Heart, Lung and Circulation

Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index

Published:January 21, 2022DOI:


      • The Pulmonary Embolism Severity Index (PESI) is a well-validated tool for prediction of 30-day mortality in acute pulmonary embolism (PE) patients that still needs additional improvement in early mortality risk estimation among intermediate-risk and high-risk groups
      • There is a need for a simple, fast, cheap and widely available marker that could be used as a reliable add-on tool to PESI in an emergency room or any clinical or organisational setting
      • This study showed that red cell distribution width reliably reclassified a substantial number of PESI intermediate-risk and high-risk patients into low-risk or very high-risk categories, and that its simple dichotomised use could further improve decision-making in acute pulmonary embolism in the emergency room setting with limited resources


      To validate red cell distribution width (RDW) as an improvement in 30-day mortality risk stratification based on the Pulmonary Embolism Severity Index (PESI) in acute pulmonary embolism (PE).

      Patients and Methods

      Prospective observational analysis of consecutive adult acute PE patients.


      Among 731 patients, 30-day mortality was 11.9%. With adjustment for the PESI score and number of covariates, higher RDW was associated with higher mortality (RDW continuous: OR 1.21, 95% CI 1.06–1.38; Bayesian OR 1.22, 1.07–1.40; RDW ‘high’ [>14.5% in men >16.1% in women] vs normal: OR 3.83, 1.98–7.46; Bayesian OR 3.98, 2.04–7.68]. Crude mortality was 3.6% if PESI 86–105 (intermediate risk), but 1.2% if RDW normal and 7.1% if RDW high; 11.8% if PESI 106–125 (high risk), but 3.6% if RDW normal and 18.8% if RDW high. Adjusted probabilities showed higher mortality (ORs between 3.5–5.8) if RDW was high in any PESI risk subgroup. Crude mortality rates in two random-split subsets (n=365 and n=366) again showed the same patterns.


      On-admission RDW above the normal range improves 30-day mortality risk stratification based on PESI score in acute PE. Particularly, it corrects PESI-based intermediate-risk or high-risk allocation by reclassification into very low-risk (<3.5%) or very high-risk (>11.0%).


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