Dynamic Increase of Red Cell Distribution Width Predicts Increased Risk of 30-Day Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Purpose Studies have demonstrated that red blood cell distribution width (RDW) is closely associated with the prognosis of patients with chronic obstructive pulmonary disease (COPD). In addition, the dynamic changes in RDW appear to play an important role. Thus, we aimed to investigate the relationship between dynamic changes in RDW and 30-day all-cause readmission of patients with acute exacerbation of COPD (AECOPD). Methods In this retrospective cohort study, we enrolled patients with AECOPD hospitalized in the Department of Respiratory Medicine in Liyuan Hospital (Wuhan China), a tertiary, university-affiliated, public hospital. Patients with AECOPD were divided into three groups based on their RDW values after the first and fourth days of admission. The normal range for RDW is 10–15%. Patients with normal RDW values were included in the normal group. Patients with an RDW value >15% on the first day, which subsequently decreased by >2% on the fourth day was included in the decreased group. The increased group was comprised of patients with an RDW value >15% on the first day which continued to increase, or those with a normal RDW value on the first day which increased >15% on the fourth day. Results A total of 239 patients (age: 72 years [range: 64–81 years]; male: n=199 [83.3%]) were included. There were 108, 72, and 59 patients in the RDW normal, decreased, and increased groups, respectively; the 30-day all-cause readmission rate was 9.3%, 9.7%, 27.1%, respectively; (p=0.003), being noticeably higher in the RDW increased group. Dynamic increase of RDW (OR:3.45, 95% CI: 1.39–8.58, p= 0.008) was independently correlated with 30-day all-cause readmission of patients with AECOPD. Conclusion The dynamic increase of RDW is an independent prognostic factor of 30-day all-cause readmission of patients with AECOPD.

Higher red cell distribution width and poorer hospitalization‐related outcomes in elderly patients

“…26,27 Mid-term prognosis, including readmission rates, has also been studied in individuals with some specific diseases, such as COPD or heart failure. [28][29][30] However, these data are still either counterbalanced by conflicting evidence or questioned about the impact of nutritional status or specific clinical circumstances. 31,32 In keeping with these previous findings, our study aimed to evaluate whether RDW value could predict the short-term worse prognosis of hospitalized elderly patients, using relevant hospitalization-related parameters of mortality, early re-admission, and hospital stay (days).…”

“…Moreover, greater variability of RBC size predicts the long‐term risk of mortality in relatively healthy, community‐based subjects 9,24,25 as well as subjects with critically ill medical conditions 26,27 . Mid‐term prognosis, including readmission rates, has also been studied in individuals with some specific diseases, such as COPD or heart failure 28–30 . However, these data are still either counterbalanced by conflicting evidence or questioned about the impact of nutritional status or specific clinical circumstances 31,32 .…”

ΔRDW: A Novel Indicator with Predictive Value for the Diagnosis and Treatment of Multiple Diseases

“…Studies have shown a correlation between dynamic changes in RDW and COPD readmission rates. The 30-day readmission rate was 27.1% in patients with a ΔRDW positive change, 39 and significantly higher than that in patients with ΔRDW dynamic reduction (9.7%). Monitoring the trend of ΔRDW can play an essential role in the timely adjustment of COPD treatment options and assessment of prognosis.…”

The Emerging Clinical Significance of the Red Cell Distribution Width as a Biomarker in Chronic Obstructive Pulmonary Disease: A Systematic Review

“…Following the full-text review of the remaining 38 articles, one was further excluded because it did not fulfil the inclusion criteria (comment letter without providing new data), thus leaving 37 studies for final analysis ( Figure 1 ). Sixteen studies investigated patients with stable COPD [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ], 20 investigated patients with AECOPD [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], and one investigated both groups [ 62 ]. Fourteen studies were conducted in China [ 32 , 33 , 35 , 36 , 38 , 40 , 41 , 48 , 51 , 53 , 56 , 57 , 58 , 61 ]; eleven in Turkey [ 26 , …”