Red Blood Cell Distribution Width (RDW) as a prognostic marker for COVID-19: A literature review




Biomarker; COVID-19; Red Cell Distribution Width; SARS-CoV-2.


The Red Cell Distribution Width (RDW) is a component of blood count which gives the variation of erythrocytes, used in laboratory hematology. The analysis of this parameter is in evidence, as the increased levels of RDW seem to be a mortality predictor. The infections of the respiratory tract are in these conditions and the increase of RDW has already been related to severe acute respiratory syndrome (SARS). In December of 2019, the first cases of severe acute pneumonia caused by the SARS-CoV-2 virus emerged in China. The Corona Virus Disease-19 (COVID-19) has as most common clinical manifestations changes in the respiratory tract that range from mild to severe symptoms, requiring respiratory support in severe cases. Current evidence point to the increase of RDW value which is related to severity of the disease and mortality rates due to COVID-19. The large number of severe cases of COVID-19 shows the urgent of the identification of cheap diagnostic parameters and easy detection, which could be used for determining the prognosis of these patients. The RDW has been shown to be a potential biomarker due to the easy obtaining, low cost, and therefore, it can be an important guide to early and effective interventions.


Álvarez-Lerma, F., Marín-Corral, J., Vila, C., Masclans, J. R., González de Molina, F. J., Martín Loeches, I., Group, H. N. G. S. S. (2016). Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome. Crit Care, 20(1), 337.

Bellani, G., Laffey, J. G., Pham, T., Fan, E., Brochard, L., Esteban, A., Group, E. T. (2016). Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA, 315(8), 788-800.

Felker, G. M., Allen, L. A., Pocock, S. J., Shaw, L. K., McMurray, J. J., Pfeffer, M. A., Investigators, C. (2007). 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, 50(1), 40-47.

Foy, B. H., Carlson, J. C. T., Reinertsen, E., Padros I Valls, R., Pallares Lopez, R., Palanques-Tost, E., Higgins, J. M. (2020). Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection. JAMA Netw Open, 3(9), e2022058.

Franco, R. S. (2009). The measurement and importance of red cell survival. Am J Hematol, 84(2), 109-114.

Gong, J., Ou, J., Qiu, X., Jie, Y., Chen, Y., Yuan, L., Hu, B. (2020). A Tool for Early Prediction of Severe Coronavirus Disease 2019 (COVID-19): A Multicenter Study Using the Risk Nomogram in Wuhan and Guangdong, China. Clin Infect Dis, 71(15), 833-840.

Henry, B. M., Benoit, J. L., Benoit, S., Pulvino, C., Berger, B. A., Olivera, M. H. S., Lippi, G. (2020). Red Blood Cell Distribution Width (RDW) Predicts COVID-19 Severity: A Prospective, Observational Study from the Cincinnati SARS-CoV-2 Emergency Department Cohort. Diagnostics (Basel), 10(9).

Herridge, M. S., Moss, M., Hough, C. L., Hopkins, R. O., Rice, T. W., Bienvenu, O. J., & Azoulay, E. (2016). Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med, 42(5), 725-738.

Karampitsakos, T., Dimakou, K., Papaioannou, O., Chrysikos, S., Kaponi, M., Bouros, D., Hillas, G. (2020). The role of increased red cell distribution width as a negative prognostic marker in patients with COPD. Pulm Pharmacol Ther, 60, 101877.

Kosmeri, C., Koumpis, E., Tsabouri, S., Siomou, E., & Makis, A. (2020). Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer, 67(12), e28745.

Lee, J. H., Chung, H. J., Kim, K., Jo, Y. H., Rhee, J. E., Kim, Y. J., & Kang, K. W. (2013). Red cell distribution width as a prognostic marker in patients with community-acquired pneumonia. Am J Emerg Med, 31(1), 72-79.

Machhi, J., Herskovitz, J., Senan, A. M., Dutta, D., Nath, B., Oleynikov, M. D., Kevadiya, B. D. (2020). The Natural History, Pathobiology, and Clinical Manifestations of SARS-CoV-2 Infections. J Neuroimmune Pharmacol, 15(3), 359-386.

