Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study
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...
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| creator | Zurauskaite, Giedre Meier, Marc Voegeli, Alaadin Koch, Daniel Haubitz, Sebastian Kutz, Alexander Bernasconi, Luca Huber, Andreas Bargetzi, Mario Mueller, Beat Schuetz, Philipp |
| description | 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.
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.
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 |
| doi_str_mv | 10.1371/journal.pone.0191280 |
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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.
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 (R2) 0.30; p<0.001), nutrition (R2 0.20; p<0.001) and blood diseases (R2 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.
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".</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0191280</identifier><identifier>PMID: 29342203</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Anemia ; Biological effects ; Biology and Life Sciences ; Biomarkers ; Blood ; Blood tests ; Chronic diseases ; Clinical outcomes ; Cohort analysis ; Emergency medical services ; Heart failure ; Hematological diseases ; Hematology ; Hospitals ; Inflammation ; Laboratories ; Malnutrition ; Measurement ; Medicine ; Medicine and Health Sciences ; Mortality ; Nutrition ; Pathways ; Patient outcomes ; Patients ; Physiological aspects ; Population ; Prognosis ; Red blood cells ; Regression analysis ; Regression models ; Selenium ; Studies ; Womens health</subject><ispartof>PloS one, 2018-01, Vol.13 (1), p.e0191280-e0191280</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Zurauskaite et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Zurauskaite et al 2018 Zurauskaite et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-8efe09ad226509fe7668b8738e15612e05841bbf2bce90a2f8e08e888d22c5a3</citedby><cites>FETCH-LOGICAL-c692t-8efe09ad226509fe7668b8738e15612e05841bbf2bce90a2f8e08e888d22c5a3</cites><orcidid>0000-0002-4660-5924</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771602/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771602/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23864,27922,27923,53789,53791,79370,79371</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29342203$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Nolan, Anna</contributor><creatorcontrib>Zurauskaite, Giedre</creatorcontrib><creatorcontrib>Meier, Marc</creatorcontrib><creatorcontrib>Voegeli, Alaadin</creatorcontrib><creatorcontrib>Koch, Daniel</creatorcontrib><creatorcontrib>Haubitz, Sebastian</creatorcontrib><creatorcontrib>Kutz, Alexander</creatorcontrib><creatorcontrib>Bernasconi, Luca</creatorcontrib><creatorcontrib>Huber, Andreas</creatorcontrib><creatorcontrib>Bargetzi, Mario</creatorcontrib><creatorcontrib>Mueller, Beat</creatorcontrib><creatorcontrib>Schuetz, Philipp</creatorcontrib><title>Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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 (R2) 0.30; p<0.001), nutrition (R2 0.20; p<0.001) and blood diseases (R2 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.
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. 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pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study</title><author>Zurauskaite, Giedre ; Meier, Marc ; Voegeli, Alaadin ; Koch, Daniel ; Haubitz, Sebastian ; Kutz, Alexander ; Bernasconi, Luca ; Huber, Andreas ; Bargetzi, Mario ; Mueller, Beat ; Schuetz, Philipp</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-8efe09ad226509fe7668b8738e15612e05841bbf2bce90a2f8e08e888d22c5a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anemia</topic><topic>Biological effects</topic><topic>Biology and Life Sciences</topic><topic>Biomarkers</topic><topic>Blood</topic><topic>Blood tests</topic><topic>Chronic diseases</topic><topic>Clinical outcomes</topic><topic>Cohort analysis</topic><topic>Emergency medical services</topic><topic>Heart failure</topic><topic>Hematological diseases</topic><topic>Hematology</topic><topic>Hospitals</topic><topic>Inflammation</topic><topic>Laboratories</topic><topic>Malnutrition</topic><topic>Measurement</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Mortality</topic><topic>Nutrition</topic><topic>Pathways</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Physiological aspects</topic><topic>Population</topic><topic>Prognosis</topic><topic>Red blood cells</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Selenium</topic><topic>Studies</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zurauskaite, Giedre</creatorcontrib><creatorcontrib>Meier, Marc</creatorcontrib><creatorcontrib>Voegeli, Alaadin</creatorcontrib><creatorcontrib>Koch, Daniel</creatorcontrib><creatorcontrib>Haubitz, Sebastian</creatorcontrib><creatorcontrib>Kutz, 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Daniel</au><au>Haubitz, Sebastian</au><au>Kutz, Alexander</au><au>Bernasconi, Luca</au><au>Huber, Andreas</au><au>Bargetzi, Mario</au><au>Mueller, Beat</au><au>Schuetz, Philipp</au><au>Nolan, Anna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-01-17</date><risdate>2018</risdate><volume>13</volume><issue>1</issue><spage>e0191280</spage><epage>e0191280</epage><pages>e0191280-e0191280</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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 (R2) 0.30; p<0.001), nutrition (R2 0.20; p<0.001) and blood diseases (R2 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.
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".</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29342203</pmid><doi>10.1371/journal.pone.0191280</doi><tpages>e0191280</tpages><orcidid>https://orcid.org/0000-0002-4660-5924</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Anemia Biological effects Biology and Life Sciences Biomarkers Blood Blood tests Chronic diseases Clinical outcomes Cohort analysis Emergency medical services Heart failure Hematological diseases Hematology Hospitals Inflammation Laboratories Malnutrition Measurement Medicine Medicine and Health Sciences Mortality Nutrition Pathways Patient outcomes Patients Physiological aspects Population Prognosis Red blood cells Regression analysis Regression models Selenium Studies Womens health |
| title | Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study |
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