Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection.
Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection.
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DOI：
10.1001/jamanetworkopen.2020.22058
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发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Higgins JM
中科院分区：
文献类型：
--
作者：
Foy BH;Carlson JCT;Reinertsen E;Padros I Valls R;Pallares Lopez R;Palanques-Tost E;Mow C;Westover MB;Aguirre AD;Higgins JM
这项队列研究评估了红细胞分布宽度在2019年冠状病毒病患者风险分层中的潜在用途。在感染SARS-CoV-2的患者中，在入院时和住院期间，死亡风险与红细胞分布宽度(RDW)之间是否存在关联？RDW是一种常规的完整血细胞计数成分。在这项对1641名住院的SARS-CoV-2感染成人患者进行的队列研究中，入院时RDW升高和住院期间RDW增加与死亡风险的统计显著增加相关。入院时RDW与死亡风险之间的关联与D-二聚体(二聚化纤溶酶片段D)水平、绝对淋巴细胞计数、人口统计因素和常见合并症无关。研究结果表明，入院时测量的RDW升高和住院期间RDW增加与SARS-CoV-2感染患者显著更高的死亡风险相关；RDW可能有助于患者危险分层。冠状病毒病2019(新冠肺炎)是一种住院率和死亡率都很高的急性呼吸道疾病。生物标记物是患者风险分层的迫切需要。红细胞分布宽度(RDW)是完整血细胞计数的一个组成部分，反映了细胞体积的变化，已被证明与多种疾病的发病率和死亡率增加有关。目的：研究新冠肺炎患者入院时和住院期间RDW升高与死亡风险之间是否存在关联。这项队列研究包括2020年3月4日至2020年4月28日期间在马萨诸塞州波士顿地区4家医院中的1家(马萨诸塞州总医院、布里格姆妇女医院、北岸医疗中心和牛顿-韦尔斯利医院)住院的被诊断为SARS-CoV-2感染的成年人。主要结果是患者在住院期间的存活情况。测量包括入院时和住院期间的RDW，RDW升高被定义为大于14.5%。死亡的相对风险(RR)通过将RDW升高的患者的死亡率除以未升高的RDW的死亡率来估计。死亡危险比(HRs)和95%的顺位用COX比例风险模型估计。共有1641名患者被纳入研究(平均年龄62[18]岁；886名男性[54%]；740名白人[45%]和497名西班牙裔[30%]；276名死亡[17%])。在所有年龄段的患者中，RDW升高(>；14.5%)与死亡风险增加相关。整个队列的RR为2.73，RDW正常者的死亡率为11%(1173)，RDW增高者的死亡率为31%(468)。50岁以下组RR为5.25(RDW正常，1%[n = 341]；RDW升高，8%[n = 65])；50~59岁组RR为2.90(RDW正常，8%[n = 256]；RDW升高，24%[n = 63])；60~69岁组RR3.96(RDW正常，8%[n = 226]；RDW升高，30%[10 4])；1.45在70~79岁年龄组(RDW正常，23%[n = 182]；RDW升高，33%[n = 113])；1.59在≥80岁组(RDW正常，29%[n = 168]；RDW升高，46%[n = 123])。在校正了年龄、D-二聚体(二聚化纤溶酶片段D)水平、绝对淋巴细胞计数以及糖尿病和高血压等常见合并症的COX比例风险模型中，RDW与死亡风险相关(风险比为每0.5%RDW增加1.09和2.01；RDW和GT增加14.5%对≤14.5%；P <； .001)。住院期间RDW增加的患者的死亡率高于RDW无变化的患者；RDW正常者的死亡率从6%上升到24%，入院时RDW升高的患者的死亡率从22%上升到40%。入院时RDW升高和住院期间RDW增加与在大型学术医学中心网络中的4家医院接受治疗的新冠肺炎患者的死亡风险增加相关。
This cohort study assesses the potential use of red blood cell distribution width for risk stratification of patients with coronavirus disease 2019. In patients with SARS-CoV-2 infection, is there an association between mortality risk and red blood cell distribution width (RDW), a routine complete blood count component, at the time of admission and during hospitalization? In this cohort study of 1641 adult patients with SARS-CoV-2 infection who were hospitalized, elevated RDW at admission and increasing RDW during hospitalization were associated with statistically significant increases in mortality risk. The association between the RDW at admission and mortality risk was independent of D-dimer (dimerized plasmin fragment D) level, absolute lymphocyte count, demographic factors, and common comorbidities. The findings suggest that an elevated RDW measured at admission and increasing RDW during hospitalization were associated with significantly higher mortality risk for patients with SARS-CoV-2 infection; RDW may be helpful for patient risk stratification. Coronavirus disease 2019 (COVID-19) is an acute respiratory illness with a high rate of hospitalization and mortality. Biomarkers are urgently needed for patient risk stratification. Red blood cell distribution width (RDW), a component of complete blood counts that reflects cellular volume variation, has been shown to be associated with elevated risk for morbidity and mortality in a wide range of diseases. To investigate whether an association between mortality risk and elevated RDW at hospital admission and during hospitalization exists in patients with COVID-19. This cohort study included adults diagnosed with SARS-CoV-2 infection and admitted to 1 of 4 hospitals in the Boston, Massachusetts area (Massachusetts General Hospital, Brigham and Women’s Hospital, North Shore Medical Center, and Newton-Wellesley Hospital) between March 4, 2020, and April 28, 2020. The main outcome was patient survival during hospitalization. Measures included RDW at admission and during hospitalization, with an elevated RDW defined as greater than 14.5%. Relative risk (RR) of mortality was estimated by dividing the mortality of those with an elevated RDW by the mortality of those without an elevated RDW. Mortality hazard ratios (HRs) and 95% CIs were estimated using a Cox proportional hazards model. A total of 1641 patients were included in the study (mean [SD] age, 62[18] years; 886 men [54%]; 740 White individuals [45%] and 497 Hispanic individuals [30%]; 276 nonsurvivors [17%]). Elevated RDW (>14.5%) was associated with an increased mortality risk in patients of all ages. The RR for the entire cohort was 2.73, with a mortality rate of 11% in patients with normal RDW (1173) and 31% in those with an elevated RDW (468). The RR in patients younger than 50 years was 5.25 (normal RDW, 1% [n = 341]; elevated RDW, 8% [n = 65]); 2.90 in the 50- to 59-year age group (normal RDW, 8% [n = 256]; elevated RDW, 24% [n = 63]); 3.96 in the 60- to 69-year age group (normal RDW, 8% [n = 226]; elevated RDW, 30% [104]); 1.45 in the 70- to 79-year age group (normal RDW, 23% [n = 182]; elevated RDW, 33% [n = 113]); and 1.59 in those ≥80 years (normal RDW, 29% [n = 168]; elevated RDW, 46% [n = 123]). RDW was associated with mortality risk in Cox proportional hazards models adjusted for age, D-dimer (dimerized plasmin fragment D) level, absolute lymphocyte count, and common comorbidities such as diabetes and hypertension (hazard ratio of 1.09 per 0.5% RDW increase and 2.01 for an RDW >14.5% vs ≤14.5%; P < .001). Patients whose RDW increased during hospitalization had higher mortality compared with those whose RDW did not change; for those with normal RDW, mortality increased from 6% to 24%, and for those with an elevated RDW at admission, mortality increased from 22% to 40%. Elevated RDW at the time of hospital admission and an increase in RDW during hospitalization were associated with increased mortality risk for patients with COVID-19 who received treatment at 4 hospitals in a large academic medical center network.
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影响因子：
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通讯作者：
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影响因子：
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DOI：
10.1073/pnas.1012747107
发表时间：
2010-11-23
影响因子：
11.1
作者：
Higgins, John M.;Mahadevan, L.
通讯作者：
Mahadevan, L.