Red blood cell distribution width as a prognostic marker of mortality in patients on chronic dialysis: a single center, prospective longitudinal study

Scientific paper - Original scientific paper

• Author: Mario Sičaja
• Author: Mario Pehar
• Author: Lovorka Đerek
• Author: Boris Starčević
• Author: Vladimira Vuletić
• Author: Željko Romić
• Author: Velimir Božikov
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

AIM:

To determine if red cell distribution width (RDW) is associated with all-cause mortality in patients on chronic dialysis and to evaluate its prognostic value among validated prognostic biomarkers. ----- METHODS:

This is a single center, prospective longitudinal study. At the time of inclusion in January 2011, all patients were physically examined and a routine blood analysis was performed. A sera sample was preserved for determination of NT-pro-brain natriuretic peptide (NT-pro-BNP) and eosinophil cationic protein. Carotid intima media thickness (IMT) was also measured. Following one year, all-cause mortality was evaluated. ----- RESULTS:

Of 100 patients, 25 patients died during the follow-up period of one-year. Patients who died had significantly higher median [range] RDW levels (16.7% [14.3-19.5] vs 15.5% [13.2-19.7], P<0.001. They had significantly higher Eastern Cooperative Oncology Group (ECOG) performance status (4 [2-4] vs 2 [1-4], Plt;0.001), increased intima-media thickness (IMT) (0.71 [0.47-1.25] vs 0.63 [0.31-1.55], P=0.011), increased NT-pro-BNP levels (8300 [1108-35000] vs 4837 [413-35000], P=0.043), and increased C-reactive protein (CRP) levels (11.6 [1.3-154.2] vs 4.9 [0.4-92.9], Plt;0.001). For each 1% point increase in RDW level as a continuous variable, one-year all cause mortality risk was increased by 54% in univariate Cox proportional hazard analysis. In the final model, when RDW was entered as a categorical variable, mortality risk was significantly increased (hazard ratio, 5.15, 95% confidence interval, 2.33 to 11.36) and patients with RDW levels above 15.75% had significantly shorter survival time (Log rank Plt;0.001) than others. ----- CONCLUSIONS:

RDW could be an additive predictor for all-cause mortality in patients on chronic dialysis. Furthermore, RDW combined with sound clinical judgment improves identification of patients who are at increased risk compared to RDW alone.

• Keywords (english): Aged; Biological Markers/blood; C-Reactive Protein/metabolism; Carotid Intima-Media Thickness; Cause of Death; Eosinophil Cationic Protein/blood; Erythrocyte Indices; Erythrocytes; Female; Humans; Longitudinal Studies; Male; Middle Aged; Natriuretic Peptide, Brain/blood; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Renal Dialysis/mortality
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Croatian Medical Journal
• Numbering: vol. 54, no. 1, pp. 25-32
• p-ISSN: 0353-9504
• DOI: https://doi.org/10.3325/cmj.2013.54.25
• URN:NBN: urn:nbn:hr:105:973488
• Publication: 2013-02
• Document URL: https://doi.org/10.3325/cmj.2013.54.25
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-27 19:51:57