Background: Universally accepted and validated instruments for predicting the outcome of patients presenting to the emergency department (ED) with severe dyspnoea do not exist so far, nor are they regularly used by the emergency physicians. This study hence aimed to establish whether red blood cell distribution width (RDW) may be a predictive parameter of 1-year mortality in a population of patients admitted to the ED with severe dyspnoea attributable to different underlying disorders.
Methods: We retrospectively evaluated all the patients undergoing arterial blood gas analysis for severe dyspnoea (irrespective of the cause) during admission to ED of University Hospital of Verona from September 1, 2014 to November 31, 2014.
Results: The final study population consisted of 287 patients for whom complete clinical and laboratory information was available. Overall, 36 patients (12.5%) died after a 1-year follow-up. The RDW value was found to be considerably increased in patients who deceased during the follow-up compared to those who survived (17.2% versus 14.8%; p<0.001). In both univariate and multivariate analyses, the RDW value was found to be a significant predictor of 1-year mortality. In particular, patients with RDW ≥ 15.0% displayed a 72% increased risk of 1-year mortality after multiple adjustments.
Conclusions: The measurement of RDW, a very simple and inexpensive laboratory parameter, may represent an important factor for predicting medium-term mortality in patients presenting to the ED with severe dyspnoea.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. American Thoracic Society. Dyspnea. Mechanisms assessment and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med 1999; 159: 321–40.
2. Parshall MB Schwartzstein RM Adams L Banzett RB Manning HL Bourbeau J et al. An official American Thoracic Society statement: update on the mechanisms assessment and management of dyspnea. Am J Respir Crit Care Med 2012 15; 185: 435–52.
3. Ray P Birolleau S Lefort Y Becquemin MH Beigelman C Isnard R et al. Acute respiratory failure in the elderly: etiology emergency diagnosis and prognosis. Crit Care 2006; 10: R82.
4. Bingisser R Nickel CH. The last century of symptom-oriented research in emergency presentations – have we made any progress? Swiss Med Wkly 2013; 143: w13829.
5. Lippi G Sanchis-Gomar F Cervellin G. Chest pain dyspnea and other symptoms in patients with type 1 and 2 myocardial infarction. A literature review. Int J Cardiol 2016; 215: 20–2.
6. Pang PS Collins SP Sauser K Andrei AC Storrow AB Hollander JE et al. Assessment of dyspnea early in acute heart failure: patient characteristics and response differences between likert and visual analog scales. Acad Emerg Med 2014; 21: 659–66.
7. Pang PS Zaman M. Airway Management & Assessment of Dyspnea in Emergency Department Patients with Acute Heart Failure. Curr Emerg Hosp Med Rep 2013; 1: 122–5.
8. Saracino A. Review of dyspnoea quantification in the emergency department: is a rating scale for breathlessness suitable for use as an admission prediction tool? Emerg Med Australas 2007; 19: 394–404.
9. Nuñez S Hexdall A Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors? Qual Saf Health Care 2006; 15: 102–8.
10. Pang PS Cleland JG Teerlink JR Collins SP Lindsell CJ Sopko G et al. A proposal to standardize dyspnoea measurement in clinical trials of acute heart failure syndromes: the need for a uniform approach. Eur Heart J 2008; 29: 816–24.
11. Salvagno GL Sanchis-Gomar F Picanza A Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015; 52: 86–105.
12. Turcato G Serafini V Dilda A Bovo C Caruso B Ricci G et al. Red blood cell distribution width independently predicts medium-term mortality and major adverse cardiac events after an acute coronary syndrome. Ann Transl Med 2016; 4: 254.
13. Huang YL Hu ZD Liu SJ Sun Y Qin Q Qin BD et al. Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies. PLoS One 2014; 9: e104861.
14. Ani C Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009; 277: 103–8.
15. Lippi G Buonocore R Cervellin G. Value of Red Blood Cell Distribution Width on Emergency Department Admission in Patients With Venous Thrombosis. Am J Cardiol 2016; 117: 670–5.
16. Lippi G Buonocore R Picanza A Schirosa F Cervellin G. Red blood cell distribution width and haemoglobin are associated with hospital admission in patients with acute allergic reactions. Br J Biomed Sci 2016; 73: 21–4.
17. Wang D Yang J Zhang J Zhang S Wang B Wang R et al. Red cell distribution width predicts deaths in patients with acute pancreatitis. J Res Med Sci 2015; 20: 424–8.
18. Theodorsson E. Quality assurance in clinical chemistry: a touch of statistics and a lot of common sense. J Med Biochem 2016; 35: 103–112.
19. Lippi G Cervellin G Sanchis-Gomar F. Red blood cell distribution width and cardiovascular disorders. Does it really matter which comes first the chicken or the egg? Int J Cardiol 2016; 206: 129–30.
20. Sanchis-Gomar F Garcia-Gimenez JL Pareja-Galeano H Romagnoli M Perez-Quilis C Lippi G. Erythropoietin and the heart: physiological effects and the therapeutic perspective. Int J Cardiol 2014; 171: 116–25.
21. Yčas JW Horrow JC Horne BD. Persistent increase in red cell size distribution width after acute diseases: A biomarker of hypoxemia? Clin Chim Acta 2015; 25; 448: 107–17.
22. Hong N Oh J Kang SM Kim SY Won H Youn JC et al. Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta 2012; 413: 992–7.