Prognostic role of red blood cell distribution width in patients with sepsis: a systematic review and meta-analysis

Abstract

Background Outcome prediction for patients with sepsis may be conductive to early aggressive interventions. Numerous biomarkers and multiple scoring systems have been utilized in predicting outcomes, however, these tools were either expensive or inconvenient. We performed a meta-analysis to evaluate the prognostic role of red blood cell distribution width (RDW) in patients with sepsis. Methods The online databases of Embase, Web of science, Pubmed, Corchrane library, Chinese Wanfang database, CNKI database were systematically searched from the inception dates to June, 24th, 2020, using the keywords red cell distribution width and sepsis. The odds ratio (OR) or Hazards ratio (HR) with corresponding 95% confidence intervals (95%CI) were pooled to evaluate the association between baseline RDW and sepsis. A random-effects model was used to pool the data, and statistical heterogeneity between studies was evaluated using the I2 statistic. Sensitivity and subgroup analyses were performed to detect the publication bias and origin of heterogeneity. Results Eleven studies with 17,961 patients with sepsis were included in the meta-analysis. The pooled analyses indicated that increased baseline RDW was associated with mortality (HR = 1.14, 95%CI 1.09–1.20, Z = 5.78, P < 0.001) with significant heterogeneity (I2 = 80%, Pheterogeneity < 0.001). Similar results were found in the subgroup analysis stratified by site of infection, comorbidity, Newcastle-Ottawa Scale (NOS) score, study design, patients’ country. The predefined subgroup analysis showed that NOS score may be the origin of heterogeneity. Conclusions For patients with sepsis, baseline RDW may be a useful predictor of mortality, patients with increased RDW are more likely to have higher mortality.

Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units

“…This study presents some limitations including the need to evaluate the possible integration of the MDW information with other hematological indices. In particular, recently published systematic reviews highlight the prognostic value of another hematological index that is the red blood cell distribution width (RDW) that has been found may be a useful predictor of mortality [28,29].…”

Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

“…While RDW values below the normal range are extremely rare in clinical practice, and of dubious significance, values above this range are commonly observed in a number of physiological and pathological states [ 10 , 12 ]. Furthermore, and perhaps more importantly, higher RDW values have been shown to independently predict adverse clinical outcomes in systematic reviews and meta-analyses focusing on specific disease states, particularly hematological malignancies, solid cancers, heart failure, ischemic heart disease, stroke, critical illness, and sepsis [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. However, it is not possible to compare the effect size between our meta-analysis and these studies as the results in the latter were expressed as risk ratio, odds ratio, or hazard ratio.…”

“…The latter has been proposed to occur in the setting of a concomitant increased leukocyte and/or platelet production in pro-inflammatory states [ 10 ]. Given that the RDW has been shown to have a good predictive capacity toward adverse clinical outcomes in several acute and chronic disease states [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], we conducted a systematic review and meta-analysis of the available evidence on the association between the RDW and measures of disease severity and survival status specifically in patients with SARS-CoV-2 infection.…”

Red Blood Cell Distribution Is a Significant Predictor of Severe Illness in Coronavirus Disease 2019

“…There is already consolidated evidence that the measurement of RDW represents a valuable aid for diagnosing, prognosticating, monitoring, and guiding the therapeutic management of a kaleidoscope of human pathologies [5,6], including critical illnesses [7]. An inspired meta-analysis, published by Zhang et al [8], recently showed that an RDW value exceeding its diagnostic threshold is a significant and independent predictor of mortality in patients with respiratory tract infections (HR = 1.15; 95% CI 1.10-1.20). This analysis confirmed similar findings in critically ill patients undergoing mechanical ventilation in the ICU [9] and persuaded us to perform a critical analysis of the current scientific literature to explore the potential prognostic role of this laboratory parameter in COVID-19.…”