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Prognostic significance of changes in red cell distribution width in an internal medicine ward
Miriam Shteinshnaider1, Dana Barchel1, Dorit Almoznino-Sarafian1
1Department of Internal Medicine "F", Assaf Harofeh Medical Center (affiliated to Sackler Faculty of Medicine, Tel Aviv University), Zerifin, Israel.
Background:
The prognostic significance of red cell distribution width (RDW) during hospitalization in internal medicine wards was not sufficiently investigated.
Methods:
Demographic, clinical and laboratory characteristics were collected from 586 internal medicine inpatients. Following discharge, all-cause mortality was recorded. The data were compared according to ΔRDW during hospitalization (primary endpoint), and to normal (≤14.7%) vs. high (>14.7%) RDW values on admission/discharge (secondary endpoint).
Results:
Group A (rise in RDW, ΔRDW +0.4%), group B (nonsignificant RDW changes, ΔRDW up to 0.4%) and group C (drop in RDW, ΔRDW -0.4%) comprised 20.3%, 60.6% and 19.1% of the patients, respectively. High RDW on admission and discharge was found in 31.7% and 31.4% of patients, respectively. In-hospital mortality rates were higher in group A than in groups B and C (14.3% vs. 2.8% and 4.5%, p<0.001), whereas increased long-term (median follow-up 43 months) mortality rates were observed in group C (35.7%), compared to groups A (17.6%) and B (23.4%), p=0.009. Mortality rates were significantly higher (p<0.001) in patients with high than normal RDW on admission (51.1% vs. 20.3%) and on discharge (50.5% vs. 20.6%). Every 1% increment of RDW on admission and discharge strongly predicted mortality (relative risks 1.21 and 1.21; 95% confidence intervals 1.12-1.31 and 1.13-1.32, respectively).
Conclusions:
High RDW on admission and discharge predicted poor prognosis. Rising RDW throughout hospitalization was associated with higher in-hospital mortality, while an elevated long-term mortality rate was observed in patients with declining RDW. Repeated RDW measurements may improve risk stratification for internal medicine inpatients.
