Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 1 ( January, 2020 ) > List of Articles

REVIEW ARTICLE

Red Cell Distribution Width as a Novel Prognostic Marker in Multiple Clinical Studies

Bahman Yousefi, Sarvin Sanaie, Ali A Ghamari, Hassan Soleimanpour, Ansar Karimian, Ata Mahmoodpoor

Keywords : Hemoglobin, Prognosis, Red cell distribution width

Citation Information : Yousefi B, Sanaie S, Ghamari AA, Soleimanpour H, Karimian A, Mahmoodpoor A. Red Cell Distribution Width as a Novel Prognostic Marker in Multiple Clinical Studies. Indian J Crit Care Med 2020; 24 (1):49-54.

DOI: 10.5005/jp-journals-10071-23328

License: CC BY-NC 4.0

Published Online: 00-01-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Red cell distribution width (RDW), which is a quantitative method applied for the measurement of anisocytosis, is the most reliable and inexpensive method for differentiation of iron deficiency anemia and thalassemia trait. An increase in its rate reflects a great heterogeneity in the size of red blood cells (RBCs). Recent studies have shown a significant relationship between RDW and the risk of morbidity and mortality in patients with multiple diseases. A strong association is established between changes in RDW and the risk of adverse outcome in patients with heart failure in multiple studies. In this review, we try to focus on the association and correlation between the increase in RDW and different outcomes of common diseases that may be related to RDW and based on the results of various studies, we are trying to introduce RDW as a diagnostic indicator for these diseases.


