysis, elevated RDW was associated with 9-fold and 16-fold increased odds of severe COVID-19 and AKI, respectively. The results of this study suggest that RDW should be part of routine laboratory assessment and monitoring of COVID-19.

Higher risk of myocardial injury in chest pain patients with elevated red blood cell distribution width

2018 ◽  
Vol 481 ◽  
pp. 121-125 ◽  
Author(s):  
Jia Wei ◽  
Rui-Xia Yang ◽  
Qin Ye ◽  
Xue-Lian Xiao ◽  
Xiao-Ling Zang ◽  
...  
Keyword(s):  
Chest Pain ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Myocardial Injury ◽  
Cell Distribution ◽  
Distribution Width ◽  
Pain Patients ◽  
Red Blood Cell Distribution

scholarly journals Red Blood Cell Distribution Width Improves Reclassification of Patients Admitted to the Emergency Department with Acute Decompensated Heart Failure

2018 ◽  
Vol 37 (3) ◽  
pp. 299-306 ◽  
Author(s):  
Gianni Turcato ◽  
Gianfranco Cervellin ◽  
Antonio Bonora ◽  
Danieli Prati ◽  
Elisabetta Zorzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Retrospective Study ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Laboratory Tests ◽  
Cell Distribution ◽  
Distribution Width ◽  
Net Reclassification Improvement ◽  
Red Blood Cell Distribution

SummaryThe usual history of chronic heart failure (HF) is characterized by frequent episodes of acute decompensation (ADHF), needing urgent management in the emergency department (ED). Since the diagnostic accuracy of routine laboratory tests remains quite limited for predicting short-term mortality in ADHF, this retrospective study investigated the potential significance of combining red blood cell distribution width (RDW) with other conventional tests for prognosticating ADHF upon ED admission. We conducted a retrospective study including visits for episodes of ADHF recorded in the ED of the Uni versity Hospital of Verona throughout a 4-year period. Demo - graphic and clinical features were recorded upon patient presentation. All patients were subjected to standard Chest X-ray, electrocardiogram (ECG) and laboratory testing in - cluding creatinine, blood urea nitrogen, B-type natriuretic peptide (BNP), complete blood cell count (CBC), sodium, chloride, potassium and RDW. The 30-day overall mortality after ED presentation was defined as primary endpoint. Results: The values of sodium, creatinine, BNP and RDW were higher in patients who died than in those who survived, whilst hypochloremia was more frequent in patients who died than in those who survived. The multivariate model, incorporating these parameters, displayed a modest efficiency for predicting 30-day mortality after ED admission (AUC, 0.701; 95% CI, 0.662-0.738; p=0.001). Notably, the inclusion of RDW in the model significantly enhanced prediction efficiency, with an AUC of 0.723 (95% CI, 0.693-0.763; p<0.001). These results were confirmed with net reclassification improvement (NRI) analysis, showing that combination of RDW with conventional laboratory tests resulted in a much better prediction performance (net reclassification index, 0.222; p=0.001). The results of our study show that prognostic assessment of ADHF patients in the ED can be significantly improved by combining RDW with other conventional laboratory tests.

scholarly journals The Role of Red Blood Cell Distribution Width for Predicting 1-year Mortality in Patients Admitted to the Emergency Department with Severe Dyspnoea

2017 ◽  
Vol 36 (1) ◽  
pp. 32-38
Author(s):  
Gianni Turcato ◽  
Gianfranco Cervellin ◽  
Gian Luca Salvagno ◽  
Eleonora Zaccaria ◽  
Giuseppe Bartucci ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Arterial Blood ◽  
Increased Risk ◽  
Red Blood Cell Distribution ◽  
Severe Dyspnoea

Summary Background: Universally accepted and validated instruments for predicting the outcome of patients presenting to the emergency department (ED) with severe dyspnoea do not exist so far, nor are they regularly used by the emergency physicians. This study hence aimed to establish whether red blood cell distribution width (RDW) may be a predictive parameter of 1-year mortality in a population of patients admitted to the ED with severe dyspnoea attributable to different underlying disorders. Methods: We retrospectively evaluated all the patients undergoing arterial blood gas analysis for severe dyspnoea (irrespective of the cause) during admission to ED of University Hospital of Verona from September 1, 2014 to November 31, 2014. Results: The final study population consisted of 287 patients for whom complete clinical and laboratory information was available. Overall, 36 patients (12.5%) died after a 1-year follow-up. The RDW value was found to be considerably increased in patients who deceased during the follow-up compared to those who survived (17.2% versus 14.8%; p<0.001). In both univariate and multivariate analyses, the RDW value was found to be a significant predictor of 1-year mortality. In particular, patients with RDW ≥ 15.0% displayed a 72% increased risk of 1-year mortality after multiple adjustments. Conclusions: The measurement of RDW, a very simple and inexpensive laboratory parameter, may represent an important factor for predicting medium-term mortality in patients presenting to the ED with severe dyspnoea.

