Acute Crit Care.  2024 Aug;39(3):359-368. 10.4266/acc.2023.01137.

Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit

• Mompiere AD
• Noble JLl
• Fleuren-Janssen M
• Broen K
• Osch Fv
• Foudraine N

• KMID: 2563525
• DOI: http://doi.org/10.4266/acc.2023.01137

Abstract

Background
Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.
Methods
This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.
Results
The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).
Conclusions
Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.

Keyword

biomarkers; COVID-19; length of stay; mortality; red cell distribution width

Figure

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  Figure 1. Patient selection with elaboration of exclusion criteria. After the exclusion of 89 patients, 321 patients were included in the analysis. Seventy-six of these patients presented with increased red blood cell distribution width (RDW), while 245 patients did not. ICU: intensive care unit; COVID-19: coronavirus disease 2019.

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  Figure 2. Distribution of red blood cell distribution width (RDW) values in the study population. The mean RDW was 13.8% and the median RDW was 13.5%. The minimum RDW was 11.4% and the maximum was 21.2%. The standard deviation was 1.51.

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  Figure 3. Mortality plot by red blood cell distribution width (RDW) quartile groups with cumulative survival time in days. The cumulative survival plot shows the progressively increasing mortality with increased RDW in coronavirus disease 2019 (COVID-19) patients when separated in quartiles. It also shows a significant 30-day mortality, which stabilises when 90-day mortality is investigated. The RDW populations of this survival analysis were separated in quartiles.

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  Figure 4. Scatter plots showing the trends of distributions in length of stay (LOS) and durations of ventilation, with continuous red blood cell distribution width (RDW) levels on the x-axis and either LOS or durations in days on the y-axis. The increased RDW group (>14.5%, red group) has shorter LOS at the intensive care unit (ICU; A) and at the hospital (B) on average, as well as reduced durations of invasive (C) and prone ventilation (D) compared to those of the normal RDW group.

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