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Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study

BACKGROUND: Red cell distribution width (RDW) predicts disease outcome in several patient populations, but its prognostic value in addition to other disease parameters in unselected medical inpatients remains unclear. Our aim was to investigate the association of admission RDW levels and mortality a...

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Autores principales: Zurauskaite, Giedre, Meier, Marc, Voegeli, Alaadin, Koch, Daniel, Haubitz, Sebastian, Kutz, Alexander, Bernasconi, Luca, Huber, Andreas, Bargetzi, Mario, Mueller, Beat, Schuetz, Philipp
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771602/
https://www.ncbi.nlm.nih.gov/pubmed/29342203
http://dx.doi.org/10.1371/journal.pone.0191280
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author Zurauskaite, Giedre
Meier, Marc
Voegeli, Alaadin
Koch, Daniel
Haubitz, Sebastian
Kutz, Alexander
Bernasconi, Luca
Huber, Andreas
Bargetzi, Mario
Mueller, Beat
Schuetz, Philipp
author_facet Zurauskaite, Giedre
Meier, Marc
Voegeli, Alaadin
Koch, Daniel
Haubitz, Sebastian
Kutz, Alexander
Bernasconi, Luca
Huber, Andreas
Bargetzi, Mario
Mueller, Beat
Schuetz, Philipp
author_sort Zurauskaite, Giedre
collection PubMed
description BACKGROUND: Red cell distribution width (RDW) predicts disease outcome in several patient populations, but its prognostic value in addition to other disease parameters in unselected medical inpatients remains unclear. Our aim was to investigate the association of admission RDW levels and mortality adjusted for several disease pathways in unselected medical patients from a previous multicenter study. METHODS: We included consecutive adult, medical patients at the time point of hospital admission through the emergency department into this observational, cohort study. The primary endpoint was mortality at 30-day. To study association of admission RDW and outcomes, we calculated regression analysis with step-wise inclusion of clinical and laboratory parameters from different biological pathways. RESULTS: The 30-day mortality of the 4273 included patients was 5.6% and increased from 1.4% to 14.3% from the lowest to the highest RDW quartile. There was a strong association of RDW and mortality in unadjusted analysis (OR 1.32; 95%CI 1.27–1.39, p<0.001). RDW was strongly correlated with different pathways including inflammation (coefficient of determination (R(2)) 0.30; p<0.001), nutrition (R(2) 0.20; p<0.001) and blood diseases (R(2) 0.30; p<0.001 The association was eliminated after including different biological pathways into the models with the fully adjusted regression model showing an OR of 1.02 (95%CI 0.93–1.12; p = 0.664) for the association of RDW and mortality. Similar effects were found for other outcomes including intensive care unit admission and hospital readmission. CONCLUSION: Our data suggests that RDW is a strong surrogate marker of mortality in unselected medical inpatients with most of the prognostic information being explained by other disease factors. The strong correlation of RDW and different biological pathways such as chronic inflammation, malnutrition and blood disease suggest that RDW may be viewed as an unspecific and general “chronic disease prognostic marker”.
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spelling pubmed-57716022018-01-23 Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study Zurauskaite, Giedre Meier, Marc Voegeli, Alaadin Koch, Daniel Haubitz, Sebastian Kutz, Alexander Bernasconi, Luca Huber, Andreas Bargetzi, Mario Mueller, Beat Schuetz, Philipp PLoS One Research Article BACKGROUND: Red cell distribution width (RDW) predicts disease outcome in several patient populations, but its prognostic value in addition to other disease parameters in unselected medical inpatients remains unclear. Our aim was to investigate the association of admission RDW levels and mortality adjusted for several disease pathways in unselected medical patients from a previous multicenter study. METHODS: We included consecutive adult, medical patients at the time point of hospital admission through the emergency department into this observational, cohort study. The primary endpoint was mortality at 30-day. To study association of admission RDW and outcomes, we calculated regression analysis with step-wise inclusion of clinical and laboratory parameters from different biological pathways. RESULTS: The 30-day mortality of the 4273 included patients was 5.6% and increased from 1.4% to 14.3% from the lowest to the highest RDW quartile. There was a strong association of RDW and mortality in unadjusted analysis (OR 1.32; 95%CI 1.27–1.39, p<0.001). RDW was strongly correlated with different pathways including inflammation (coefficient of determination (R(2)) 0.30; p<0.001), nutrition (R(2) 0.20; p<0.001) and blood diseases (R(2) 0.30; p<0.001 The association was eliminated after including different biological pathways into the models with the fully adjusted regression model showing an OR of 1.02 (95%CI 0.93–1.12; p = 0.664) for the association of RDW and mortality. Similar effects were found for other outcomes including intensive care unit admission and hospital readmission. CONCLUSION: Our data suggests that RDW is a strong surrogate marker of mortality in unselected medical inpatients with most of the prognostic information being explained by other disease factors. The strong correlation of RDW and different biological pathways such as chronic inflammation, malnutrition and blood disease suggest that RDW may be viewed as an unspecific and general “chronic disease prognostic marker”. Public Library of Science 2018-01-17 /pmc/articles/PMC5771602/ /pubmed/29342203 http://dx.doi.org/10.1371/journal.pone.0191280 Text en © 2018 Zurauskaite et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Zurauskaite, Giedre
Meier, Marc
Voegeli, Alaadin
Koch, Daniel
Haubitz, Sebastian
Kutz, Alexander
Bernasconi, Luca
Huber, Andreas
Bargetzi, Mario
Mueller, Beat
Schuetz, Philipp
Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
title Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
title_full Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
title_fullStr Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
title_full_unstemmed Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
title_short Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
title_sort biological pathways underlying the association of red cell distribution width and adverse clinical outcome: results of a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771602/
https://www.ncbi.nlm.nih.gov/pubmed/29342203
http://dx.doi.org/10.1371/journal.pone.0191280
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