scholarly journals The prognostic value of red blood cell distribution width in patients with suspected infection in the emergency department

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jan Willem Uffen ◽  
Patrick Oomen ◽  
Marieke de Regt ◽  
Jan Jelrik Oosterheert ◽  
Karin Kaasjager
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Prognostic Value ◽  
Clinical Deterioration ◽  
Cell Distribution ◽  
Distribution Width ◽  
Suspected Infection ◽  
Red Blood Cell Distribution

Abstract Background Sepsis is a potential life threatening dysregulated immune response to an infection, which can result in multi-organ failure and death. Unfortunately, good prognostic markers are lacking in patients with suspected infection to identify those at risk. Red blood cell distribution width (RDW) is a common and inexpensive hematologic laboratory measurement associated with adverse prognosis in multiple diseases. The aim of this study was to determine the prognostic value of RDW for mortality and early clinical deterioration in patients with a suspected infection in the emergency department. Methods In this single center prospective observational cohort study, consecutive patients with suspected infection presenting for internal medicine in the emergency department between September 2016 and March 2018 were included. For prognostic validation of bedside sepsis scores and RDW receiver operating characteristics were generated. Association between RDW and mortality and ICU admission was analyzed univariate and in a multivariate logistic regression model. Results 1046 patients were included. In multivariate analyses, RDW was significantly associated with 30-day mortality (OR 1.15, 95% CI: 1.04–1.28) and early clinical deterioration (OR 1.09, 95% CI: 1.00–1.18). For 30-day mortality RDW had an AUROC of 0.66 (95% CI 0.59–0.72). Optimal cut-off value for RDW 2 was 12.95%. For early clinical deterioration RDW had an AUROC of 0.59 (95% CI 0.54–0.63) with an optimal cut-off value of 14.48%. Conclusions RDW was found to be a significant independent prognostic factor of 30-day mortality and early clinical deterioration in patients with suspected infection.. Therefore it can be a used as an extra marker besides bedside sepsis scores in identifying patients at risk for worse outcome in patients with suspected infection.

Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes

2009 ◽  
Vol 47 (3) ◽  
Author(s):  
Giuseppe Lippi ◽  
Luca Filippozzi ◽  
Martina Montagnana ◽  
Gian Luca Salvagno ◽  
Massimo Franchini ◽  
...  
Keyword(s):  
Chest Pain ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Acute Coronary Syndromes ◽  
False Negative ◽  
Cardiac Markers ◽  
Cell Distribution ◽  
Distribution Width ◽  
Coronary Syndromes ◽  
Red Blood Cell Distribution

Abstract: Conventional cardiac markers used for the biochemical diagnosis of acute coronary syndromes (ACS) have a high specificity but low sensitivity within 2–4 h of symptoms onset. The red blood cell distribution width (RDW), reflecting the size variability of circulating red blood cells, has been shown to be independently associated with an increased risk of major cardiovascular events. We assessed whether there is an association between RDW at admission and cardiac troponin T (cTnT) elevation in patients with chest pain.: We analyzed RDW values in 2304 adult patients, who were consecutively admitted over a 1-year period to the local emergency department for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine haematological testing, whereas cTnT was measured at baseline and after 4, 6, and 12 h.: A total of 456 patients (19.8% of total) had ACS. These patients, all having cTnT≥0.03 μg/L up to 12 h from admission other than ischaemic electrocardiographic changes, had higher RDW than non-ACS patients [median 15.1%, (5th–95th percentiles) 13.2%–19.0% vs. 13.5%, 12.9%–17.1%, p<0.001]. On admission, the sensitivity and specificity of cTnT were 94% (25 false negative results) and 100%, respectively. The diagnostic accuracy of RDW, as calculated by the receiver operating characteristic curve analysis, was 0.705 (p<0.001). At the cut-off value of 14%, the clinical sensitivity and specificity of RDW on admission were 79% and 50%, respectively. In 21 out of 25 patients classified as false negative for cTnT on admission, the RDW was >14%. Accordingly, the diagnostic sensitivity of the two combined measurements on admission was 99%.: As RDW is widely available to clinicians as a part of the complete blood count, and therefore incurs no additional costs, it might be considered with other conventional cardiac markers for the risk stratification of ACS patients admitted to emergency departments.Clin Chem Lab Med 2009;47:353–7.

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