Abstract
Red blood cell distribution width (RDW) is the coefficient of variation of red blood cell size, considered to be associated with cardiovascular disease (CVD). This study aimed to comprehensively synthesize previous studies on RDW and CVD outcomes through an overall and dose-response meta-analysis. PubMed, Embase and Web of Science were searched systematically for English and Chinese language publications up to November 30, 2015. We extracted data from publications matching our inclusion criteria for calculating pooled hazard ratio (HR), which was used to assess prognostic impact of RDW on CVD. Twenty-seven articles, consisting of 28 studies and 102,689 participants (mean age 63.9 years, 63,703 males/36,846 females, 2,140 gender-unmentioned subjects) were included in the present meta-analysis. The pooled HRs are 1.12 (95% CI = 1.09–1.15) for the association of all-cause mortality (ACM) per 1% increase of RDW, 1.12(95% CI = 1.08–1.17) for major adverse cardiac events (MACEs) per 1% increase of RDW. A dose-response curve relating RDW increase to its effect on CVD outcomes was established (pcurve < 0.001). For every 1-unit increase of RDW, there is an increased risk of occurrence of ACM (pooled HR = 1.03, 95% CI = 1.02–1.04) and MACEs (pooled HR = 1.04, 95% CI = 1.01–1.06). This study indicates RDW may be a prognostic indicator for CVD outcomes.
Highlights
Red blood cell distribution width (RDW) is a quantitative parameter in routine hematologic analysis for representing the variation of red blood cell size
After combining adjusted hazard ratios (HRs) and 95% confidence interval (CI) of the 19 studies, we found that the all-cause mortality (ACM) risk of cardiovascular disease (CVD) patients significantly increased by 12% per 1% increase of RDW among CVD patients
The pooled results demonstrated that baseline RDW level was remarkably associated with CVD outcomes
Summary
Red blood cell distribution width (RDW) is a quantitative parameter in routine hematologic analysis for representing the variation of red blood cell size. The clinical significance of higher RDW has been considered in relation to cardiovascular disease (CVD), autoimmune disease and respiratory disease[3,4,5,6]. In these non-hematologic disorders, RDW is one of significant indicators of morbidity and mortality[7,8]. Clinical studies conducted among CVD patients have reported that RDW is a novel, independent predictor for all-cause mortality (ACM), and major adverse cardiac events (MACEs) as well[5,9,10,11,12,13], which is the most important outcomes of CVD. The prognostic value of RDW for ACM and MACEs were comprehensively reviewed among CVD (e.g. coronary artery disease, HF, MI) patients
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