title: Red Cell Distribution Width as an Independent Predictor of Long-Term Mortality in Hip Fracture Patients: A Prospective Cohort Study.
abstract: Red blood cell distribution width (RDW) has been found to be a significant prognostic factor of mortality in many cardiovascular diseases. However, a link between RDW at admission with long-term mortality in the hip fracture population has not been well established. Therefore, we sought to evaluate the long-term prognostic value of RDW in a well-defined hip fracture cohort, and to compare the effect of RDW in patients with and without anemia. A prospective cohort study was performed on 1479 hip fracture patients admitted at the General Hospital of Chinese PLA between January 2000 and October 2011 with a follow-up study over a 2-year period. A total of 1479 patients were used for the evaluation of 2-year all-cause mortality, while 804 patients with more than 4 years of follow-up were extracted for further evaluation of 4-year all-cause mortality. Cox proportional regression was used to evaluate the association between admission RDW and long-term mortality, adjusting for potential confounding variables. Higher RDW values were strongly associated with increased all-cause mortality. After adjusting for age, mean corpuscular volume, admission hemoglobin, comorbidities, and complications, RDW had a significant independent association with both 2-year mortality with a hazard ratio (HR) of 1.183 (95% confidence interval [CI], 1.017 to 1.376) and 4-year mortality with an HR of 1.244 (95% CI, 1.052 to 1.471). In stratified analysis, the effect of RDW was even more pronounced, with 2-year mortality HR of 1.341 (95% CI, 1.095 to 1.643) and 4-year mortality HR of 1.345 (95% CI, 1.071 to 1.688) in non-anemic patients. In non-anemic patients, elevated RDW values are significantly associated with increased odds of all-cause mortality, implying that RDW may be a possible laboratory biomarker for risk stratification in non-anemic hip fracture patients. Further studies are needed to confirm the current finding in different and larger hip fracture cohorts.
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Houchen
authors.initials: H
authors.lastname: Lv
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Licheng
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.|School of Medicine, Nankai University, Tianjin, China.
authors.forename: Anhua
authors.initials: A
authors.lastname: Long
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Pengbin
authors.initials: P
authors.lastname: Yin
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zeng
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Lihai
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004909:Erythrocyte Indices; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate
keywords: ALL-CAUSE MORTALITY; ANEMIA; HIP FRACTURE; RED BLOOD CELL DISTRIBUTION WIDTH