Red cell distribution width and mortality in older patients with frailty in the emergency department

Abstract

Background The red cell distribution width (RDW) reflects the degree of heterogeneity of red blood cells. Elevated RDW is associated both with frailty and with increased mortality in hospital-admitted patients. In this study we evaluate whether high RDW values are associated with mortality in older emergency department (ED) patients with frailty, and if the association is independent of the degree of frailty. Methods We included ED patients with the following criteria: ≥ 75 years of age, Clinical Frailty Scale (CFS) score of 4 to 8, and RDW % measured within 48 h of ED admission. Patients were allocated to six classes by their RDW value: ≤ 13%, 14%, 15%, 16%, 17%, and ≥ 18%. The outcome was death within 30 days of ED admission. Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for a one-class increase in RDW for 30-day mortality were calculated via binary logistic regression analysis. Age, gender and CFS score were considered as potential confounders. Results A total of 1407 patients (61.2% female), were included. The median age was 85 with an inter-quartile range (IQR) of 80–89, median CFS score 6 (IQR: 5–7), and median RDW 14 (IQR: 13–16). Of the included patients, 71.9% were admitted to hospital wards. A total of 85 patients (6.0%) died during the 30-day follow-up. Mortality rate was associated with RDW increase (p for trend < .001). Crude OR for a one-class increase in RDW for 30-day mortality was 1.32 (95% CI: 1.17–1.50, p < .001). When adjusted for age, gender and CFS-score, OR of mortality for one-class RDW increase was still 1.32 (95% CI: 1.16–1.50, p < .001). Conclusion Higher RDW values had a significant association with increased 30-day mortality risk in frail older adults in the ED, and this risk was independent of degree of frailty. RDW is a readily available biomarker for most ED patients. It might be beneficial to include it in risk stratification of older frail ED patients to identify those who could benefit from further diagnostic assessment, targeted interventions, and care planning.

Preoperatively-determined Red Distribution Width (RDW) predicts prolonged length of stay after single-level spinal fusion in elderly patients

“…However, the frailty status can significantly influence surgical outcomes and complications. Alkare et al have shown that high RDW values are associated with frailty in elderly patients at an emergency departments and are associated with a higher mortality-rate ( Alakare et al, 2023 ). The authors think that it might be beneficial to include RDW in risk stratification models of elderly patients' prior lumbar fusion surgery to identify patients with extended lengths of stay.…”

“…Several hypotheses exist for how erythrocyte heterogeneity is associated with frailty and adverse outcomes in patients ( Alakare et al, 2023 ). These include compromised erythropoiesis and reduced lifespan of red blood cells due to organ dysfunction, metabolic disturbances, oxidative stress, and inflammatory responses, which lead to variations in red cell volumes.…”

“…Furthermore inadequate nutrition and erythrocyte fragmentation have been identified as potential causes for elevated RDW. Also a long-term clinical deterioration due to telomere shortening, indicative of cellular ageing is correlating with the mean corpuscular volume may be reflected in elevated RDW levels ( Alakare et al, 2023 ; Salvagno et al, 2015b ; Pan et al, 2019 ; Kim et al, 2022 ).…”

Association Between Hemoglobin-to-Red Cell Distribution Width Ratio and Bone Mineral Density in the Elderly in the United States: Evidence from NHANES

“…Previous research has shown that osteoporosis is associated with aging, low Body Mass Index (BMI) [7], low vitamin D levels [8],increased pro-in ammatory factors [9], and poor nutritional status [10]. Additionally, past research suggests that anemia is linked to a higher risk of osteoporosis and fractures [15], with studies in the aging population revealing a notable correlation between Hemoglobin (Hb) levels and bone density [14] [29][36]. Higher Hb levels have been shown to exert a preventive effect on osteoporosis [11][12] [13], although the underlying mechanism of this in uence is not yet fully understood.…”

Red cell distribution width in cardiac diseases: Role of hemorheology and chronic inflammation

“…Along with the appearance of superaged societies in modern countries, cardiac diseases are based not only on the conventional cardiovascular (CV) risk factors (hyper tension, diabetes, dyslipidemia, obesity, and smoking) but also on the newly recognized risk factors such as frailty and sarcopenia. Such pathological senile conditions are com monplace of many CV disorders, and higher RDW in the elderly is associated with adverse outcomes such as frailty, impaired cognitive functions, hospitalization, and higher mortality [4,5]. Therefore, this review introduces the prin ciple, evaluation, and current concept of RDW and summa rizes the importance of RDW in some CV diseases affecting on the elderly.…”