The role of serum red blood cell distribution width level in predicting the short term mortality of community-acguired pneumonia, acute attack chronic pulmonary disease, and acute pulmonary thromboembolism

Abstract

Background: There is a growing concern in inflammatory parameters that are commonly used in routine practice and can be measured cost-effectively for predicting mortality community-acquired pneumonia (CAP), acute-attack chronic obstructive pulmonary disease (COPD), and acute pulmonary thromboembolism (PTE). Red blood cell distribution width (RDW) is a significant parameter indicating the heterogeneity of the size of red blood cells (RBCs). The present study was designed to compare RDW levels among patients that were hospitalized due to CAP, acute PTE, and acute-attack COPD, all of which are characterized by persistent inflammation, and to investigate the role of RDW in predicting 30-day mortality. Materials and Methods: The RDW levels measured on admission in all three groups were evaluated retrospectively. Results:The 554 patients comprised 320 (57.76%) men and 234 (42.24%) women with a mean age of 67.074±14.73 years. The patients comprised 92 (16.6%) CAP, 265 (47.8%) acute PTE, and 197 (35.6%) acute-attack COPD patients. Mean RDW was 14.42%±2.73% (range, 3.77-28%) while it was 14.88%±3.30% in the CAP group, 13.21%±2.77% in the COPD group, and 15.15%±2.12% in the PTE group. In the COPD, CAP, and PTE groups, RDW levels were significantly higher in patients with 30-day mortality compared to those without mortality (p=0.008, p=0.020, and p<0.05, respectively). Conclusion: RDW is a practical, inexpensive and automatically reported blood test parameter which can be used along with scoring systems in the prediction of prognosis and ICU requirement and also in the follow-up of patients with diseases that are characterized by persistent inflammation in their pathophysiology.

Keywords

• RDW
• COPD
• CAP
• PTE

References

1. Mandell LA, Wunderink RG, Anzuwto A, et al. Infectious Diseases Society of America/America Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-72.
2. Saar JA, Maack C. Diagnosis and management of acute pulmonary embolism. ESC guidelines 2014. Herz 2015; 40: 1048-54.
3. Konstantinides SV, Meyer G, Becattini C, et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 9: 54.
4. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from: http://goldcopd.org.
5. Hammons L, Filopel J, Steiger D, Bondarsky E. A narrative review of red blood cell distribution width as a marker for pulmonary embolism. J Thromb Thrombolysis 2019; 48: 638-47.
6. Han YQ, Yan L, Zhang L, et al. Red blood cell distribution width provides additional prognostic value beyond severity scores in adult critical illness. Clin Chim Acta 2019; 498: 62-7.
7. Ge YL, Liu CH, Rana MA, et al. Elevated red blood cell distribution width combined white blood cell in peripheral blood routine have a better sensivity than CURB-65 Scores in Predicting ICU Admission and Mortality in Adult Community-Acguired Pneumonia Patients. Clin Lab 2019; 1: 65.
8. Hu GP, Zhou YM, Wu ZL, et al. Red blood cell distribuiton width is an independent predictor of mortality for an acute exacerbation of COPD. Int J Tuberc Lung Dis 2019; 23: 817-23.

9. Han YQ, Zhang L, Yan L, et al. Red blood cell distribution width predicts long-term outcomes in sepsis patients admitted to the intensive care unit.Clim Chim Acta 2018; 487: 112-6.
10. Zhou XY, Chen HL, Ni SS. Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism. Journal of Critical Care 2017; 37: 197-201.
11. Park S, Lee SJ, Shin B, et al. The association of delta neutrophil index with the prognosis of acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2020; 20: 47.
12. Crisafulli E, Manco A, Torres A. How may we improve clinical outcomes for patients hospitalizes with acute exacerabtions of chronic obstructive pulmonary disease? A narrative review about possible therapeutic and preventive strategies.Expert Rev Respir Med 2020; 14: 493-500.
13. Viasus D, Del RP, Simonetti AF, et al. Biomarkers for predicting short-term mortality in community-acguired pneumonia: A systematic review and meta-analysis. J Infect 2016; 72: 273-82.
14. Huang Y, Liu A, Liang L, et al. Diagnostic value of blood parameters for commnutiy-acguired pneumonia. Int Immunopharm 2018; 64: 10-15.
15. Lippi G, Plebani M. Red blood cell distribution width (RDW) and human pathology. One size fits all. Clin Chem Lab Med 2014; 52: 1247-9.
16. Mahmood NA, Mathew J, Kang B, et al. Broadening of the red blood cekk distribution width is associated with increased severity of illness in patients with sepsis. Int J Crit Illn Inj Sci 2014; 4: 278-82.
17. Hu ZD, Lippi G, Montagnana M. Diagnostic and prognostic value of red blood cell distribution width in sepsis: A narrative review. Clin Biochem 2010; 77: 1-6.
18. Jiang Y, Jiang FQ, Kong F, et al. Inflammatory anemia-associated parameters are related to 28- day mortality in patients with sepsis admitted to the ICU: a preliminary observational study. Ann Intensive Care 2019; 9: 67.
19. Gorelik O, Izhakian S, Barchel D, et al. Changes in red cell distribution width during hospitalization for community-acguired pneumonia: clinical characteristic and prognostic significance. Lung 2016; 194: 985-95.
20. Orfanu AE, Popescu C, Leuştean A, et al. The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients. J Crit Care Med 2017; 3: 105-10.
21. Karampitsakos T, Dimakou K, Papaioannou O, et al. The role of increased red cell distribution width as a negative prognostic marker in patients with COPD. Pulm Pharmacol Ther 2020; 60: 101877.
22. Tertemiz KC, Alpaydın AO, Sevinc C, et al. Could “red cell distribution width” predict COPD severity ?Rev Port Pneumol 2016; 22: 196-201.
23. Grant BJ, Kudalkar DP, Muti P, et al. Relation between lung function and RBC distribution width in a population-based study. Chest 2002; 124: 494-500.
24. Epstein D, Nasser R, Mashiach T, et al. Increased red cell distribution width: A novel predictor of adverse outcome in patients hospitalized due to acute exacerbation of chronic obstructive pulmonary disease. Respir Med 2018; 136: 1-7.
25. Ycas JW, Horrow JC, Horne BD. Persistent increase in red cell size distribution width after acute diseases: A biomarker of hypoxemia? Clin Chim Acta 2015; 448: 107-17.