University of Oulu

Alakare, J., Kemp, K., Strandberg, T. et al. Red cell distribution width and mortality in older patients with frailty in the emergency department. BMC Emerg Med 23, 24 (2023).

Red cell distribution width and mortality in older patients with frailty in the emergency department

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Author: Alakare, Janne1,2; Kemp, Kirsi1; Strandberg, Timo3,4;
Organizations: 1Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Geriatric Acute Care, Espoo Hospital, 2550 02070, City of Espoo, PL, Finland
3University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
4University of Oulu, Center for Life Course Health Research, Oulu, Finland
5Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
Persistent link:
Language: English
Published: Springer Nature, 2023
Publish Date: 2023-09-19


Background: The red cell distribution width (RDW) reflects the degree of heterogeneity of red blood cells. Elevated RDW is associated both with frailty and with increased mortality in hospital-admitted patients. In this study we evaluate whether high RDW values are associated with mortality in older emergency department (ED) patients with frailty, and if the association is independent of the degree of frailty.

Methods: We included ED patients with the following criteria: ≥ 75 years of age, Clinical Frailty Scale (CFS) score of 4 to 8, and RDW % measured within 48 h of ED admission. Patients were allocated to six classes by their RDW value: ≤ 13%, 14%, 15%, 16%, 17%, and ≥ 18%. The outcome was death within 30 days of ED admission. Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for a one-class increase in RDW for 30-day mortality were calculated via binary logistic regression analysis. Age, gender and CFS score were considered as potential confounders.

Results: A total of 1407 patients (61.2% female), were included. The median age was 85 with an inter-quartile range (IQR) of 80–89, median CFS score 6 (IQR: 5–7), and median RDW 14 (IQR: 13–16). Of the included patients, 71.9% were admitted to hospital wards. A total of 85 patients (6.0%) died during the 30-day follow-up. Mortality rate was associated with RDW increase (p for trend < .001). Crude OR for a one-class increase in RDW for 30-day mortality was 1.32 (95% CI: 1.17–1.50, p < .001). When adjusted for age, gender and CFS-score, OR of mortality for one-class RDW increase was still 1.32 (95% CI: 1.16–1.50, p < .001).

Conclusion: Higher RDW values had a significant association with increased 30-day mortality risk in frail older adults in the ED, and this risk was independent of degree of frailty. RDW is a readily available biomarker for most ED patients. It might be beneficial to include it in risk stratification of older frail ED patients to identify those who could benefit from further diagnostic assessment, targeted interventions, and care planning.

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Series: BMC emergency medicine
ISSN: 1471-227X
ISSN-E: 1471-227X
ISSN-L: 1471-227X
Volume: 23
Issue: 1
Article number: 24
DOI: 10.1186/s12873-023-00801-1
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
Funding: Open Access funding provided by University of Helsinki including Helsinki University Central Hospital. This study was supported by state funding for university-level health research, granted by Helsinki University Hospital, and by the Department of Emergency Medicine and Services, Helsinki University Hospital. JA and KK were supported by personal grants for the study from the Finnish Association for Emergency Medicine. JA was also supported by a grant from the Finnish Medical Foundation. The funding bodies played no role in the design of the study, data collection, data analysis, or interpretation of data, or in writing of the manuscript.
Copyright information: © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.