  1. Alcaíno H, Pozo J, Pavez M, Toledo H. Red cell distribution width as a risk marker in patients with cardiovascular diseases. Rev Med Chil 2016;144(5):634–642. DOI: 10.4067/S0034-98872016000500012.
  2. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med 2012;50:635–641.
  3. Lippi G, Mattiuzzi C, Cervellin G. Learning more and spending less with neglected laboratory parameters: the paradigmatic case of red blood cell distribution width. Acta Biomed 2017;87(3):323–328.
  4. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015;52(2):86–105. DOI: 10.3109/10408363.2014.992064.
  5. Patel KV, Mohanty JG, Kanapuru B, Hesdorffer C, Ershler WB, Rifkind JM. Association of the red cell distribution width with red blood cell deformability. Adv Exp Med Biol 2013;765:211–216.
  6. Lippi G, Salvagno GL, Guidi GC. Red blood cell distribution width is significantly associated with aging and gender. Clin Chem Lab Med 2014;52:e197–e199.
  7. Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, et al. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci 2010;65:258–265.
  8. Alis R, Fuster O, Rivera L, Romagnoli M, Vaya A. Influence of age and gender on red blood cell distribution width. Clin Chem Lab Med 2015;53(2):e25–e28. DOI: 10.1515/cclm-2014-0756.
  9. Qiang P, Hai S, Ji-Wei W, Qing-Hua W, Xiao-shu C. The gender differences of red blood cell distribution width in patients with coronary heart disease. Heart 2010;96(Suppl 3):A188.
  10. Hoffmann JJ, Nabbe KC, van den Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV). Clin Chem Lab Med 2015;53(12):2015–2019. DOI: 10.1515/cclm-2015-0155.
  11. Liu S, Wang P, Shen PP, Zhou JH. Predictive values of red blood cell distribution width in assessing severity of chronic heart failure. Med Sci Monit 2016;22:2119–2125. DOI: 10.12659/MSM.898103.
  12. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM program and the Duke databank. J Am Coll Cardiol 2007;50(1):40. DOI: 10.1016/j.jacc.2007.02.067.
  13. Ark HYV. Red cell distribution width predicts length of stay in patients with acutely decompensated heart failure. Eur J Health Sci 2015;1(1):1–8.
  14. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 2008;117:163–168. DOI: 10.1161/CIRCULATIONAHA.107.727545.
  15. Sun XP, Chen WM, Sun ZJ, Ding XS, Gao XY, Liang SW, et al. Impact of red blood cell distribution width on long-term mortality in patients with ST-elevation myocardial infarction. Cardiology 2014;128(4):343–348. DOI: 10.1159/000359994.
  16. Tunçez A, Çetin MS, Çetin EH, Ylmaz S, Korkmaz A, Uçar FM. Association between RDW and stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Medicine 2017;96:e5986. DOI: 10.1161/CIRCULATIONAHA.107.727545.
  17. Skjelbakken T, Lappegård J, Ellingsen TS, Barrett-Connor E, Brox J, Løchen ML, et al. Red cell distribution width is associated with incident myocardial infarction in a general population: The Tromsø Study. J Am Heart Assoc 2014;3:845–847. DOI: 10.1161/JAHA.114.001109.
  18. Chen PC, Sung FC, Chien KL, Hsu HC, Su TC, Lee YT. Red blood cell distribution width and risk of cardiovascular events and mortality in a community cohort in Taiwan. Am J Epidemiol 2010;171:214–220. DOI: 10.1093/aje/kwp360.
  19. Nijjar Aman PK, Wang H, Quan H, Khan NA. Ethnic and sex differences in the incidence of hospitalized acute myocardial infarction: British Columbia, Canada 1995-2002. BMC Cardiovasc Disord 2010;10:1–7. DOI: 10.1186/1471-2261-10-38.
  20. Li N, Zhou H, Tang Q. Red blood cell distribution width: A novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers. 2017;2017:7089493. DOI: 10.1155/2017/7089493.
  21. Ozsu S, Abul Y, Gunaydin S, Orem A, Ozlu T. Prognostic value of red cell distribution width in patients with pulmonary embolism. Clin Appl Thromb Hemost 2014;20(4):365–370. DOI: 10.1177/1076029612464901.
  22. Zhou XY, Chen HL, Ni SS. Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism. J Crit Care 2017;37:197–201. DOI: 10.1016/j.jcrc.2016.09.024.
  23. Abul Y, Ozsu S, Korkmaz A, Bulbul Y, Orem A, Ozlu T. Red cell distribution width: a new predictor for chronic thromboembolic pulmonary hypertension after pulmonary embolism. Chron Respir Dis 2014;11(2):73–81. DOI: 10.1177/1479972314525057.
  24. Wang W, Liu J, Yang YH, Zhai ZG, Wang C, Wang J. Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension. Clin Respir J 2016;10(1):54–60. DOI: 10.1111/crj.12181.
  25. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012;109(1):128–134. DOI: 10.1016/j.amjcard.2011.08.015.
  26. Lappegård J, Ellingsen TS, Skjelbakken T, Mathiesen EB, Njølstad I, Wilsgaard T, et al. Red cell distribution width is associated with future risk of incident stroke. The Tromsø study. Thromb Haemost 2016;115(1):126–134. DOI: 10.1160/TH15-03-0234.
  27. Feng GH, Li HP, Li QL, Fu Y, Huang RB. Red blood cell distribution width and ischaemic stroke. Stroke Vasc Neurol 2017;2(3):172–175. DOI: 10.1136/svn-2017-000071.eCollection.
  28. Pinho J, Marques SA, Freitas E, Araújo J, Taveira M, Alves JN, et al. Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis. Thromb Res 2018;164:4–8. DOI: 10.1016/j.thromres.2018.02.002.
  29. Söderholm M, Borné Y, Hedblad B, Persson M, Engström G. Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study. PLoS One 2015;10(5):e0124957. DOI: 10.1371/journal.pone.0124957.
  30. Ren D, Wang J, Li H, Li Y, Li Z. Red blood cell distribution width and carotid intima-media thickness in patients with metabolic syndrome. BMC Cardiovasc Disord 2017;17(1):44. DOI: 10.1186/s12872-017-0481-x.
  31. Furer A, Finkelstein A, Halkin A, Revivo M, Zuzut M, Berliner S, et al. High red blood cell distribution width and preclinical carotid atherosclerosis. Biomarkers 2015;20(6–7):376–381. DOI: 10.3109/1354750X.2015.1096304.
  32. Wang AY, Ma HP, Kao WF, Tsai SH, Chang CK. Red blood cell distribution width is associated with mortality in elderly patients with sepsis. Am J Emerg Med 2018;36(6):949–953. DOI: 10.1016/j.ajem.2017.10.056.
