Diagnostic Accuracy of the RDW for Predicting Death in COVID-19

Ratio of red blood cell distribution width to albumin: a predictive biomarker of In-hospital mortality in heart failure patients

BACKGROUND

The ratio of red blood cell distribution width (RDW) to albumin (ALB), known as RAR, functions as an innovative indicator related to prognosis. However, whether RAR can predict the in-hospital mortality (IHM) for heart failure (HF) patients remains ambiguous.

METHODS

This study included HF patients derived from the Medical Information Mart for Intensive Care III (MIMIC-III) and IV (MIMIC-IV) databases. To examine the association between RAR and IHM, multiple Logistic regression models were conducted, complemented by subgroup analyses. Additionally, to ascertain the optimal threshold for RAR, restricted cubic spline (RCS) regressions were applied.

RESULTS

In the MIMIC-III (n = 9,413) and MIMIC-IV (n = 18,685) HF cohorts, the incidence of IHM was observed in 1,639 (17.41%) and 1,175 (6.29%) participants. Following adjustment for various covariates, RAR was shown to correlate with IHM (OR, 1.45 [95% CI, 1.08-1.39]). The areas under the curves for RAR were 0.683 (MIMIC-III) and 0.710 (MIMIC-IV), indicating superior predictive value than RDW and ALB. In subgroup analysis, younger HF patients with diabetes and without atrial fibrillation or anaemia showed higher ORs than older patients without diabetes or atrial fibrillation and those with anaemia, respectively. RCS indicated the OR for RAR was non-linear with IHM, and the optimal threshold for RAR prediction was between 4.5 and 5.

CONCLUSION

An elevated RAR correlates with an increased risk of IHM in HF patients. Given that RAR can be readily derived from routine laboratory tests, it holds potential as a novel biomarker for identifying high-risk HF patients.

The value of preoperative RDW for post-pancreatectomy haemorrhage and surgical prognosis in patients with pancreatic cancer: a retrospective study

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, and only some patients can receive surgical treatment. Complex surgical procedures combined with various postoperative complications seriously affect the prognosis of patients. It is very important to use appropriate biomarkers to prevent and predict the occurrence of complications. On the basis of our previous attention to red blood cell distribution width (RDW), this study aimed to investigate the correlation between RDW and the prognosis of pancreatic cancer patients.

METHODS

Patients who underwent elective radical resection of pancreatic tumors from January 2017 to June 2021 were retrospectively analyzed. Relevant clinical data were collected to evaluate the correlation between preoperative absolute RDW changes and post-pancreatectomy haemorrhage and clinical outcomes.

RESULTS

A total of 2268 patients were analyzed. We found that the preoperative RDW, preoperative LMR, anesthesia method, operation method, preoperative jaundice, operation with NSAIDs, and intravenous administration in patients with PDAC were significantly correlated with the infusion of albumin and R colloidal/crystal and post-pancreatectomy haemorrhage (PPH). In addition, sensitivity analysis revealed that preoperative RDW was associated with 30-day survival (P = 0.026), whereas PPH had a significant effect on in-hospital outcomes (P = 0.002), 30-day outcomes (P < 0.001) and 90-day outcomes (P < 0.001).

CONCLUSION

The preoperative RDW may be a useful marker for predicting and evaluating PPH and short-term prognosis in patients with PDAC.

Modified Early Warning Score (MEWS) combined with biomarkers in predicting 7-day mortality in traumatic brain injury patients in the emergency department: a retrospective cohort study

Background

Traumatic brain injury (TBI) is a leading cause of injury-related disability and death globally, which negatively affects individuals, families, and society. Predicting the risk for mortality among TBI patients is crucial in guiding further timely and effective treatment plans. Both the standard risk assessment tools and blood-based biomarkers are helpful in predicting outcomes among TBI patients. However, no studies have compared the predicting performance of the individual and combined indicators from the two major types.

Aim

This study aimed to compare the Modified Early Warning Score (MEWS), Red blood cell distribution width (RDW), and creatine in predicting 7-day mortality among TBI patients.

Methods

A retrospective study was conducted in the emergency department of the First People's Hospital of Changde, China, from January 1, 2023, to June 30, 2023. Data of 1,701 patients with TBI were obtained from the hospital's electronic medical records. A logistic regression model was used to determine independent factors influencing 7-day mortality. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was calculated to compare the individual and combined effects of MEWS, RDW, and creatine in predicting 7-day mortality based on bootstrap resampling (500 times).

Results

Among the 1,701 patients, 225 died, with a mortality rate of 13.23%. The multivariate analysis showed that the type of TBI lesion, MEWS, SBP, DBP, MAP, SpO2, temperature, RDW, and creatine were significantly associated with 7-day mortality. MEWS (AUC: 0.843) performed better than RDW (AUC: 0.785) and creatine (AUC: 0.797) in predicting 7-day mortality. MEWS+RDW (AUC: 0.898) performed better than MEWS+creatine (AUC: 0.875) and RDW+ creatine (AUC: 0.822) in predicting 7-day mortality. The combination of all three indicators, MEWS+RDW+creatine, showed the best predicting performance (AUC: 0.906).

