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      Red Blood Cell Distribution Is a Significant Predictor of Severe Illness in Coronavirus Disease 2019

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          Abstract

          Introduction

          As red blood cell distribution width (RDW) significantly predicts clinical outcomes in patients with respiratory tract infections and in those with critical illnesses, we performed a critical analysis of the literature to explore the potential prognostic role of this laboratory parameter in coronavirus disease 2019 (COVID-19).

          Methods

          An electronic search was conducted in Medline, Scopus and Web of Science, using the keywords “coronavirus disease 2019” OR “COVID-19” AND “red blood cell distribution width” OR “RDW” in all fields, up to the present time, with no language restriction. Studies reporting the value of RDW-CV in CO­VID-19 patients with or without severe illness were included in a pooled analysis.

          Results

          The pooled analysis included 3 studies, totaling 11,445 COVID-19 patients' samples (2,654 with severe disease; 23.2%). In all investigations RDW-CV was higher in COVID-19 patients with severe illness than in those with mild disease, with differences between 0.30 and 0.70%. The pooled analysis, despite consistent heterogeneity ( I 2: 88%), revealed that the absolute RDW-CV value was 0.69% higher (95% CI 0.40–0.98%; p < 0.001) in COVID-19 patients with severe illness compared to those with mild disease.

          Conclusion

          These results, along with data published in other studies, support the use of RDW for assessing the risk of unfavorable COVID-19 progression.

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          Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis

          Brandon Michael Henry, Maria de Oliveira, Stefanie Benoit … (2020)
          As coronavirus disease 2019 (COVID-19) pandemic rages on, there is urgent need for identification of clinical and laboratory predictors for progression towards severe and fatal forms of this illness. In this study we aimed to evaluate the discriminative ability of hematologic, biochemical and immunologic biomarkers in patients with and without the severe or fatal forms of COVID-19. An electronic search in Medline (PubMed interface), Scopus, Web of Science and China National Knowledge Infrastructure (CNKI) was performed, to identify studies reporting on laboratory abnormalities in patients with COVID-19. Studies were divided into two separate cohorts for analysis: severity (severe vs. non-severe and mortality, i.e. non-survivors vs. survivors). Data was pooled into a meta-analysis to estimate weighted mean difference (WMD) with 95% confidence interval (95% CI) for each laboratory parameter. A total number of 21 studies was included, totaling 3377 patients and 33 laboratory parameters. While 18 studies (n = 2984) compared laboratory findings between patients with severe and non-severe COVID-19, the other three (n = 393) compared survivors and non-survivors of the disease and were thus analyzed separately. Patients with severe and fatal disease had significantly increased white blood cell (WBC) count, and decreased lymphocyte and platelet counts compared to non-severe disease and survivors. Biomarkers of inflammation, cardiac and muscle injury, liver and kidney function and coagulation measures were also significantly elevated in patients with both severe and fatal COVID-19. Interleukins 6 (IL-6) and 10 (IL-10) and serum ferritin were strong discriminators for severe disease. Several biomarkers which may potentially aid in risk stratification models for predicting severe and fatal COVID-19 were identified. In hospitalized patients with respiratory distress, we recommend clinicians closely monitor WBC count, lymphocyte count, platelet count, IL-6 and serum ferritin as markers for potential progression to critical illness.
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            Co-infection with respiratory pathogens among COVID-2019 cases

            Xiaojuan Zhu, Yiyue Ge, Tao Wu … (2020)
            Highlights • We describe the presence of 24 respiratory pathogens as co-infections in COVID-19 patients. • Most of these co-infections occurred 1–4 days after the onset of disease in COVID-19 patients. • The proportion of viral co-infections, fungal co-infections and bacterial-fungal co-infections were the highest in severe COVID-19 cases.
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              Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis

              Brandon Michael Henry, Jens Vikse, Stefanie Benoit … (2020)
              Highlights • SARS-CoV-2 may impair host antiviral response, causing subsequent hyperinflammation. • SARS-CoV-2 likely deranges the renin angiotensin aldosterone system (RAAS). • Hyperinflammation and RAAS imbalance may drive acute lung injury and coagulopathy. • RAAS imbalance impairs fibrinolysis, which can result in relative hypofibrinolysis. • This can lead widespread immunothrombosis, contributing to multi-organ damage.
              Article 0 comments Cited 190 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acta Haematol
                Journal ID (iso-abbrev): Acta Haematol
                Journal ID (publisher-id): AHA
                Title: Acta Haematologica
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                ISSN (Print): 0001-5792
                ISSN (Electronic): 1421-9662
                Publication date (Electronic): 25 August 2020
                Pages: 1-5
                Affiliations
                [1] aSection of Clinical Biochemistry, University of Verona, Verona, Italy
                [2] bCardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
                [3] cDepartment of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
                Author notes
                *Giuseppe Lippi, Section of Clinical Biochemistry, University Hospital of Verona, Piazzale Ludovico Antonio Scuro, 10, IT–37134 Verona (Italy), giuseppe.lippi@ 123456univr.it

                Brandon M. Henry and Fabian Sanchis-Gomar share equal senior authorship of this work.

                Article
                Publisher ID: aha-0001
                DOI: 10.1159/000510914
                PMC ID: 7490490
                PubMed ID: 32841949
                SO-VID: 566e11ae-1267-4587-b2d8-8b2094e7d923
                Copyright © Copyright © 2020 by S. Karger AG, Basel
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 20 July 2020
                Date accepted : 14 August 2020
                Page count
                Figures: 1, Tables: 1, References: 31, Pages: 5
                Categories
                Subject: Systematic Review

                Keywords: coronavirus,covid-19,red blood cell distribution width
                Data availability:
                Keywords: coronavirus, covid-19, red blood cell distribution width

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