Association between red blood cell distribution width and mortality and severity among patients with COVID‐19: A systematic review and meta‐analysis

Lee, Jane J.; Montazerin, Sahar M.; Jamil, Adeel; Jamil, Umer; Marszalek, Jolanta; Chuang, Michael L.; Chi, Gerald

Emerging evidence has underscored the potential usefulness of red blood cell distribution width (RDW) measurement in predicting the mortality and disease severity of COVID‐19. This study aimed to assess the association of the plasma RDW levels with adverse prognosis in COVID‐19 patients. A comprehensive literature search from inception to September 2020 was performed to harvest original studies reporting RDW on admission and clinical outcomes among patients hospitalized with COVID‐19. RDW levels were compared between cases (patients who died or developed more severe symptoms) and controls (patients who survived or developed less severe symptoms). A total of 14,866 subjects from 10 studies were included in the meta‐analysis. Higher levels of RDW were associated with adverse outcomes in COVID‐19 patients (mean differences = 0.72; 95% CI = 0.47–0.97; I (2) = 89.51%). Deceased patients had higher levels of RDW compared to patients who survived (mean differences = 0.93; 95% CI = 0.63–1.23; I (2) = 85.58%). Severely ill COVID‐19 patients showed higher levels of RDW, as opposed to patients classified to have milder symptoms (mean differences = 0.61; 95% CI = 0.28–0.94; I (2) = 82.18%). Elevated RDW levels were associated with adverse outcomes in COVID‐19 patients. This finding warrants further research on whether RDW could be utilized as a simple and reliable biomarker for predicting COVID‐19 severity and whether RDW is mechanistically linked with COVID‐19 pathophysiology.