Predicting Long-Term Mortality in Acute Pulmonary Embolism: The Role of RDW Levels

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Murat Kerkutluoglu
Anil Sahin
Oguzhan Yucel
Hakan Gunes
Mehmet Birhan Yilmaz
Ali Zorlu


Objective: Acute pulmonary embolism (PE) is a life-threatening cardiovascular emergency. PE long-term mortality data is scarce. Red cell distribution width (RDW) may predict PE mortality independently. This research examined the association between admission RDW and long-term mortality in acute PE patients.

Material and Methods: A prospective registry-based cohort design was used in this investigation. Included were a total of 115 discharged individuals with acute PEThe documentation of clinical features, test data, cardiovascular risk factors, and comorbidities was conducted for patients who were observed for a median of 140 months (range: 2-168) to determine the occurrence of cardiovascular mortality.

Results: The mean age of the patients was 62±16 years. After follow-up, 52 of 115 patients (45%) died from cardiovascular causes. Those who perished had greater RDW levels than those who survived [16.4±3.1 vs. 14.6±2.1%, p<0.001]. The optimum RDW threshold for predicting long-term mortality was >14.6% (AUC =0.704, 95% CI =0.608-0.808).

Conclusion: Long-term mortality in PE patients was likely associated with elevated RDW levels..


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Kerkutluoglu, M., Sahin, A. ., Yucel, O. ., Gunes, H. ., Yilmaz, M. B. ., & Zorlu, A. . (2023). Predicting Long-Term Mortality in Acute Pulmonary Embolism: The Role of RDW Levels. Medical Science and Discovery, 10(5), 319–324.
Research Article
Received 2023-04-10
Accepted 2023-05-19
Published 2023-05-21


Elias A, Mallett S, Daoud-Elias M, Poggi J-N, Clarke M. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open. 2016;6(4):e010324.

Sandal A, Korkmaz ET, Aksu F, Köksal D, Toros Selçuk Z, Demir AU, et al. Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism. Anatol J Cardiol. 2021;25(8):544–54.

Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533.

Liu X, Zheng L, Han J, Song L, Geng H, Liu Y. Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality. Sci Rep. 2021;11(1):14909.

Abul Y, Karakurt S, Ozben B, Toprak A, Celikel T. C-reactive protein in acute pulmonary embolism. J Investig Med. 2011;59(1):8–14.

Demirkol S, Balta S, Cakar M, Unlu M, Arslan Z, Kucuk U. Red cell distribution width: a novel inflammatory marker in clinical practice. Cardiol J. 2013;20(2):209.

Felker G, Allen L, Pocock S, Shaw L, McMurray J, Pfeffer M, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007;50:40–7.

Baltazares-Lipp ME, Aguilera-Velasco A, Aquino-Gálvez A, Velázquez-Cruz R, Hernández-Zenteno RJ, Alvarado-Vásquez N, et al. Evaluating of Red Blood Cell Distribution Width, Comorbidities and Electrocardiographic Ratios as Predictors of Prognosis in Patients with Pulmonary Hypertension. Diagnostics (Basel, Switzerland). 2021;11(7):1297.

Ozsu S, Abul Y, Gunaydin S, Orem A, Ozlu T. Prognostic value of red cell distribution width in patients with pulmonary embolism. Clin Appl Thromb Hemost. 2014;20(4):365–70.

Zorlu A, Bektasoglu G, Guven FMK, Dogan OT, Gucuk E, Ege MR, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol. 2012;109(1):128–34.

Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Hear J. 2008;29(18):2276–315.

Nutritional anaemias. Report of a WHO scientific group. World Heal Organ Tech Rep Ser. 1968;405:5–37.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and t. J Am Soc Echocardiogr. 2010;23(7):685–713.

Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(4):307–32.

Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984;70(4):657–62.

Ovechkin A V, Lominadze D, Sedoris KC, Robinson TW, Tyagi SC, Roberts AM. Lung ischemia-reperfusion injury: implications of oxidative stress and platelet-arteriolar wall interactions. Arch Physiol Biochem. 2007;113(1):1–12.

Balta S, Demirkol S, Cakar M, Ardic S, Celik T, Demirbas S. Red cell distribution width: a novel and simple predictor of mortality in acute pancreatitis. Am J Emerg Med. 2013;31(6):991–2.

Yousefi B, Sanaie S, Ghamari AA, Soleimanpour H, Karimian A, Mahmoodpoor A. Red Cell Distribution Width as a Novel Prognostic Marker in Multiple Clinical Studies. Indian J Crit Care Med. 2020;24(1):49–54.

Hammons L, Filopei J, Steiger D, Bondarsky E. A narrative review of red blood cell distribution width as a marker for pulmonary embolism. J Thromb Thrombolysis. 2019;48(4):638–47.

Pehlivanlar Küçük M, Öztuna F, Abul Y, Özsu S, Kutlu M, Özlü T. Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism. Adv Respir Med. 2019;87(2):69–76.

Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009;133(4):628–32.

Jurin I, Trkulja V, Lucijanić M, Pejić J, Letilović T, Radonić V, et al. Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index. Hear Lung Circ. 2022;31(6):859–66.

Zhou X-Y, Chen H-L, Ni S-S. Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism. J Crit Care. 2017;37:197–201.

Liang L, Huang L, Zhao X, Zhao L, Tian P, Huang B, et al. Prognostic value of RDW alone and in combination with NT-proBNP in patients with heart failure. Clin Cardiol. 2022 Jul;45(7):802-813.

Sen HS, Abakay O, Tanrikulu AC, Sezgi C, Taylan M, Abakay A, et al. Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr. 2014: 25;1–8.

Kheirkham-Sabetghadam S, Jenab Y, Ghoreyshi-Hefzabad S-M, Gohari-Moghadam K, Lotfi-Tokaldany M, Jalali A, et al. Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism. Turk J Med Sci. 2018;48(2):318–23.