Usefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism

doi:10.1016/j.amjcard.2011.08.015

The American Journal of Cardiology

Volume 109, Issue 1, 1 January 2012, Pages 128-134

https://doi.org/10.1016/j.amjcard.2011.08.015 Get rights and content

Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 ± 15 years. The mean follow-up duration was 11 ± 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE.

Section snippets

Methods

A total of 180 consecutive patients admitted to the emergency unit and then hospitalized for suspicion of acute PE were prospectively considered for enrollment at 3 participating centers from January 2008 to January 2010 (Figure 1). Six patients with chronic liver disease, 5 patients who were receiving dialysis treatment for chronic renal failure, 4 patients with previous diagnoses of malignancies, 8 patients who were previously treated for anemia, 6 patients who received erythrocyte suspension

Results

The mean age of the patients was 63 ± 15 years (52% women, 48% men). Receiver-operating characteristic curve analysis of RDW is shown in Figure 2. According to the receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity (area under the curve 0.734, 95% confidence interval 0.646 to 0.822).

Baseline characteristics of patients with acute PE classified into 2 categories according to

Discussion

Acute PE, as an emergency diagnosis, requires precise recognition and timely risk stratification, because early recognition and accurate risk stratification determine prognosis.¹ Risk stratification in acute PE gradually begins with initial hemodynamic status assessment, a well-established marker of poor prognosis. It is followed by biomarker tests, performed to determine RV dysfunction and myocardial damage.¹

RDW reflects the variation of red blood cell volume and can easily be measured by

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Cited by (171)

Red blood cell distribution width (RDW) – A new nutritional biomarker to assess nutritional risk and response to nutritional therapy?
2024, Clinical Nutrition
Red cell distribution width (RDW) has been proposed as a surrogate marker for acute and chronic diseases and may be influenced by nutritional deficits. We assessed the prognostic value of RDW regarding clinical outcomes and nutritional treatment response among medical inpatients at nutritional risk.
This is a secondary analysis of EFFORT, a randomized, controlled, prospective, multicenter trial investigating the effects of nutritional support in patients at nutritional risk in eight Swiss hospitals. We examined the association between RDW and mortality in regression analysis.
Among 1,244 included patients (median age 75 years, 46.6 % female), high RDW (≥15 %) levels were found in 38 % of patients (n = 473) with a significant association of higher malnutrition risk [OR 1.48 (95%CI 1.1 to 1.98); p = 0.009]. Patients with high RDW had a more than doubling in short-term (30 days) mortality risk [adjusted HR 2.12 (95%CI 1.44 to 3.12); p < 0.001] and a signficant increase in long-term (5 years) mortality risk [adjusted HR 1.73 (95%CI 1.49 to 2.01); p < 0.001]. Among patients with high RDW, nutritional support reduced morality within 30 days [adjusted OR 0.56 (95%CI 0.33 to 0.96); p = 0.035], while the effect of the nutritional intervention in patients with low RDW was markedly smaller.
Among medical patients at nutritional risk, RDW correlated with several nutritional parameters and was a strong prognostic marker for adverse clinical outcomes at short- and long-term, respectively. Patients with high baseline RDW levels also showed a strong benefit from the nutritional intervention. Further research is needed to understand whether monitoring of RDW over time severs as a nutritional biomarker to assess effectiveness of nutritional treatment in the long run.
ClinicalTrials.gov Identifier: NCT02517476.
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Citation Excerpt :
Red blood cell distribution width (RDW) is a quantitative measure of circulating erythrocyte volume variability, and it is measured as part of a complete blood count examination. Furthermore, RDW has significant associations with the risk of adverse clinical outcomes in patients with coronary artery disease,5-17 heart failure,18,19 stroke,20,21 acute pulmonary embolism,22-25 community-acquired pneumonia,26-28 peripheral occlusive artery disease,29 cancer,30,31 sepsis,32 and kidney disease.33-35 Furthermore, an increase in RDW is associated with right ventricular dysfunction,36,37 pulmonary arterial hypertension,37 and mortality.38-41
Red blood cell distribution width (RDW) is associated with increased mortality risk in patients with chronic obstructive pulmonary disease (COPD). However, limited data are available for critically ill patients with COPD.
Data from the Medical Information Mart for Intensive Care III V1.4 database were analyzed in this retrospective cohort research. The International Classification of Diseases codes were used to identify critically ill patients with COPD. The first value of RDW was extracted within the first 24 h after intensive care unit admission. The endpoint was 28-day all-cause mortality. Multivariable logistic regression analysis was performed to examine the relationship between RDW and 28-day mortality. Age, sex, ethnicity, anemia status, comorbidities, clinical therapy, and disease severity score were considered for subgroup analysis.
A total of 2,344 patients were included with mean (standard deviation) age of 72.3 (11.3) years, in which 1,739 (53.6%) patients were men. The increase in RDW was correlated with an increased risk of 28-day mortality in the multivariate logistic regression model (odds ratio [OR] 1.15; 95% confidence interval [CI] 1.09−1.21). In comparison with the low-RDW group, the middle and high-RDW groups tended to have higher risks of 28-day all-cause mortality (OR [95% CI] 1.03 [0.78−1.34]; OR [95% CI] 1.70 [1.29−2.22]; P trend < 0.0001). Subgroup analyses show no evidence of effect modifications on the correlation of RDW and 28-day all-cause mortality.
An increase in RDW was associated with an increased risk of 28-day all-cause mortality in critically ill patients with COPD. Further studies are required to investigate this association.
Prognostic value of red blood cell distribution width for mortality in patients with sepsis-induced cardiomyopathy: a propensity score-matched cohort study
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MiscellaneousUsefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism

Section snippets

Methods

Results

Discussion

J Am Soc Echocardiogr

J Am Coll Cardiol

Am Heart J

J Card Fail

Int J Cardiol

Am J Cardiol

Am J Cardiol

Kidney Int

Chest

Chest

J Am Coll Cardiol

Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)

Eur Heart J

Nutritional Anemia: Report of a WHO Scientific Group World Health Organization

European Association of Echocardiography recommendations for the assessment of valvular regurgitationPart 2: mitral and tricuspid regurgitation (native valve disease)

Eur J Echocardiogr

Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation

Circulation

Miscellaneous
Usefulness of Admission Red Cell Distribution Width as a Predictor of Early Mortality in Patients With Acute Pulmonary Embolism