Skip to main content

Advertisement

SpringerLink
Log in

Changes in Red Cell Distribution Width During Hospitalization for Community-Acquired Pneumonia: Clinical Characteristics and Prognostic Significance

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

We investigated outcomes of patients hospitalized with community-acquired pneumonia (CAP) according to the changes in red cell distribution width (RDW).

Methods

For 980 adults, clinical characteristics, outcomes during hospitalization for CAP (transfer to the intensive care unit, treatment with mechanical ventilation, prolonged hospital stay, and death), and all-cause mortality following discharge were compared: according to RDW changes versus stable RDW during hospitalization, and according to normal (≤14.7 %) versus high (>14.7 %) RDW values on admission/discharge.

Results

RDW changes (n = 386) during hospitalization were associated with more severe clinical and laboratory characteristics than stable RDW (n = 594). Changes in RDW strongly predicted poor in-hospital outcomes (p < 0.001). The respective 30, 90-day, and total (median follow-up 54 months) mortality rates were significantly higher (9.8, 16.0 and 43.5 %) among patients with RDW changes, compared to 4.0, 7.6 and 30.5 % among those with stable RDW (p < 0.001 for all comparisons). RDW changes, as well as high RDW (each 1 % increment) on admission and discharge, were powerful predictors of mortality (the respective relative risks 1.41, 1.13, and 1.15, and 95 % confidence intervals 1.13–1.74, 1.08–1.19, and 1.10–1.21).

Conclusions

RDW changes during hospitalization for CAP are common and associated with a severe clinical profile. Time-dependent RDW changes strongly predict poor in-hospital outcomes and increased short- and long-term mortality. Repeated RDW determinations during hospitalization for CAP may provide useful prognostic information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Simel DL, DeLong ER, Feussner JR et al (1988) Erythrocyte anisocytosis: visual inspection of blood films vs automated analysis of red blood cell distribution width. Arch Intern Med 148:822–824

    Article  CAS  PubMed  Google Scholar 

  2. Salvagno GL, Sanchis-Gomar F, Picanza A et al (2015) Red blood cell distribution width: a simple parameter with multiple clinical implications. Crit Rev Clin Lab Sci 52:86–105

    Article  PubMed  Google Scholar 

  3. Felker GM, Allen LA, Pocock SJ et al (2007) Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the duke databank. J Am Coll Cardiol 50:40–47

    Article  PubMed  Google Scholar 

  4. Tonelli M, Sacks F, Arnold M et al (2008) Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 117:163–168

    Article  PubMed  Google Scholar 

  5. Förhécz Z, Gombos T, Borgulya G et al (2009) Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional status. Am Heart J 158:659–666

    Article  PubMed  Google Scholar 

  6. Ani C, Ovbiagele B (2009) Elevated red cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 277:103–108

    Article  PubMed  Google Scholar 

  7. Dabbah S, Hammerman H, Markiewicz W et al (2010) Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol 105:312–317

    Article  PubMed  Google Scholar 

  8. Allen LA, Felker GM, Mehra MR et al (2010) Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 16:230–238

    Article  PubMed  Google Scholar 

  9. Makhoul BF, Khourieh A, Kaplan M et al (2013) Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol 167:1412–1416

    Article  PubMed  Google Scholar 

  10. Bazick HS, Chang D, Mahadevappa K et al (2011) Red cell distribution with and all-cause mortality in critically ill patients. Crit Care Med 39:1913–1921

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hunziker S, Stevens J, Howell MD (2012) Red cell distribution width and mortality in newly hospitalized patients. Am J Med 125:283–291

    Article  PubMed  Google Scholar 

  12. Lam AP, Gundabolu K, Sridharan A et al (2013) Multiplicative interaction between mean corpuscular volume and red cell distribution width in predicting mortality of elderly patients with and without anemia. Am J Hematol 88:245–249

    Article  Google Scholar 

  13. Arbel Y, Weitzman D, Raz R et al (2014) Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality: a population-based study. Thromb Haemost 111:300–307

    Article  CAS  PubMed  Google Scholar 

  14. Shteinshnaider M, Barchel D, Almoznino-Sarafian D et al (2015) Prognostic significance of changes in red cell distribution width in an internal medicine ward. Eur J Intern Med 26:616–622

