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Comparative Study
. 2009 Mar 9;169(5):515-23.
doi: 10.1001/archinternmed.2009.11.

Red blood cell distribution width and the risk of death in middle-aged and older adults

Kushang V Patel  1 , Luigi Ferrucci, William B Ershler, Dan L Longo, Jack M Guralnik
Affiliations
Comparative Study

Red blood cell distribution width and the risk of death in middle-aged and older adults

Kushang V Patel et al. Arch Intern Med. .

Abstract

Background: Red blood cell distribution width (RDW), a component of an electronic complete blood count, is a measure of heterogeneity in the size of circulating erythrocytes. In patients with symptomatic cardiovascular disease (CVD), RDW is associated with mortality. However, it has not been demonstrated that RDW is a predictor of mortality independent of nutritional deficiencies or in the general population.

Methods: Red blood cell distribution width was measured in a national sample of 8175 community-dwelling adults 45 years or older who participated in the 1988-1994 National Health and Nutrition Examination Survey; mortality follow-up occurred through December 31, 2000. Deaths from all causes, CVD, cancer, and other causes were examined as a function of RDW.

Results: Higher RDW values were strongly associated with an increased risk of death. Compared with the lowest quintile of RDW, the following were adjusted hazard ratios (HRs) for all-cause mortality (and 95% confidence intervals [CIs]): second quintile, HR, 1.1 (95% CI, 0.9-1.3); third quintile, HR, 1.2 (95% CI, 1.0-1.4); fourth quintile, HR, 1.4 (95% CI, 1.2-1.8); and fifth quintile, HR, 2.1 (95% CI, 1.7-2.6). For every 1% increment in RDW, all-cause mortality risk increased by 22% (HR, 1.22; 95% CI, 1.15-1.30; P < .001). Even when analyses were restricted to nonanemic participants or to those in the reference range of RDW (11%-15%) without iron, folate, or vitamin B(12) deficiency, RDW remained strongly associated with mortality. The prognostic effect of RDW was observed in both middle-aged and older adults for multiple causes of death.

Conclusion: Red blood cell distribution width is a widely available test that is a strong predictor of mortality in the general population of adults 45 years or older.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curves by quintiles of RDW according to age group
Figure 2
Figure 2
Risk of death by RDW according to age group and cause of death*.
Figure 3
Figure 3
Probability of death by RDW levels in the normal range among adults aged 45 and older
See this image and copyright information in PMC

Comment in

References

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