Red Blood Cell Distribution Width in Hospitalized COVID-19 Patients

  1. Preethi Ramachandran
  2. Mahesh Gajendran
  3. Abhilash Perisetti
  4. Karim Osama Elkholy
  5. Abhishek Chakraborti
  6. Giuseppe Lippi
  7. Hemant Goyal

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Abstract

Introduction: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases.

Objective: To assess if elevated RDW is associated with unfavorable outcomes in hospitalized COVID-19.

Methods: We retrospectively studied clinical outcomes of hospitalized COVID-19 patients for their RDW values. In-hospital mortality was defined as primary outcome, while septic shock, need for mechanical ventilation, and length of stay (LOS) were secondary outcomes.

Results: A total of 294 COVID-19 patients were finally studied. Overall prevalence of increased RDW was 49.7% (146/294). RDW was associated with increased risk of in-hospital mortality (aOR, 4.6; 95%CI, 1.5-14.6) and septic shock (aOR, 4.6; 95%CI, 1.4-15.1) after adjusting for anemia, ferritin, lactate, and absolute lymphocyte count. The association remained unchanged even after adjusting for other clinical confounders such as age, sex, body mass index, coronary artery disease, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. No association was found instead with mechanical ventilation and median LOS.

Conclusion: Elevated RDW in hospitalized COVID-19 patients is associated with a significantly increased risk of mortality and septic shock.

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  1. Version published to 10.3389/fmed.2021.582403
  2. ScreenIT

    SciScore for 10.1101/2020.06.29.20143081: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the institutional review board.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisThe receiver operating characteristic (ROC) curve was used for exploring the discriminant power of the model.
    Sex as a biological variableExclusion criteria were-individuals who were not hospitalized or treated on an ambulatory basis, age < 18 years, pregnancy, non-availability of nasopharyngeal testing, lack of clinical or laboratory information on disposition and/or mortality data anemia was defined as a hemoglobin value <130 g/L in males and <120 g/L in females, respectively.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    (SPSS Inc, Armonk, NY)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.06.29.20143081v1 on medRxiv