Conclusion

MEWS performed best in predicting the 7-day mortality of TBI patients, and its predicting performance was improved when combined with blood-based biomarkers such as RDW and creatine. Our findings provide preliminary evidence supporting the combination of MEWS with blood-based biomarkers as a new method for predicting 7-day mortality in patients with TBI.

Exploring the hemoglobin-to-red blood cell distribution width ratio (HRR) to peripheral arterial disease nexus: a comprehensive analysis of NHANES data from 1999 to 2004

Objective

This study aimed to investigate the correlation between the Hemoglobin-to-Red Blood Cell Distribution Width Ratio (HRR) and Peripheral Artery Disease (PAD) prevalence, utilizing data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004.

Methods

The study employed a cross-sectional design, analyzing data from 5,196 participants aged 40 and above. PAD was diagnosed using the Ankle-Brachial Index (ABI), with ABI less than 0.9 indicating PAD. HRR, calculated as the ratio of hemoglobin (HB) to red blood cell distribution width (RDW), was stratified into quartiles. Covariates included demographic and clinical variables such as BMI, lipid profiles, and diabetes status. Logistic regression analysis was conducted to assess the relationship between HRR and PAD, adjusting for potential confounders.

Results

The study found that higher HRR quartiles were associated with a decreased risk of PAD. After adjusting for confounders, the odds ratios for PAD in relation to the second, third, and fourth quartiles of HRR compared to the first quartile were 0.71, 0.62, and 0.44, respectively (P < 0.001). A one-unit increase in HRR corresponded to a 56% reduction in the probability of PAD. ROC analysis indicated HRR as a stronger protective factor for PAD compared to other variables. Stratified analyses revealed that younger age and lower BMI amplified the protective effect of HRR on PAD.

Conclusion

The study demonstrated a significant inverse relationship between HRR and PAD, suggesting that HRR may serve as a protective factor against PAD. This finding highlights the potential role of HRR in the pathogenesis of PAD and its clinical implications.

Red cell distribution width-to-platelet ratio (RPR) as a predictor of prolonged stay at hospital for COVID-19 inpatients

AIMS/BACKGROUND

We looked at novel hematological composites like the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, red cell distribution width-to-lymphocyte ratio, red cell distribution width-to-platelet ratio, leukocyte-to-C reactive protein ratio, and lymphocyte-to-C reactive protein ratio as explanatory variables for COVID-19 patients´ hospital length of stay (LoS).

METHODS

The association of hematological indices with LoS was analyzed on 2930 COVID-19 patients using the univariate and multivariable Cox proportional hazards regression models with enter method. The Kaplan-Meier survival estimates were applied to LoS.

RESULTS

The survivors´ mean LoS was 7.8 ± 24.0 days, but the deaths´ mean LoS was 38.6 ± 41.9 days (W = 31338, p < 0.01). Every hematological scores representative of the inflammatory status was significantly correlated in the univariate analysis with a prolonged LoS (p < 0.001). In the multivariate analysis, it was discovered that just the monocyte-to-lymphocyte and lymphocyte-to-C reactive protein ratios had not achieved statistical significance. However, most systemic inflammation measures showed hazards ratios close to one. One exemption was the red cell distribution width-to-platelet ratio (RPR) index, which can increase the probability of a longer hospital stay by up to ten times (HR(IC95%) = 0.092(0.03-0.29); p < 0.001).

CONCLUSION

The most effective biomarker to identify COVID-19 patients at high risk for extended hospital stay was RPR.

HIGHLIGHTS

IntroductionDetermining hospital Length of Stay (LoS) is vital for resource management, especially for future COVID-19 outbreaks.Previous studies have primarily focused on sociodemographic and clinical attributes, along with resource availability, but have not accounted for other factors like routine laboratory tests, which can significantly impact LoS predictions.This study examines novel hematology scores as predictors of LoS, emphasizing their importance in resource-limited settings like Ecuador.MethodsThis retrospective cohort study analyzed 2,930 COVID-19 patients admitted to Hospital IESS Quito Sur in Ecuador focusing on confirmed cases with complete blood count (CBC) values to assess LoS.The study explored various hematological ratios, such as the neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width-to-lymphocyte ratio (RLR), as potential predictors of LoS and in-hospital outcomes for COVID-19 patients, using a combination of univariate and multivariable Cox proportional hazards regression models.Kaplan-Meier survival estimates and log-rank tests were used to analyze survival and discharge probabilities over time, highlighting sex-dependent effects and the significant association between selected hematological indices and patient outcomes.ResultsThe mean LoS for survivors was significantly shorter compared to those who died (p < 0.001), indicating that longer hospitalization was associated with higher mortality risk.Women had a shorter average LoS (with lower mortality risk (p < 0.001), suggesting an asymmetrical hospitalization pattern based on sex.While most hematological markers had minimal clinical relevance for LoS, the red cell distribution width-to-platelet ratio (RPR) stood out, increasing the likelihood of a longer hospital stay by up to tenfold, making it a critical factor in predicting prolonged hospitalization.DiscussionMen had longer hospital stays and higher mortality rates than women, likely due to differing inflammatory responses, though hyperinflammation markers like NLR, PLR, and Leu-CPR had minimal clinical impact.RPR had the strongest link to longer hospital stays, indicating a higher risk of extended hospitalization in severe COVID-19 cases.Elevated RPR is tied to oxidative stress and coagulation issues, suggesting early identification could help reduce prolonged stays and complications.ConclusionResearch generally points to clinical complications from COVID-19 as the main factor behind prolonged hospitalizations, underlining the importance of early identification and management of these issues.

