Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey.
Am J Cardiol. 2012 Jan 1;109(1):128-34. doi: 10.1016/j.amjcard.2011.08.015. Epub 2011 Sep 28.
Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 ± 15 years. The mean follow-up duration was 11 ± 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE.
红细胞分布宽度（RDW）与冠心病、急性心肌梗死、急性和慢性心力衰竭、肺动脉高压等心肺疾病的预后密切相关。然而，其在急性肺栓塞（PE）中的预后意义尚不清楚。本研究旨在探讨入院时 RDW 与急性 PE 患者早期死亡率的关系。
共纳入 165 例确诊为急性 PE 的患者。排除既往接受贫血、恶性肿瘤或慢性肝病治疗、接受慢性肾衰竭透析治疗以及因任何原因接受红细胞悬液治疗的患者。前瞻性评估了 136 例连续急性 PE 患者。根据受试者工作特征曲线分析，RDW 预测早期死亡率的最佳截断值为>14.6%，灵敏度为 95.2%，特异性为 53%。根据 14.6%的截断值，前瞻性将患者分为 RDW 不变（组 1）或增加（组 2）。患者的平均年龄为 63±15 岁。平均随访时间为 11±7 天，21 例患者死亡。在这 21 例患者中，1 例（1.6%）在组 1，20 例（27%）在组 2（p<0.001）。单因素 Cox 比例风险分析显示，入院时增加的 RDW>14.6%、年龄、休克、心率、血氧饱和度和肌酐水平均具有预后意义。仅入院时增加的 RDW>14.6%（风险比 15.465，p=0.012）和休克（风险比 9.354，p<0.001）在多因素 Cox 比例风险模型中与急性 PE 相关的早期死亡率增加相关。
总之，高 RDW 与更差的血流动力学参数相关，RDW 似乎有助于对急性 PE 患者进行风险分层。