  33. Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013;31(3):545–548. DOI: 10.1016/j.ajem.2012.10.017.
  34. Jandial A, Kumar S, Bhalla A, Sharma N, Varma N, Varma S. Elevated red cell distribution width as a prognostic marker in severe sepsis: A prospective observational study. Indian J Crit Care Med 2017;21(9):552–562. DOI: 10.4103/ijccm.IJCCM_208_17.
  35. Ramby AL, Goodman DM, Wald EL, Weiss SL. Red blood cell distribution width as a pragmatic marker for outcome in pediatric critical illness. PLoS One 2015;10(6):e0129258. DOI: 10.1371/journal.pone.0129258.
  36. Said AS, Spinella PC, Hartman ME, Steffen KM, Jackups R, Holubkov R, et al. RBC distribution width: Biomarker for red cell dysfunction and critical illness outcome? Pediatr Crit Care Med 2017;18(2):134–142. DOI: 10.1097/PCC.0000000000001017.
  37. Kim CH, Park JT, Kim EJ, Han JH, Han JS, Choi JY, et al. An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock. Crit Care 2013;17(6):R282. DOI: 10.1186/ cc13145.
  38. Ellingsen TS, Lappegård J, Skjelbakken T, Braekkan SK, Hansen JB. Impact of red cell distribution width on future risk of cancer and all-cause mortality among cancer patients—the Tromsø Study. Haematologica 2015;100(10):e387–e389. DOI: 10.3324/haematol.2015.129601.
  39. Ai L, Mu S, Hu Y. Prognostic role of RDW in hematological malignancies: a systematic review and meta-analysis. Cancer Cell Int 2018;18:61. DOI: 10.1186/s12935-018-0558-3.
  40. Xu WY, Yang XB, Wang WQ, Bai Y, Long JY, Lin JZ, et al. Prognostic impact of the red cell distribution width in esophageal cancer patients: A systematic review and meta-analysis. World J Gastroenterol 2018;24(19):2120–2129. DOI: 10.3748/wjg.v24.i19.2120.
  41. Tham T, Bardash Y, Teegala S, Herman WS, Costantino PD. The red cell distribution width as a prognostic indicator in upper aerodigestive tract (UADT) cancer: A systematic review and meta-analysis. Am J Otolaryngol 2018;39(4):453–458. DOI: 10.1016/ j.amjoto.2018.04.013.
  42. Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med 2016;4(20):399.
  43. Hu L, Li M, Ding Y, Pu L, Liu J, Xie J, et al. Prognostic value of RDW in cancers: a systematic review and meta-analysis. Oncotarget 2017;8(9):16027–16035. DOI: 10.18632/oncotarget.13784.
  44. Lippi G, Bovo C, Buonocore R, Mitaritonno M, Cervellin G. Red blood cell distribution width in patients with limb, chest and head trauma. Arch Med Sci 2017;13(3):606–611. DOI: 10.5114/aoms.2017.67282.
  45. Majercik S, Fox J, Knight S, Horne BD. Red cell distribution width is predictive of mortality in trauma patients. J Trauma Acute Care Surg 2013;74(4):1021–1026. DOI: 10.1097/TA.0b013e3182826f02.
  46. Kong T, Park JE, Park YS, Lee HS, You JS, Chung HS, et al. Usefulness of serial measurement of the red blood cell distribution width to predict 28-day mortality in patients with trauma. Am J Emerg Med 2017;35(12):1819–1827. DOI: 10.1016/ j.ajem.2017.06.008.
  47. Sadaka F, Doctors N, Pearson T, Snyders B, O’Brien J. Does red cell distribution width predict outcome in traumatic brain injury: Comparison to corticosteroid randomization after significant head injury. J Clin Med Res 2018;10(1):9–12. DOI: 10.14740/jocmr3173w.
  48. Lee HB, Kim J, Oh SH, Kim SH, Kim HS, Kim WC, et al. Red blood cell distribution width is associated with severity of leukoaraiosis. PLoS One 2016;11(2):e0150308. DOI: 10.1371/journal.pone.0150308.
  49. Winchester LM, Powell J, Lovestone S, Nevado-Holgado AJ. Red blood cell indices and anaemia as causative factors for cognitive function deficits and for Alzheimer's disease. Genome Med 2018;10(1):51. DOI: 10.1186/s13073-018-0556-z.
  50. Öztürk ZA, Ünal A, Yiğiter R, Yesil Y, Kuyumcu ME, Neyal M, et al. Is increased red cell distribution width (RDW) indicating the inflammation in Alzheimer's disease (AD)? Arch Gerontol Geriatr 2013;56(1):50–54. DOI: 10.1016/j.archger.2012.10.002.
  51. Weuve J, Mendes de Leon CF, Bennett DA, Dong X, Evans DA. The red cell distribution width and anemia in association with prevalent dementia. Alzheimer Dis Assoc Disord 2014;28(2):99–105. DOI: 10.1097/WAD.0b013e318299673c.
  52. Clarke K, Sagunarthy R, Kansal S. RDW as an additional marker in inflammatory bowel disease/undifferentiated colitis. Dig Dis Sci 2008;53(9):2521–2523. DOI: 10.1007/s10620-007-0176-8.
  53. Cravo M. RDW as a surrogate marker for active Crohn's disease: Potential utility. GE Port J Gastroenterol 2016;23(1):1–3. DOI: 10.1016/j.jpge.2015.12.004.
  54. Song CS, Park DI, Yoon MY, Seok HS, Park JH, Kim HJ, et al. Association between red cell distribution width and disease activity in patients with inflammatory bowel disease. Dig Dis Sci 2012;57(4):1033–1038. DOI: 10.1007/s10620-011-1978-2.
  55. Oliveira AM, Cardoso FS, Rodrigues CG, Santos L, Martins A, de Deus JR, et al. Can red cell distribution width be used as a marker of Crohn's disease activity? GE Port J Gastroenterol 2015;23(1):6–12. DOI: 10.1016/j.jpge.2015.10.003.
  56. Cakal B, Akoz AG, Ustundag Y, Yalinkilic M, Ulker A, Ankarali H. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci 2009;54(4):842–847. DOI: 10.1007/s10620-008-0436-2.
  57. Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009;169(5):515–523. DOI: 10.1001/archinternmed.2009.11.
  58. Safdar SA, Modi T, Sriramulu LD, Shaaban H, Sison R, Modi V, et al. The role of red cell distribution width as a predictor of mortality for critically ill patients in an inner-city hospital. J Nat Sci Biol Med 2017;8(2):154–158. DOI: 10.4103/0976-9668.210017.
  59. Chu Y, Yuan Z, Meng M, Zhou H, Wang C, Yang G, et al. Red blood cell distribution width as a risk factor for inhospital mortality in obstetric patients admitted to an intensive care unit: a single centre retrospective cohort study. BMJ Open 2017;7(6):e012849. DOI: 10.1136/bmjopen-2016-012849.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.