Abstract
Background: Coronavirus disease (COVID-19) was first described at the end of 2019 in China and has since spread across the globe. Red cell distribution width (RDW) is a potent prognostic marker in several medical conditions and has recently been suggested to be of prognostic value in COVID-19.Methods: This retrospective, observational study of consecutive patients with COVID-19 was conducted from March 12, 2020 to December 4, 2020 in the Wilhelminenhospital, Vienna, Austria. RDWlevels on admission were collected and tested for their predictive value of 28-day mortality.Results: A total of 423 eligible patients with COVID-19 were included in the final analyses and 15.4% died within 28 days (n = 65). Median levels of RDWwere significantly higher in non-survivors compared to survivors [14.6% (IQR, 13.7–16.3) vs. 13.4% (IQR, 12.7– 14.4), P < 0.001]. Increased RDW was a significant predictor of 28-day mortality [crude odds ratio (OR) 1.717, 95% confidence interval (CI) 1.462–2.017; P = < 0.001], independent of clinical confounders, comorbidities and established prognostic markers of COVID-19 (adjusted OR of the final model 1.368, 95% CI 1.126–1.662; P = 0.002). This association remained consistent upon sub-group analysis. Our study data also demonstrate that RDW levels upon admission for COVID-19 were similar to previously recorded, non-COVID-19 associated RDW levels [14.2% (IQR, 13.3–15.7) vs. 14.0% [IQR, 13.2–15.1]; P = 0.187].Conclusions: In this population, RDWwas a significant, independent prognostic marker of short-term mortality in patients with COVID-19.
Highlights
The outbreak of coronavirus disease (COVID-19) originated late December, 2019, in Wuhan, China and has since spread rapidly across the globe causing an international pandemic
Higher levels of white blood cells, neutrophil to lymphocyte ratio, c-reactive protein (CRP), creatinine, blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) were observed in non-survivors, while levels of hemoglobin and red blood cells were significantly lower (Table 1)
The main findings of our study were, that (i) an increased Red Cell Distribution Width (RDW) was a significant, independent predictor of 28-day mortality in hospitalized patients with COVID-19, both on a continuous and a categorical level at a prespecified cut-off of > 14.5%, (ii) the association of RDW and short-term mortality persisted across multiple sub-groups, (iii) there was no significant difference between levels of RDW at hospital admission compared to pre-COVID-19 times, and (iv) higher levels of RDW were observed in patients presenting early in the disease course of COVID-19, defined by the time to symptom onset
Summary
The outbreak of coronavirus disease (COVID-19) originated late December, 2019, in Wuhan, China and has since spread rapidly across the globe causing an international pandemic. Several laboratory markers have been identified to be of prognostic value in COVID-19, including lactate dehydrogenase (LDH), blood urea nitrogen (BUN) and neutrophil to lymphocyte ratio (NLR) among others [3,4,5]. RDW has been suggested to be of prognostic value in patients with COVID-19 [16,17,18,19,20]. Coronavirus disease (COVID-19) was first described at the end of 2019 in China and has since spread across the globe. Red cell distribution width (RDW) is a potent prognostic marker in several medical conditions and has recently been suggested to be of prognostic value in COVID-19
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