Hornick Andrew, Tashtish Nour, Osnard Michael, Shah Binita, Bradigan Allison, Albar Zainab, Tomalka Jeffrey, Dalton Jarrod, Sharma Ashish, Sekaly Rafick P, Hejal Rana, Simon Daniel I, Zidar David A, Al-Kindi Sadeer G
Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center.
New York VA Harbor Healthcare System and New York University School of Medicine, New York, NY.
Pathog Immun. 2020 Oct 2;5(1):312-326. doi: 10.20411/pai.v5i1.391. eCollection 2020.
Red cell distribution width (RDW), a measure of anisocytosis, is observed in chronic inflammation and is a prognostic marker in critically ill patients without COVID-19, but data in COVID-19 are limited.
Between March 12 and April 19, 2020, 282 individuals with confirmed COVID-19 and RDW available within 7 days prior to COVID-19 confirmation were evaluated. Individuals were grouped by quartiles of RDW. Association between quartiles of RDW and mortality was assessed using the Kaplan-Meier method and statistical significance was assessed using the log-rank test. The association between RDW and all-cause mortality was further assessed using a Cox proportional hazards model. Plasma cytokine levels in uninfected ambulatory adults without cardiovascular disease (n=38) were measured and bivariate Spearman correlations and principle components analysis were used to identify relationships between cytokine concentrations with RDW.
After adjusting for age, sex, race, cardiovascular disease, and hemoglobin, there was an association between RDW and mortality (Quartile 4 vs Quartile 1: HR 4.04 [1.08-15.07]), with each 1% increment in RDW associated with a 39% increased rate of mortality (HR 1.39 [1.21-1.59]). Remote RDW was also associated with mortality after COVID-19 infection. Among uninfected ambulatory adults without cardiovascular disease, RDW was associated with elevated pro-inflammatory cytokines (TNF-α, IL8, IL6, IL1b), but not regulatory cytokines (TGFb).
Anisocytosis predicts short-term mortality in COVID-19 patients, often predates viral exposure, and may be related to a pro-inflammatory phenotype. Additional study of whether the RDW can assist in the early identification of pending cytokine storm is warranted.
红细胞分布宽度（RDW）是反映红细胞体积异质性的参数，在慢性炎症中可见，是未感染新型冠状病毒肺炎（COVID-19）的危重症患者的预后标志物，但COVID-19患者的数据有限。
在2020年3月12日至4月19日期间，对282例确诊COVID-19且在确诊前7天内有RDW数据的患者进行评估。根据RDW四分位数对患者进行分组。采用Kaplan-Meier法评估RDW四分位数与死亡率之间的关联，并采用对数秩检验评估统计学显著性。使用Cox比例风险模型进一步评估RDW与全因死亡率之间的关联。检测了无心血管疾病的未感染非卧床成人（n = 38）的血浆细胞因子水平，并采用双变量Spearman相关性分析和主成分分析来确定细胞因子浓度与RDW之间的关系。
在调整年龄、性别、种族、心血管疾病和血红蛋白后，RDW与死亡率之间存在关联（四分位数4与四分位数1相比：HR 4.04 [1.08 - 15.07]），RDW每增加1%，死亡率增加39%（HR 1.39 [1.21 - 1.59]）。COVID-19感染前的RDW也与死亡率相关。在无心血管疾病的未感染非卧床成人中，RDW与促炎细胞因子（TNF-α、IL8、IL6、IL1b）升高有关，但与调节性细胞因子（TGFb）无关。
红细胞体积异质性可预测COVID-19患者的短期死亡率，且通常在病毒暴露之前出现，可能与促炎表型有关。有必要进一步研究RDW是否有助于早期识别即将发生的细胞因子风暴。
