Role of Red Blood Cell Distribution Width, As a Prognostic Indicator in COVID-19: A Systematic Review and Meta-analysis

Overview

Journal Rev Med Virol

Publisher Wiley

Specialty Microbiology

Date 2021 Jun 6

PMID 34091982

Citations 25

Authors

Soumya Sarkar

Sundara Kannan

Puneet Khanna

Akhil Kant Singh

Affiliations

Soon will be listed here.

Abstract

The red blood cell distribution width (RDW), an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients with sepsis. Prognostic predictors are of paramount interest for prompt intervention and optimal utilization of the healthcare system in this ongoing context of the Coronavirus Disease 2019 (COVID-19) pandemic. The current systematic review and meta-analysis aims to explore the utility of RDW in the prognosis of COVID-19 patients. A comprehensive screening of electronic databases was performed up to 30th April 2021 after enrolling in PROSPERO (CRD42020206685). Observational studies or interventional studies, evaluating the impact of RDW in COVID-19 outcomes (mortality and severity) are included in this meta-analysis.Our search retrieved 25 studies, with a total of 18,392 and 3,446 COVID-19 patients for mortality and disease severity outcomes. Deceased and critically ill patients had higher RDW levels on admission in comparison to survivors and non-severe patients (SMD = 0.46; 95%CI 0.31-0.71; I = 88% and SMD = 0.46; 95%CI 0.26-0.67; I = 60%, respectively). In a sub-group analysis of 2,980 patients, RDW > 14.5 has been associated with increased risk of mortality (OR = 2.73; 95%CI 1.96-3.82; I = 56%). However, the evidences is of low quality. A higher level of RDW on admission in COVID-19 patients is associated with increased morbidity and mortality. However, further studies regarding the cut-off value of RDW are the need of the hour.

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References

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

Asan A, Ustundag Y, Koca N, Simsek A, Sayan H, Parildar H . Do initial hematologic indices predict the severity of COVID-19 patients?. Turk J Med Sci. 2020; 51(1):39-44. PMC: 7991886. DOI: 10.3906/sag-2007-97. View

Sarkar S, Kannan S, Khanna P, Singh A . Role of red blood cell distribution width, as a prognostic indicator in COVID-19: A systematic review and meta-analysis. Rev Med Virol. 2021; 32(2):e2264. PMC: 8209859. DOI: 10.1002/rmv.2264. View

Gong J, Ou J, Qiu X, Jie Y, Chen Y, Yuan L . A Tool for Early Prediction of Severe Coronavirus Disease 2019 (COVID-19): A Multicenter Study Using the Risk Nomogram in Wuhan and Guangdong, China. Clin Infect Dis. 2020; 71(15):833-840. PMC: 7184338. DOI: 10.1093/cid/ciaa443. View

Sterne J, Hernan M, Reeves B, Savovic J, Berkman N, Viswanathan M . ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355:i4919. PMC: 5062054. DOI: 10.1136/bmj.i4919. View

Zalawadiya S, Veeranna V, Panaich S, Afonso L, Ghali J . Gender and ethnic differences in red cell distribution width and its association with mortality among low risk healthy United state adults. Am J Cardiol. 2012; 109(11):1664-70. DOI: 10.1016/j.amjcard.2012.01.396. View

Bommenahalli Gowda S, Gosavi S, Rao A, Shastry S, Raj S, Menon S . Prognosis of COVID-19: Red Cell Distribution Width, Platelet Distribution Width, and C-Reactive Protein. Cureus. 2021; 13(2):e13078. PMC: 7932824. DOI: 10.7759/cureus.13078. View

Solmaz I, Ozcaylak S, Alakus O, Kilic J, Kalin B, Guven M . Risk factors affecting ICU admission in COVID-19 patients; Could air temperature be an effective factor?. Int J Clin Pract. 2020; 75(3):e13803. DOI: 10.1111/ijcp.13803. View

Guyatt G, Oxman A, Vist G, Kunz R, Brozek J, Alonso-Coello P . GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol. 2011; 64(4):407-15. DOI: 10.1016/j.jclinepi.2010.07.017. View

10.

Yagci S, Serin E, Acicbe O, Zeren M, Odabasi M . The relationship between serum erythropoietin, hepcidin, and haptoglobin levels with disease severity and other biochemical values in patients with COVID-19. Int J Lab Hematol. 2021; 43 Suppl 1:142-151. PMC: 8014125. DOI: 10.1111/ijlh.13479. View

11.

Tocoglu A, Dheir H, Bektas M, Acikgoz S, Karabay O, Sipahi S . Predictors of Mortality in Patients with COVID-19 Infection-associated Acute Kidney Injury. J Coll Physicians Surg Pak. 2021; 31(1):S60-S65. DOI: 10.29271/jcpsp.2021.01.S60. View

12.

Balcells M, Rojas L, Le Corre N, Martinez-Valdebenito C, Ceballos M, Ferres M . Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial. PLoS Med. 2021; 18(3):e1003415. PMC: 7929568. DOI: 10.1371/journal.pmed.1003415. View

13.

Soni M, Gopalakrishnan R . Significance of RDW in predicting mortality in COVID-19-An analysis of 622 cases. Int J Lab Hematol. 2021; 43(4):O221-O223. PMC: 8250958. DOI: 10.1111/ijlh.13526. View

14.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

15.

Thomas T, Stefanoni D, Dzieciatkowska M, Issaian A, Nemkov T, Hill R . Evidence of Structural Protein Damage and Membrane Lipid Remodeling in Red Blood Cells from COVID-19 Patients. J Proteome Res. 2020; 19(11):4455-4469. PMC: 7640979. DOI: 10.1021/acs.jproteome.0c00606. View

16.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7):e1000100. PMC: 2707010. DOI: 10.1371/journal.pmed.1000100. View

17.

Vashistha T, Streja E, Molnar M, Rhee C, Moradi H, Soohoo M . Red Cell Distribution Width and Mortality in Hemodialysis Patients. Am J Kidney Dis. 2016; 68(1):110-21. PMC: 4921311. DOI: 10.1053/j.ajkd.2015.11.020. View

18.

Wang C, Zhang H, Cao X, Deng R, Ye Y, Fu Z . Red cell distribution width (RDW): a prognostic indicator of severe COVID-19. Ann Transl Med. 2020; 8(19):1230. PMC: 7607068. DOI: 10.21037/atm-20-6090. View

19.

Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H . Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020; 13(5):667-673. PMC: 7142680. DOI: 10.1016/j.jiph.2020.03.019. View

20.

Martinelli N, Montagnana M, Pizzolo F, Friso S, Salvagno G, Forni G . A relative ADAMTS13 deficiency supports the presence of a secondary microangiopathy in COVID 19. Thromb Res. 2020; 193:170-172. PMC: 7367811. DOI: 10.1016/j.thromres.2020.07.034. View