Original scientific paper
Red blood cell distribution width as a prognostic marker of mortality in patients on chronic dialysis: a single center, prospective longitudinal study
Mario Sičaja
; Department of Medicine, Dubrava University Hospital, Zagreb, Croatia
Mario Pehar
; Department of Medicine, Dubrava University Hospital, Zagreb, Croatia
Lovorka Đerek
; Clinical Department for Laboratory Diagnostic, Dubrava University Hospital, Zagreb, Croatia
Boris Starčević
; Clinical Department for Laboratory Diagnostic, Dubrava University Hospital, Zagreb, Croatia
Vladimira Vuletić
; Department of Neurology Dubrava University Hospital Zagreb, Croatia
Željko Romić
; Clinical Department for Laboratory Diagnostic, Dubrava University Hospital, Zagreb, Croatia
Velimir Božikov
; Department of Medicine, Dubrava University Hospital, Zagreb, Croatia
Abstract
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], P < 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], P < 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 P < 0.001) than others.
Conclusions RDW could be an additive predictor for allcause
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
Hrčak ID:
102791
URI
Publication date:
15.2.2013.
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