Red Cell Distribution Width Is Associated with All-Cause and Cardiovascular Mortality in Patients with Diabetes

Abstract

Background and Methods Red cell distribution width (RDW) has emerged as a prognostic marker in patients with cardiovascular diseases. We investigated mortality in patients with diabetes included in the National Health and Nutrition Examination Survey, in relation to baseline RDW. RDW was divided into 4 quartiles (Q1: ≤12.4%, Q2: 12.5%–12.9%, Q3: 13.0%–13.7%, and Q4: >13.7%). Results A total of 3,061 patients were included: mean age 61 ± 14 years, 50% male, 39% White. Mean RDW was 13.2% ± 1.4%. Compared with first quartile (Q1) of RDW, patients in Q4 were more likely to be older, female, and African-American, have had history of stroke, myocardial infarction, and heart failure, and have chronic kidney disease. After a median follow-up of 6 years, 628 patient died (29% of cardiovascular disease). Compared with Q1, patients in Q4 were at increased risk for all-cause mortality (HR 3.44 [2.74–4.32], P < .001) and cardiovascular mortality (HR 3.34 [2.16–5.17], P < .001). After adjusting for 17 covariates, RDW in Q4 remained significantly associated with all-cause mortality (HR 2.39 [1.30–4.38], P = 0.005) and cardiovascular mortality (HR 1.99 [1.17–3.37], P = 0.011). Conclusion RDW is a powerful and an independent marker for prediction of all-cause mortality and cardiovascular mortality in patients with diabetes.

Correlation Between Red Cell Distribution Width and Peripheral Vascular Disease Severity and Complexity

“…Since 2007, numerous studies have been performed regarding the prognostic value of RDW. Red cell distribution width was found to be a predictor of cardiovascular and all-cause mortality [8]. Patients with a higher RDW percentile tend to have more prevalent atherosclerotic process.…”

“…Red cell distribution width was a predictor for acute coronary syndromes and also chronic stable coronary heart disease. Red cell distribution predicts both short term and long-term mortality in vascular diseases [1,6,7,8,16,23].…”

“…Clinical usefulness of the RDW has increased in the last 10 years, since it was reported that RDW could be a prognostic factor in the various diseases, as well as all-cause mortality [1]. Correlation between RDW and atherosclerotic vascular disease was clearly reported in numerous studies [2,3,4,5,6,7,8,9,10,11,12,13,14]. The indicator of atherosclerotic process, carotid plaque and increased carotid intima/media thickness, in asymptomatic patients was associated with higher RDW percentile [2].…”

“…The correlation between RDW and coronary atherosclerosis was also clearly demonstrated [1,6]. Subjects with higher RDW levels tend to have higher mortality regarding coronary artery disease [7,8,9]. There was also linkage between the extent and complexity of the coronary artery disease and RDW levels.…”

Red cell distribution width as a prognostic marker in diabetes; a pilot cross-sectional study

“…RDW higher than 15% was associated with approximately 10-fold increase in mortality, thus serving as a powerful tool for risk stratification in this high-risk group. The change in RDW could potentially serve as a surrogate marker for all-cause and cardiovascular mortality that could be used in pilot studies of primary and secondary prevention of CVD in diabetes (14).…”