Red cell distribution width and mortality in older patients with frailty in the emergency department
Dublin Core
Title
Red cell distribution width and mortality in older patients with frailty in the emergency department
Subject
Frailty, Red cell distribution width, Biomarkers, Mortality, Prognostic factor, Emergency departments
Description
Background The red cell distribution width (RDW) refects 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% confdence 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 signifcant 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 benefcial to include it in risk stratifcation of older frail ED patients to identify those who could beneft
from further diagnostic assessment, targeted interventions, and care planning.
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% confdence 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 signifcant 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 benefcial to include it in risk stratifcation of older frail ED patients to identify those who could beneft
from further diagnostic assessment, targeted interventions, and care planning.
Creator
Janne Alakare, Kirsi Kemp, Timo Strandberg, Maaret Castrén, Jukka Tolonen and Veli‑Pekka Harjola
Publisher
BMC Emergency Medicine
Date
(2023) 23:24
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Janne Alakare, Kirsi Kemp, Timo Strandberg, Maaret Castrén, Jukka Tolonen and Veli‑Pekka Harjola, “Red cell distribution width and mortality in older patients with frailty in the emergency department,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/4326.