San Francisco Coordinating Center, San Francisco, California, USA.
California Pacific Medical Center Research Institute, San Francisco, California, USA.
J Am Geriatr Soc. 2022 Aug;70(8):2354-2362. doi: 10.1111/jgs.17819. Epub 2022 May 4.
Red cell distribution width (RDW), an index for variation of red blood cell (RBC) size, has been proposed as a potential marker for poorer outcomes in several aging-related diseases and conditions. We tested whether greater variability of RBC size, presented as a higher RDW value, predicts poor prognoses among hospitalized patients over 60 years old.
We retrospectively collected data from older hospitalized patients aged ≥60 years between January 2013 to December 2017 at Sutter Health, a large integrated health system in Northern California. The RDW was measured during hospital admission and categorized with 1% intervals (≤13.9, 14.0-14.9, 15.0-15.9, 16.0-16.9, 17.0-17.9 and ≥18.0%). The primary outcome was the rate of in-hospital mortality and secondary outcomes included 30-day re-admission rate and length of hospital stay (in days).
A total of 167,292 admissions from 94,617 patients were included. The overall in-hospital mortality rate was 6.3%. As the RDW value increased, the rate of in-hospital mortality gradually increased from 2.7% for the lowest RDW category to 12.2% in the highest category (p-trend <0.001). The overall 30-day re-admission rate after discharge was 12.5% and the rate of 30-day re-admission also increased with increasing RDW categories (7.4% in the lowest group vs. 15.8% in the highest group, p-trend <0.001). Patients with the highest RDW values at admission stayed 1.5-2.0 times longer in the hospital than patients with lower RDW values who were admitted for the same causes.
Greater variability of RBC size is significantly associated with worse prognosis in hospitalized elderly patients, indicating higher mortality, greater risk of early re-admission, and longer hospital stay days. Risk stratification strategies for hospitalized elderly should include RDW value.
红细胞分布宽度（RDW）是红细胞大小变异的指标，已被提出作为几种与衰老相关的疾病和病症中预后较差的潜在标志物。我们检验了红细胞大小变异程度，表现为更高的 RDW 值，是否可预测 60 岁以上住院患者的不良预后。
我们回顾性地收集了 2013 年 1 月至 2017 年 12 月期间在加利福尼亚州北部大型综合卫生系统 Sutter Health 住院的年龄≥60 岁的老年住院患者的数据。在住院期间测量 RDW，并按 1%的间隔分类（≤13.9、14.0-14.9、15.0-15.9、16.0-16.9、17.0-17.9 和≥18.0%）。主要结局是院内死亡率，次要结局包括 30 天再入院率和住院时间（天）。
共纳入 94617 例患者的 167292 例住院患者。总体院内死亡率为 6.3%。随着 RDW 值的增加，院内死亡率逐渐从最低 RDW 类别（2.7%）增加到最高类别（12.2%）（趋势检验<0.001）。出院后 30 天再入院率总体为 12.5%，随着 RDW 分类的增加，再入院率也逐渐增加（最低组为 7.4%，最高组为 15.8%，趋势检验<0.001）。入院时 RDW 值最高的患者的住院时间比因相同原因入院的 RDW 值较低的患者长 1.5-2.0 倍。
红细胞大小变异程度越大与住院老年患者的预后不良显著相关，表明死亡率更高、早期再入院风险更大、住院时间更长。住院老年患者的风险分层策略应包括 RDW 值。
