Increased Red Cell Distribution Width Is Associated With Disease Severity in Hospitalized Adults With SARS-CoV-2 Infection: An Observational Multicentric Study

Karampitsakos, Theodoros; Akinosoglou, Karolina; Papaioannou, Ourania; Panou, Vasiliki; Koromilias, Athanasios; Bakakos, Petros; Loukides, Stelios; Bouros, Demosthenes; Gogos, Charalampos; Tzouvelekis, Argyrios

doi:10.3389/fmed.2020.616292

Cited by 27 publications

(22 citation statements)

References 17 publications

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“…The results may facilitate a change in COVID-19 patient management and encourage screening high-risk patients; according to the RDW lab results, RDW cut-off value of 14.5% provides a strong sensitivity (63.8%) and specificity (81.7%) for predicting COVID-19 related mortality. This cut-off value corroborates the 14.5% RDW cut-off value given in other COVID-19 research articles [ 4 , 30 , 31 ].…”

Section: Discussionsupporting

confidence: 88%

Evaluating red blood cell distribution width from community blood tests as a predictor of hospitalization and mortality in adults with SARS-CoV-2: a cohort study

et al. 2021

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Background Red blood cell distribution width (RDW) has been assessed during COVID-19 patient hospitalization, however, further research should be done to evaluate RDW from routine community blood tests, before infection, as a risk factor for COVID-19 related hospitalization and mortality. Patients and methods RDW was measured as a predictor along with age, sex, chronic illnesses, and BMI in logistic regressions to predict hospitalization and mortality. Hospitalization and mortality odds ratios (ORs) were estimated with 95% confidence intervals (CI). RDW was evaluated separately as continuous and discrete (High RDW ≥ 14.5) variables. Results Four thousand one hundred and sixty-eight patients were included in this study, where 824 patients (19.8%) had a high RDW value ≥14.5% (High RDW: 64.7% were female, mean age 58 years [±22] vs. Normal RDW: 60.2% female, mean age 46 years [±19]). Eight hundred and twenty-nine patients had a hospitalization, where the median time between positive PCR and hospital entry was 5 [IQR 1–18] days. Models were analyzed with RDW (continuous) and adjusted for age, sex, comorbidities, and BMI suggested an OR of 1.242 [95% CI = 1.187–2.688] for hospitalization and an OR of 2.911 [95% CI = 1.928–4.395] for mortality ( p < .001). RDW (discrete) with the same adjustments presented an OR of 2.232 [95% CI = 1.853–1.300] for hospitalization and an OR of 1.263 [95% CI = 1.166–1.368] for mortality ( p < .001). Conclusions High RDW values obtained from community blood tests are associated with greater odds of hospitalization and mortality for patients with COVID-19. KEY MESSAGES RDW measures before SARS-CoV-2 infection is a predictive factor for hospitalization and mortality. RDW threshold of 14.5% provides high sensitivity and specificity for COVID-19 related mortality, comparatively to other blood tests. Patient records should be accessed by clinicians for prior RDW results, if available, followed by further monitoring.

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Section: Discussionsupporting

confidence: 88%

Evaluating red blood cell distribution width from community blood tests as a predictor of hospitalization and mortality in adults with SARS-CoV-2: a cohort study

et al. 2021

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“…Recently it has also been suggested that RDW may be associated with disease severity and mortality in patients with COVID-19 (16)(17)(18)(19)(20). Most notably, Foy et al reported a significantly increased risk of short-term mortality in patients with higher levels of RDW at the time of hospital admission when using a cut-off of 14.5% (21).…”

Section: Clinical Evidencementioning

confidence: 99%

“…In patients with pneumonia, specifically, RDW was associated with both short-and longterm mortality in multiple studies (12)(13)(14)(15). Recently RDW has also been suggested to be of prognostic value in patients with COVID-19 (16)(17)(18)(19)(20). Most notably, Foy et al found a significantly increased mortality risk in patients with elevated RDW at the time of hospital admission with a hazard ratio of 2.01 when using a cut-off of 14.5% (21).…”

