Red blood cell distribution width and mortality risk in a community-based prospective cohort.
Red blood cell distribution width and mortality risk in a community-based prospective cohort.
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DOI：
10.1001/archinternmed.2009.55
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发表时间：
2009-03-23
影响因子：
--
通讯作者：
Beckman, Joshua A.
中科院分区：
文献类型：
--
作者：
Perlstein, Todd S.;Weuve, Jennifer;Pfeffer, Marc A.;Beckman, Joshua A.
红细胞分布宽度(RDW)是一种对红细胞大小异质性(如红细胞异质性)的自动化测量，但在很大程度上被忽视，是新发现的心血管疾病(CVD)患者的危险标志物。目前尚不清楚RDW是否与普通人群的死亡率有关，或者这种联系是否与心血管疾病有关。我们在第三次全国健康和营养检查调查(1988-1994)中对15,852名成年人的RDW与全原因死亡率以及心血管、癌症和慢性下呼吸道疾病死亡率的关系进行了研究。第三次全国健康和营养检查调查是美国人口的全国代表性样本。通过与国家死亡指数进行匹配获得死亡状况，并进行跟踪调查，直至2000年12月31日。在考虑年龄因素后，估计死亡率从RDW的最低五分之一到最高五分之一增加了5倍，在多变量调整后增加了2倍(每个P趋势和lt；0.001)。在多变量调整后，RDW每增加1个标准差(0.98)，全因死亡风险(危险比(HR)1.23，95%可信区间(CI)1.18-1.28)增加23%。RDW还与心血管疾病(HR 1.22，95%CI 1.14-1.31)、癌症(HR 1.28，95%CI 1.21-1.36)和慢性下呼吸道疾病(HR 1.32，95%CI 1.17-1.49)相关。在以社区为基础的大样本中，较高的RDW与死亡风险增加相关，这种关联不是心血管疾病所特有的。因此，对细胞异质性的研究可能会产生新的病理生理学见解，而RDW的测量可能有助于风险评估。
The red cell distribution width (RDW), an automated measure of red blood cell size heterogeneity (e.g. anisocytosis) that is largely overlooked, is a newly recognized risk marker in patients with established cardiovascular disease (CVD). It is unknown whether RDW is associated with mortality in the general population, or whether this association is specific to CVD. We examined the association of RDW with all-cause mortality, as well as cardiovascular, cancer, and chronic lower respiratory disease mortality among 15,852 adult participants in The Third National Health and Nutrition Examination Survey (1988–1994), a nationally representative sample of the United States population. Mortality status was obtained by matching to the National Death Index, with follow-up through December 31, 2000. Estimated mortality rates increased 5-fold from the lowest to highest quintile of RDW after accounting for age, and 2-fold after multivariable adjustment (each Ptrend < 0.001). A 1- standard deviation increment in RDW (0.98) was associated with a 23% greater risk of all-cause mortality (hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.18–1.28) after multivariable adjustment. RDW was also associated with risk of death due to cardiovascular disease (HR 1.22, 95% CI 1.14–1.31), cancer (HR 1.28, 95% CI 1.21–1.36), and chronic lower respiratory disease (HR 1.32, 95% CI 1.17–1.49). Higher RDW was associated with increased mortality risk in this large, community-based sample, an association not specific to CVD. Study of anisocytosis may therefore yield novel pathophysiological insights, and measurement of RDW may contribute to risk assessment.
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