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. 2014 Oct;6(10):1429-40.
doi: 10.3978/j.issn.2072-1439.2014.09.10.

The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases: a systematic review and meta-analysis

Chang Su  1 , Li-Zhen Liao  1 , Yan Song  1 , Zhi-Wei Xu  1 , Wei-Yi Mei  1
Affiliations

The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases: a systematic review and meta-analysis

Chang Su et al. J Thorac Dis. 2014 Oct.

Abstract

Background: Red cell distribution width (RDW) might be a novel biomarker that reflects multiple physiological impairments related to atherosclerosis and coronary artery diseases (CAD). We conducted this systematic review and meta-analysis to evaluate the association of RDW between all-cause mortality and fatal/non-fatal cardiovascular disease (CVD) events in CAD patients.

Methods: Relevant studies were searched and identified in the MEDLINE and EMBASE databases. English-language prospective studies that reported risk estimates for RDW and mortality/CVD events were included. Data were extracted regarding the characteristics and clinical outcomes, and a quality assessment was conducted. Results were extracted for the highest versus lowest RDW level, and meta-analyses were carried out using random effects models.

Results: We identified 22 studies enrolling 80,216 participants. The study duration ranged between 1 month and 23 years. Of the 15 studies that were included in the meta-analysis, higher RDW indicated a significant increased risk for all-cause mortality in CAD patients: pooled risk ratio (RR) 2.20 (95% CI, 1.42-3.39; P<0.0004). The results for fatal, non-fatal and fatal/non-fatal events were: pooled RR 1.80 (95% CI, 1.35-2.41; P<0.0001), RR 1.86 (95% CI, 1.50-2.31; P<0.00001) and RR 2.13 (95% CI, 1.20-3.77; P=0.01). Heterogeneity was moderately present; however, sensitivity analyses for follow-up duration, CAD subtype, or RDW as dichotomous values showed similar results.

Conclusions: The meta-analysis indicates that higher RDW levels are associated with increased risk of mortality and CVD events in patients with established CAD.

Keywords: Red cell distribution width (RDW); cardiovascular (CV); coronary artery diseases (CAD); meta-analysis; mortality.

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Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Pooled relative risk of RDW and all-cause mortality of the included studies. Risk ratios (RRs) are shown with 95% CIs. RDW, red cell distribution width.
Figure 3
Figure 3
Pooled relative risk of red cell distribution width (RDW) and fatal cardiovascular (CV) events, non-fatal CV events and fatal/non-fatal CV events of the included studies. Risk ratios (RRs) are shown with 95% CIs.
Figure 4
Figure 4
Funnel plot for red cell distribution width (RDW) and all-cause mortality. Each square indicates one study with its standard error indicating the weight of the study and its relative risk. The dotted lines represent 95% CI to visualize the symmetry around the pooled estimate.
Figure 5
Figure 5
Forest plots of red cell distribution width (RDW) and all-cause mortality of the included studies: studies with follow-up >4 years; B, ACS patients; percutaneous coronary intervention (PCI) patients; studies with RDW categories as quartiles. Risk ratios (RRs) are shown with 95% CIs.
See this image and copyright information in PMC

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