PMID- 36894893
OWN - NLM
STAT- MEDLINE
DCOM- 20230313
LR  - 20230410
IS  - 1471-227X (Electronic)
IS  - 1471-227X (Linking)
VI  - 23
IP  - 1
DP  - 2023 Mar 9
TI  - Red cell distribution width and mortality in older patients with frailty in the 
      emergency department.
PG  - 24
LID - 10.1186/s12873-023-00801-1 [doi]
LID - 24
AB  - BACKGROUND: The red cell distribution width (RDW) reflects the degree of 
      heterogeneity of red blood cells. Elevated RDW is associated both with frailty 
      and with increased mortality in hospital-admitted patients. In this study we 
      evaluate whether high RDW values are associated with mortality in older emergency 
      department (ED) patients with frailty, and if the association is independent of 
      the degree of frailty. METHODS: We included ED patients with the following 
      criteria: >/= 75 years of age, Clinical Frailty Scale (CFS) score of 4 to 8, and 
      RDW % measured within 48 h of ED admission. Patients were allocated to six 
      classes by their RDW value: </= 13%, 14%, 15%, 16%, 17%, and >/= 18%. The outcome was 
      death within 30 days of ED admission. Crude and adjusted odds ratios (OR) with 
      95% confidence intervals (CI) for a one-class increase in RDW for 30-day 
      mortality were calculated via binary logistic regression analysis. Age, gender 
      and CFS score were considered as potential confounders. RESULTS: A total of 1407 
      patients (61.2% female), were included. The median age was 85 with an 
      inter-quartile range (IQR) of 80-89, median CFS score 6 (IQR: 5-7), and median 
      RDW 14 (IQR: 13-16). Of the included patients, 71.9% were admitted to hospital 
      wards. A total of 85 patients (6.0%) died during the 30-day follow-up. Mortality 
      rate was associated with RDW increase (p for trend < .001). Crude OR for a 
      one-class increase in RDW for 30-day mortality was 1.32 (95% CI: 1.17-1.50, 
      p < .001). When adjusted for age, gender and CFS-score, OR of mortality for 
      one-class RDW increase was still 1.32 (95% CI: 1.16-1.50, p < .001). CONCLUSION: 
      Higher RDW values had a significant association with increased 30-day mortality 
      risk in frail older adults in the ED, and this risk was independent of degree of 
      frailty. RDW is a readily available biomarker for most ED patients. It might be 
      beneficial to include it in risk stratification of older frail ED patients to 
      identify those who could benefit from further diagnostic assessment, targeted 
      interventions, and care planning.
CI  - (c) 2023. The Author(s).
FAU - Alakare, Janne
AU  - Alakare J
AD  - Department of Emergency Medicine and Services, Helsinki University Hospital and 
      University of Helsinki, Helsinki, Finland. janne.alakare@hus.fi.
AD  - Department of Geriatric Acute Care, Espoo Hospital, 2550 02070, City of Espoo, 
      PL, Finland. janne.alakare@hus.fi.
FAU - Kemp, Kirsi
AU  - Kemp K
AD  - Department of Emergency Medicine and Services, Helsinki University Hospital and 
      University of Helsinki, Helsinki, Finland.
FAU - Strandberg, Timo
AU  - Strandberg T
AD  - University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, 
      Finland.
AD  - University of Oulu, Center for Life Course Health Research, Oulu, Finland.
FAU - Castren, Maaret
AU  - Castren M
AD  - Department of Emergency Medicine and Services, Helsinki University Hospital and 
      University of Helsinki, Helsinki, Finland.
FAU - Tolonen, Jukka
AU  - Tolonen J
AD  - Department of Internal Medicine, Helsinki University Hospital and University of 
      Helsinki, Helsinki, Finland.
FAU - Harjola, Veli-Pekka
AU  - Harjola VP
AD  - Department of Emergency Medicine and Services, Helsinki University Hospital and 
      University of Helsinki, Helsinki, Finland.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230309
PL  - England
TA  - BMC Emerg Med
JT  - BMC emergency medicine
JID - 100968543
SB  - IM
MH  - Humans
MH  - Female
MH  - Aged
MH  - Aged, 80 and over
MH  - Male
MH  - Erythrocyte Indices
MH  - *Frailty
MH  - Prognosis
MH  - Emergency Service, Hospital
MH  - Retrospective Studies
MH  - Hospital Mortality
PMC - PMC9998144
OTO - NOTNLM
OT  - Biomarkers
OT  - Emergency departments
OT  - Frailty
OT  - Mortality
OT  - Prognostic factor
OT  - Red cell distribution width
COIS- The authors declare they have no competing interests.
EDAT- 2023/03/10 06:00
MHDA- 2023/03/14 06:00
PMCR- 2023/03/09
CRDT- 2023/03/09 23:34
PHST- 2022/10/10 00:00 [received]
PHST- 2023/03/01 00:00 [accepted]
PHST- 2023/03/09 23:34 [entrez]
PHST- 2023/03/10 06:00 [pubmed]
PHST- 2023/03/14 06:00 [medline]
PHST- 2023/03/09 00:00 [pmc-release]
AID - 10.1186/s12873-023-00801-1 [pii]
AID - 801 [pii]
AID - 10.1186/s12873-023-00801-1 [doi]
PST - epublish
SO  - BMC Emerg Med. 2023 Mar 9;23(1):24. doi: 10.1186/s12873-023-00801-1.