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

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.

Download Full-text

Prognostic value of admission red blood cell distribution width in acute pancreatitis: a systematic review

Annals of Translational Medicine ◽

10.21037/atm.2017.06.61 ◽

2017 ◽

Vol 5 (17) ◽

pp. 342-342 ◽

Cited By ~ 13

Author(s):

Hemant Goyal ◽

Hamza Awad ◽

Zhi-De Hu

Keyword(s):

Systematic Review ◽

Acute Pancreatitis ◽

Blood Cell ◽

Red Blood Cell ◽

Prognostic Value ◽

Cell Distribution ◽

Distribution Width ◽

Red Blood Cell Distribution

Download Full-text

Prognostic Value of Red Blood Cell Distribution Width in Transcatheter Aortic Valve Replacement Patients

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211041360 ◽

2021 ◽

pp. 155698452110413

Author(s):

Seyed Hossein Aalaei-Andabili ◽

R. David Anderson ◽

Anthony A. Bavry ◽

Brian Barr ◽

George J. Arnaoutakis ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Blood Cell ◽

Red Blood Cell ◽

Transcatheter Aortic Valve Replacement ◽

Prognostic Value ◽

Cell Distribution ◽

Distribution Width ◽

Transcatheter Aortic Valve ◽

Red Blood Cell Distribution

Objective Elevated red blood cell distribution width (RDW) level has been shown to be associated with poor outcomes in patients with cardiovascular disease. Limited data are available regarding the prognostic value of RDW in transcatheter aortic valve replacement (TAVR) patients. Therefore, we aimed to investigate the impact of RDW variation on outcomes of TAVR patients. Methods From March 20, 2012, to February 20, 2020, the pre-TAVR RDW levels of 1,163 consecutive TAVR patients were examined. Receiver operating curves were set to define the most accurate cut-point, which was subsequently validated in our validation set. Associations of RDW levels with early and long-term outcomes were investigated. Results A total of 988 patients were eligible for the analysis. Patients with 30-day, 1-year, and 7-year mortality had significantly higher pre-TAVR RDW levels (15.8% [12.9-19.1] vs 14.7% [11.6-26.3], P = 0.01; 16% [12.3-26.3] vs 14.7% [11.6-24.3], P < 0.001; 15.6% [12.3-26.3] vs 14.6% [11.6-24.3], P < 0.001, respectively). A RDW of 14.5% was found as the most sensitive and specific cut-point for mortality at 1 and 7 years (HR = 2.6, 95% CI: 1.6-4.2, P < 0.001; HR = 1.8, 95% CI: 1.3-2.4, P < 0.001), with mortality of 22% versus 10% at 1 year ( P < 0.001) and 37% versus 27% at 7 years ( P < 0.001) in patients with RDW ≥14.5% versus those with RDW <14.5%. Conclusions RDW is an important prognostic factor in TAVR patients. A RDW level higher than 14.5% is significantly associated with post-TAVR early and late mortality. RDW levels should be incorporated into current risk assessment models as an additional variable to predict post-TAVR outcomes.

Download Full-text

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

Diagnostics ◽

10.3390/diagnostics10090618 ◽

2020 ◽

Vol 10 (9) ◽

pp. 618 ◽

Cited By ~ 2

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.

Download Full-text