Abstract
Introduction: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases.Objective: To assess if elevated RDW is associated with unfavorable outcomes in hospitalized COVID-19.Methods: We retrospectively studied clinical outcomes of hospitalized COVID-19 patients for their RDW values. In-hospital mortality was defined as primary outcome, while septic shock, need for mechanical ventilation, and length of stay (LOS) were secondary outcomes.Results: A total of 294 COVID-19 patients were finally studied. Overall prevalence of increased RDW was 49.7% (146/294). RDW was associated with increased risk of in-hospital mortality (aOR, 4.6; 95%CI, 1.5-14.6) and septic shock (aOR, 4.6; 95%CI, 1.4-15.1) after adjusting for anemia, ferritin, lactate, and absolute lymphocyte count. The association remained unchanged even after adjusting for other clinical confounders such as age, sex, body mass index, coronary artery disease, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. No association was found instead with mechanical ventilation and median LOS.Conclusion: Elevated RDW in hospitalized COVID-19 patients is associated with a significantly increased risk of mortality and septic shock.
Highlights
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide
This study aimed to explore whether Red Blood Cell Distribution Width (RDW) value upon admission may predict clinical progression in patients hospitalized for COVID-19
Elevated RDW was defined as a value > 14.6%, which is the upper limit of the healthy adult reference interval in the local institution
Summary
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases. The ongoing Coronavirus Disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), has started as a cluster of pneumonia-like illness in Wuhan, China, and has spread all around the world [1]. During the initial outbreak of COVID-19, respiratory involvement was the primary cause of morbidity and mortality. The US Center for Disease Control and Prevention (CDC) emphasizes that patients with preexisting conditions such as advanced age (65 years or older) or pathologies like cardiovascular disease, diabetes, cancer, hypertension, chronic obstructive pulmonary disease (COPD) are at higher risk of COVID-19-associated morbidity and mortality [9]. Similar to other viral illnesses, COVID-19 is associated with leukopenia, lymphopenia, and elevated values of many traditional inflammatory biomarkers [10, 11]
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