    Article  PubMed  Google Scholar 

  15. Wunderink RG, Waterer GW (2014) Community-acquired pneumonia. N Engl J Med 370:543–551

    Article  CAS  PubMed  Google Scholar 

  16. Jain S, Self WH, Wunderink RG et al (2015) Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 373:415–427

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Eurich DT, Marrie TJ, Minhas-Sandhu JK et al (2015) Ten year mortality following community acquired pneumonia: a prospective cohort. Am J Respir Crit Care Med 192:597–604

    Article  PubMed  Google Scholar 

  18. Braun E, Domany E, Kenig Y et al (2011) Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia. Crit Care 15:R194

    Article  PubMed  PubMed Central  Google Scholar 

  19. Braun E, Kheir J, Mashiach T et al (2014) Is elevated red cell distribution width a prognostic predictor in adult patients with community acquired pneumonia? BMC Infect Dis 14:129

    Article  PubMed  PubMed Central  Google Scholar 

  20. Naffaa ME, Mustafa M, Azzam M et al (2015) Serum inorganic phosphorus levels predict 30-day mortality in patients with community acquired pneumonia. BMC Infect Dis 15:332

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lee JH, Chung HJ, Kim K et al (2013) Red cell distribution width as a prognostic marker in patients with community-acquired pneumonia. Am J Emerg Med 31:72–79

    Article  PubMed  Google Scholar 

  22. Bello S, Fandos S, Lasierra AB et al (2015) Red blood cell distribution width [RDW] and long-term mortality after community-acquired pneumonia. A comparison with proadrenomedullin. Respir Med 109:1193–1206

    Article  CAS  PubMed  Google Scholar 

  23. Oh J, Kang SM, Won H et al (2012) Prognostic value of change in red cell distribution width 1 month after discharge in acute decompensated heart failure patients. Circ J 76:109–116

    Article  CAS  PubMed  Google Scholar 

  24. Ferreira JP, Girerd N, Arrigo M et al (2016) Enlarging red blood cell distribution width during hospitalization identifies a very high-risk subset of acutely decompensated heart failure patients and adds valuable prognostic information on top of hemoconcentration. Medicine (Baltimore) 95:e3307

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maes M, Scharpé S, Cooreman W et al (1995) Components of biological, including seasonal, variation in hematological measurements and plasma fibrinogen concentrations in normal humans. Experientia 51:141–149

    Article  CAS  PubMed  Google Scholar 

  26. Levey AS, Coresh J, Greene T et al (2006) Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254

    Article  CAS  PubMed  Google Scholar 

  27. Lim WS, van der Eerden MM, Laing R et al (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Fine MJ, Auble TE, Yealy DM et al (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250

    Article  CAS  PubMed  Google Scholar 

  29. Dixon WJ (Chief editor) (1993) BMDP statistical software. University of California Press, Los-Angeles

  30. Lippi G, Targher G, Montagnana M et al (2009) Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 133:628–632

    CAS  PubMed  Google Scholar 

  31. Semba RD, Patel KV, Ferrucci L et al (2010) Serum antioxidants and inflammation predict red cell distribution width in older women: the women’s health and aging study I. Clin Nutr 29:600–604

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine “F”, Assaf Harofeh Medical Center, 70300, Zerifin, Israel

    Oleg Gorelik, Shimon Izhakian, Dana Barchel, Dorit Almoznino-Sarafian, Irma Tzur, Muhareb Swarka, Natan Cohen & Miriam Shteinshnaider

  2. Nephrology Division, Assaf Harofeh Medical Center, 70300, Zerifin, Israel

    Ilia Beberashvili & Leonid Feldman

  3. Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

    Oleg Gorelik, Shimon Izhakian, Dana Barchel, Dorit Almoznino-Sarafian, Irma Tzur, Muhareb Swarka, Ilia Beberashvili, Leonid Feldman, Natan Cohen & Miriam Shteinshnaider

Authors
  1. Oleg Gorelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shimon Izhakian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dana Barchel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dorit Almoznino-Sarafian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Irma Tzur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Muhareb Swarka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ilia Beberashvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Leonid Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Natan Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Miriam Shteinshnaider
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oleg Gorelik.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gorelik, O., Izhakian, S., Barchel, D. et al. Changes in Red Cell Distribution Width During Hospitalization for Community-Acquired Pneumonia: Clinical Characteristics and Prognostic Significance. Lung 194, 985–995 (2016). https://doi.org/10.1007/s00408-016-9942-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9942-8

Keywords

Search

Navigation