Malka, R., Delgado, F. F., Manalis, S. R., & Higgins, J. M. (2014). In vivo volume and hemoglobin dynamics of human red blood cells. PLoS Comput Biol, 10(10), e1003839.

Patel, K. V., Ferrucci, L., Ershler, W. B., Longo, D. L., & Guralnik, J. M. (2009). Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med, 169(5), 515-523.

Rello, J., Rodríguez, A., Ibañez, P., Socias, L., Cebrian, J., Marques, A., Group, H. N. S. W. (2009). Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain. Crit Care, 13(5), R148.

Ruuskanen, O., Lahti, E., Jennings, L. C., & Murdoch, D. R. (2011). Viral pneumonia. Lancet, 377 (9773), 1264-1275.

Said, A. S., Spinella, P. C., Hartman, M. E., Steffen, K. M., Jackups, R., Holubkov, R., Doctor, A. (2017). RBC Distribution Width: Biomarker for Red Cell Dysfunction and Critical Illness Outcome? Pediatr Crit Care Med, 18(2), 134-142.

Salvagno, G. L., Sanchis-Gomar, F., Picanza, A., & Lippi, G. (2015). Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci, 52(2), 86-105.

Taneri, P. E., Gómez-Ochoa, S. A., Llanaj, E., Raguindin, P. F., Rojas, L. Z., Roa-Díaz, Z. M., Muka, T. (2020). Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol, 35(8), 763-773.

Thompson, B. T., Chambers, R. C., & Liu, K. D. (2017). Acute Respiratory Distress Syndrome. N Engl J Med, 377(6), 562-572.

Topaz, G., Kitay-Cohen, Y., Peled, L., Gharra, W., Kaminer, K., Eitan, M., Shilo, L. (2017). The association between red cell distribution width and poor outcomes in hospitalized patients with influenza. J Crit Care, 41, 166-169.

Tsatsakis, A., Calina, D., Falzone, L., Petrakis, D., Mitrut, R., Siokas, V., Docea, A. O. (2020). SARS-CoV-2 pathophysiology and its clinical implications: An integrative overview of the pharmacotherapeutic management of COVID-19. Food Chem Toxicol, 146, 111769.

Wang, C., Deng, R., Gou, L., Fu, Z., Zhang, X., Shao, F., Li, C. (2020). Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters. Ann Transl Med, 8(9), 593.

Wang, C., Zhang, H., Cao, X., Deng, R., Ye, Y., Fu, Z., Lu, Z. (2020). Red cell distribution width (RDW): a prognostic indicator of severe COVID-19. Ann Transl Med, 8(19), 1230.

Wong, C. K., Lam, C. W., Wu, A. K., Ip, W. K., Lee, N. L., Chan, I. H., Sung, J. J. (2004). Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol, 136(1), 95-103.

Yu, X. S., Chen, Z. Q., Hu, Y. F., Chen, J. X., Xu, W. W., Shu, J., & Pan, J. Y. (2020). Red blood cell distribution width is associated with mortality risk in patients with acute respiratory distress syndrome based on the Berlin definition: A propensity score matched cohort study. Heart Lung, 49(5), 641-645.

Zhang, J. J. Y., Lee, K. S., Ang, L. W., Leo, Y. S., & Young, B. E. (2020). Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Clin Infect Dis, 71(16), 2199-2206.

Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Team, C. N. C. I. a. R. (2020). A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med, 382(8), 727-733.

Zinellu, A., & Mangoni, A. A. (2021). Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis. J Clin Med, 10(2).




How to Cite

CUNHA, A. C. C. H. .; CARNEIRO, A. C. D. M. .; TANAKA, S. C. S. V. .; PEREIRA, L. Q.; VITO, F. B. D. .; MORAES-SOUZA, H. Red Blood Cell Distribution Width (RDW) as a prognostic marker for COVID-19: A literature review . Research, Society and Development, [S. l.], v. 10, n. 9, p. e51810918377, 2021. DOI: 10.33448/rsd-v10i9.18377. Disponível em: Acesso em: 20 sep. 2021.



Review Article