Highlights
- •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
Purpose
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.
Results
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.
Conclusions
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%).
Keywords
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References
- Derivation and validation of prognostic model for pulmonary embolism.Am J Resp Crit Care Med. 2005; 172: 1041-1046
- 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC).Eur Heart J. 2020; 41: 543-603
- Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism.Clin Res Cardiol. 2020; 109: 1008-1017
- Risk stratifying emergency department patients with acute pulmonary embolism: does the simplified pulmonary embolism severity index perform as well as the original?.Thromb Res. 2016; 148: 1-8
- Red blood cell distribution width: a simple parameter with multiple clinical applications.Crit Rev Clin Lab Sci. 2015; 52: 86-105
- Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: results of a prospective cohort study.PloS One. 2018; 13: e0191280
- Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism.Clin Respir J. 2016; 00: 1-9
- Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism.J Crit Care. 2017; 37: 197-201
- Relation between dynamic change of red cell distribution width and 30-day mortality in patients with acute pulmonary embolism.Clin Respir J. 2018; 12: 953-960
- Red cell distribution with in acute pulmonary embolism patients: a simple aid for improvement of the 30-day mortality risk stratification based on the pulmonary embolism severity index.Heart Lung. 2019; 48: 436-445
- 2021 Interpretative Handbook.(Mayo Foundation for Medical Education and Research (MFMER) 2021, pp. 689. Available at:)MayoTestCatalog-Rochester--SortedByTestName-duplex-interpretive.pdf(mayocliniclabs.com)Date accessed: May 31, 2021
- Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism.Eur Heart J. 2010; 31: 1836-1844
- Clinical and echocardiographic predictors of mortality in acute pulmonary embolism.Cardiovasc Ultrasound. 2016; 14: 44
- The role of red blood cell distribution width (RDW) in cardiovascular risk assessment: useful or hype?.Ann Transl Med. 2019; 7: 581
Article info
Publication history
Published online: January 21, 2022
Accepted:
December 5,
2021
Received in revised form:
November 24,
2021
Received:
July 31,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
