Red blood cell distribution width predicts early mortality in patients with acute dyspnea

BackgroundRed blood cell distribution width (RDW) has been shown to predict clinical outcomes in cardiovascular diseases. We studied whether RDW is useful to predict early mortality in patients with acute dyspnea at an emergency department (ED).MethodsWe retrospectively analyzed 907 patients with acute dyspnea who visited the ED from January 2009 to May 2009. Primary outcome was 30-day mortality.ResultsAcute decompensated heart failure (29.9%) was the most common adjudicated discharge diagnosis followed by cancer (14.8%) and pneumonia (12.5%). There was a stepwise increase of 30-day mortality risk from lowest (RDW < 12.9%) to highest (RDW > 14.3%) RDW tertiles (1.4% vs. 8.3% vs. 18.3%; log-rank P < 0.001). In multivariate Cox hazard analysis, RDW was an independent predictor of 30-day mortality after adjusting for other risk factors (HR 1.23; 95% CI 1.11–1.36; P < 0.001). Adding RDW to conventional clinical predictors significantly improved prediction for 30-day mortality as measured by the area under the ROC curve (AUC, from 0.873 to 0.885; P = 0.023) and the net reclassification improvement (NRI = 14.1%; P < 0.001)/integrated discrimination improvement (IDI = 0.038; P = 0.006).ConclusionsOur findings suggest that RDW measured at ED is an independent and additive predictor of early mortality in patients with acute dyspnea.

► RDW was an independent predictor for 30-day mortality in patients with acute dyspnea.
► Elevated RDW was associated with severity of comorbidities, anemia, and lower renal function.
► Adding RDW to conventional predictors significantly improved prognostication for mortality.