Section: Introductionmentioning

confidence: 99%

Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience

et al. 2021

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Background: Coronavirus disease (COVID-19) was first described at the end of 2019 in China and has since spread across the globe. Red cell distribution width (RDW) is a potent prognostic marker in several medical conditions and has recently been suggested to be of prognostic value in COVID-19.Methods: This retrospective, observational study of consecutive patients with COVID-19 was conducted from March 12, 2020 to December 4, 2020 in the Wilhelminenhospital, Vienna, Austria. RDWlevels on admission were collected and tested for their predictive value of 28-day mortality.Results: A total of 423 eligible patients with COVID-19 were included in the final analyses and 15.4% died within 28 days (n = 65). Median levels of RDWwere significantly higher in non-survivors compared to survivors [14.6% (IQR, 13.7–16.3) vs. 13.4% (IQR, 12.7– 14.4), P < 0.001]. Increased RDW was a significant predictor of 28-day mortality [crude odds ratio (OR) 1.717, 95% confidence interval (CI) 1.462–2.017; P = < 0.001], independent of clinical confounders, comorbidities and established prognostic markers of COVID-19 (adjusted OR of the final model 1.368, 95% CI 1.126–1.662; P = 0.002). This association remained consistent upon sub-group analysis. Our study data also demonstrate that RDW levels upon admission for COVID-19 were similar to previously recorded, non-COVID-19 associated RDW levels [14.2% (IQR, 13.3–15.7) vs. 14.0% [IQR, 13.2–15.1]; P = 0.187].Conclusions: In this population, RDWwas a significant, independent prognostic marker of short-term mortality in patients with COVID-19.

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“…The spread of 2019 coronavirus disease and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst public health crisis of the latest century [1]. Despite major advances in the management of COVID-19, a considerable proportion of infected individuals experiences critical illness with hypoxic respiratory failure requiring prolonged ventilatory support [2][3][4]. Hypoxic respiratory failure in patients with COVID-19 has been associated with release of pro-in ammatory cytokines including interleukin (IL)-6 [5].…”

Section: Introductionmentioning

confidence: 99%

Tocilizumab in Hospitalized Patients with Severe COVID-19: An Open Label, Prospective Study

Karampitsakos

Malakounidou

Papaioannou

et al. 2021

Preprint

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Background: Data on the safety and efficacy profile of tocilizumab in patients with severe COVID-19 needs to be enriched.Methods: In this open label, prospective study, we evaluated clinical outcomes in consecutive patients with COVID-19 and PaO2/FiO2<200 receiving tocilizumab plus usual care versus usual care alone. The primary outcome was 28-day mortality. Secondary outcomes included time to discharge, change in PaO2/FiO2 at day 5 and change in WHO progression scale at day 10.Findings: Overall, 114 patients were included in the analysis (tocilizumab plus usual care: 56, usual care: 58). Allocation to usual care was associated with significant increase in 28-day mortality compared to tocilizumab plus usual care [Cox proportional-hazards model: HR: 3.34, (95%CI: 1.21 to 9.30), (p=0.02)]. There was not a statistically significant difference with regards to hospital discharge over the 28-day period for patients receiving tocilizumab compared to usual care [11.0 days (95%CI: 9.0 to 16.0) vs 14.0 days (95%CI: 10.0 to 24.0), HR: 1.32 (95%CI: 0.84 to 2.08), p=0.21]. ΔPaO2/FiO2 at day 5 was significantly higher in the tocilizumab group compared to the usual care group [42.0 (95%CI: 23.0 to 84.7) vs 15.8 (95%CI: -19.4 to 50.3), p=0.03]. ΔWHO scale at day 10 was significantly lower in the tocilizumab group compared to the usual care group (-0.5±2.1 vs 0.6±2.6, p=0.005). Conclusion: This is the first study administrating tocilizumab in patients with COVID-19 based on PaO2/FiO2. Tocilizumab improved survival and other clinical outcomes in hospitalized patients with COVID-19 and PaO2/FiO2<200 irrespective of systemic inflammatory markers levels.

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Increased Red Cell Distribution Width Is Associated With Disease Severity in Hospitalized Adults With SARS-CoV-2 Infection: An Observational Multicentric Study

Cited by 27 publications

References 17 publications

Evaluating red blood cell distribution width from community blood tests as a predictor of hospitalization and mortality in adults with SARS-CoV-2: a cohort study

Evaluating red blood cell distribution width from community blood tests as a predictor of hospitalization and mortality in adults with SARS-CoV-2: a cohort study

Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience

Tocilizumab in Hospitalized Patients with Severe COVID-19: An Open Label, Prospective Study

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