Accounting for Red Cell Distribution Width Improves Risk Stratification by Commonly Used Mortality/Deterioration Risk Scores in Adult Patients Hospitalized Due to COVID-19

Higher red blood cell distribution width (RDW) levels have gained attention in the prognostication of many chronic metabolic and malignant diseases, as well as coronavirus disease 2019 (COVID-19). We aimed to evaluate whether accounting for RDW might contribute to risk stratification when added to commonly used risk scoring systems in adult COVID-19 patients. We retrospectively analyzed a cohort of 3212 non-critical COVID-19 patients hospitalized in a tertiary-level institution from March 2020 to June 2021. Admission RDW values were considered normal if they were ≤14.5% in males or ≤16.1% in females. The Modified Early Warning Score (MEWS), International Severe Acute Respiratory and Emerging Infections Consortium Coronavirus Clinical Characterisation Consortium score (ISARIC 4C), and Veterans Health Administration COVID-19 (VACO) index were evaluated as prognostic scores. RDW exceeded the upper limit in 628 (19.6%) of the patients. When RDW was accounted for, risks of the predicted outcomes were considerably different within the same MEWS, 4C score, and VACO index levels. The same patterns applied equally to patients who started, and those who did not start, remdesivir before deterioration. RDW may be a useful tool for stratifying risk when considered on top of commonly used prognostic scores in non-critical COVID-19 patients.

Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit

BACKGROUND

Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.

METHODS

This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.

RESULTS

The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54-8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59-8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).

CONCLUSIONS

Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.

Analysis of Risk Factors for Death in the Coronavirus Disease 2019 (COVID-19) Population: Data Analysis from a Large General Hospital in Anhui, China

During the coronavirus disease 2019 (COVID-19) pandemic, clinical prevention, early diagnosis, and hematological monitoring were challenging areas. This study aims to compare risk factors and hematological and biochemical data in non-survivor group patients with COVID-19 versus survivor group patients. A total of 204 patients with COVID-19 were selected as research subjects from December 2022 to January 2023. We analyzed the age, sex, time from onset to admission, and laboratory test indicators upon admission. The differences between surviving and deceased patients and mortality-related risk factors were examined. Among the 204 patients, 168 survived, whereas 36 died during hospitalization. Significant differences were observed between the two groups with COVID-19 across various factors, including age (p < 0.0001), WBC count (p < 0.0001), RBC count (p < 0.05), neutrophils (p < 0.0001), lymphocytes (p < 0.05), mean corpuscular hemoglobin concentration (MCHC) (p < 0.0001), RBC distribution width-standard deviation (RDW-SD) (p < 0.0001), RBC distribution width coefficient of variation (RDW-CV) (p < 0.0001), aspartate aminotransferase (AST) (p < 0.05), albumin (ALB) (p < 0.0001), creatinine (CR) (p < 0.0001), uric acid (UA) (p < 0.0001), blood urea nitrogen (BUN) (p < 0.0001), plasma thrombin time (TT) (p < 0.05), prothrombin time (PT) (p < 0.0001), and D-dimer (p < 0.0001). Multivariate logistic analysis revealed that older age, CR, UA, and ALB were independent factors associated with death (p < 0.05). Elderly patients with underlying diseases, abnormal routine blood test indices, and abnormal renal function and coagulation indices are at an increased worse prognosis and should be identified early. Age, UA, CR, and ALB can be used as predictors to assess the worse prognosis in the hospital.

Promising applications of red cell distribution width in diagnosis and prognosis of diseases with or without disordered iron metabolism

Many indicators, including red cell distribution width (RDW) and iron metabolism, are sensitive to a variety of risk factors, and are associated with the pathological alterations and disease onset. RDW reflects the degree of heterogeneous volumes of peripheral red blood cells (RBCs). It has been well-known that increased RDW indicates iron deficiency anemia, hemolytic anemia, ineffective erythropoiesis, and shorten lifespan of RBCs. Increased RDW is also prevalent in various non-anemic pathological conditions and diseases. We here review the factors affecting RDW, particularly disordered iron metabolism, chronic inflammation, and oxidative stress, and recapitulate the interplays among these factors. Furthermore, we review the application of increased RDW together with disordered iron homeostasis and the deregulations of hepcidin expression and ferritin levels in the diagnoses and prognosis of anemic and nonanemic diseases. RDW is inexpensive and readily available and may be valuable in adding to the diagnosis and monitoring of many pathological conditions. RDW combined with other indicators, for example, hepcidin and ferritin levels, should be utilized more frequently in clinical practice.

The potential role of ischaemia-reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Ischaemia-reperfusion (I-R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I-R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.