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

Abstract

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.

Hematological Parameters and Inflammatory Markers in Children with Multisystem Inflammatory Syndrome

“…RDW reflects the heterogeneity of erythrocyte volume and assess the variation in size and form of circulating erythrocytes. The increase in RDW reflects the increase in other inflammatory markers in the blood (16). Cytokines may directly inhibit erythropoietin-induced erythrocyte maturation which leads to an increase in RDW (17).…”

Role of red blood cell distribution width, as a prognostic indicator in COVID‐19: A systematic review and meta‐analysis

“…25 studies 33–57 out of 1,008 identified publications were incorporated according to the inclusion criteria (Figure 1; Table 1). 19 articles were peer‐reviewed and 6 were preprints 35–37,40,45,53 .…”

Red blood cell distribution width: A severity indicator in patients with COVID‐19

“…There were several studies that defined ≥14.5% as the abnormally elevated RDW, and have demonstrated good predictive performance in terms of unfavorable clinical outcomes. 15 , 16 , 17 , 18 However, some studies found that cutoff values from different centers might vary—ranging from 12.85% to 14.35%. 19 , 20 , 21 , 22 The cutoff value generated in our study population was 11.5%, which was close to Wang et al 21 Whether the minor difference between the cutoff values of our study and Wang et al's study was significant required further investigations.…”

“…Currently, there was no consensus on the optimal cutoff of RDW. There were several studies that defined ≥14.5% as the abnormally elevated RDW, and have demonstrated good predictive performance in terms of unfavorable clinical outcomes 15–18 . However, some studies found that cutoff values from different centers might vary—ranging from 12.85% to 14.35% 19–22 .…”