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Meta-Analysis
. 2021 Apr;93(4):2513-2522.
doi: 10.1002/jmv.26797. Epub 2021 Jan 26.

Association between red blood cell distribution width and mortality and severity among patients with COVID-19: A systematic review and meta-analysis

Jane J Lee  1 , Sahar M Montazerin  2 , Adeel Jamil  3 , Umer Jamil  3 , Jolanta Marszalek  4 , Michael L Chuang  2 , Gerald Chi  2
Affiliations
Meta-Analysis

Association between red blood cell distribution width and mortality and severity among patients with COVID-19: A systematic review and meta-analysis

Jane J Lee et al. J Med Virol. 2021 Apr.

Abstract

Emerging evidence has underscored the potential usefulness of red blood cell distribution width (RDW) measurement in predicting the mortality and disease severity of COVID-19. This study aimed to assess the association of the plasma RDW levels with adverse prognosis in COVID-19 patients. A comprehensive literature search from inception to September 2020 was performed to harvest original studies reporting RDW on admission and clinical outcomes among patients hospitalized with COVID-19. RDW levels were compared between cases (patients who died or developed more severe symptoms) and controls (patients who survived or developed less severe symptoms). A total of 14,866 subjects from 10 studies were included in the meta-analysis. Higher levels of RDW were associated with adverse outcomes in COVID-19 patients (mean differences = 0.72; 95% CI = 0.47-0.97; I2 = 89.51%). Deceased patients had higher levels of RDW compared to patients who survived (mean differences = 0.93; 95% CI = 0.63-1.23; I2 = 85.58%). Severely ill COVID-19 patients showed higher levels of RDW, as opposed to patients classified to have milder symptoms (mean differences = 0.61; 95% CI = 0.28-0.94; I2 = 82.18%). Elevated RDW levels were associated with adverse outcomes in COVID-19 patients. This finding warrants further research on whether RDW could be utilized as a simple and reliable biomarker for predicting COVID-19 severity and whether RDW is mechanistically linked with COVID-19 pathophysiology.

Keywords: COVID-19; biomarkers; erythrocyte indices; red blood cell distribution width; severe acute respiratory syndrome coronavirus 2.

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Figures

Figure 1
Figure 1
Flowchart presenting the literature search process according to the PRISMA Statement
Figure 2
Figure 2
Red blood cell distribution width and adverse outcomes in COVID‐19 patients
Figure 3
Figure 3
Funnel plot of red blood cell distribution width and adverse outcomes in COVID‐19 patients
Figure 4
Figure 4
Red blood cell distribution width and subgroups of COVID‐19 patients with adverse outcomes
See this image and copyright information in PMC

Comment in

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