Dataset Information

Extreme erythrocyte macrocytic and microcytic percentages are highly predictive of morbidity and mortality.

ABSTRACT:

Background

The red cell distribution width (RDW) is associated with health outcomes. Whether non-RDW risk information is contained in RBC sizes is unknown. This study evaluated the association of the percentage of extreme macrocytic RBCs (%Macro, RBC volume > 120 fl) and microcytic RBCs (%Micro, RBC volume < 60 fl) and the RDW-size distribution (RDW-sd) with mortality and morbidity.

Methods

Patients (females, n = 165,770; males, n = 100,210) at Intermountain Healthcare were studied if they had a hematology panel between May 2014 and September 2016. Adjusted sex-specific associations of %Macro/%Micro and RDW-sd with mortality and 33 morbidities were evaluated.

Results

Among females with fourth-quartile values of %Macro quartile and %Micro (referred to throughout as 4/4), there was an average of 7.2 morbidities versus 2.9 in the lowest risk (LR1) categories, 1/1, 1/2, 2/1, and 2/2 (P < 0.001). Among males, those in the 4/4 category had 8.0 morbidities, while those in the LR1 had 3.4 (P < 0.001). Cox regressions found %Macro/%Micro (4/4 vs. LR1, females: hazard ratio [HR] = 1.97 [95% CI = 1.53, 2.54]; males: HR = 2.17 [CI = 1.72, 2.73]), RDW-sd (quartile 4 vs. 1, females: HR = 1.33 [CI = 1.04, 1.69]; males: HR = 1.41 [CI = 1.10, 1.80]), and RDW (quartile 4 vs. 1, females: HR = 1.59 [CI = 1.26, 2.00]; males: HR = 1.23 [CI = 0.99, 1.52]) independently predicted mortality. Limitations include that the observational design did not reveal causality and unknown confounders may be unmeasured.

Conclusions

Concomitantly elevated %Macro and %Micro predicted the highest mortality risk and the greatest number of morbidities, revealing predictive ability of RBC volume beyond what is measured clinically. Mechanistic investigations are needed to explain the biological basis of these observations.

Funding

This study was supported by internal Intermountain Heart Institute funds and in-kind support from Sysmex America Inc.

SUBMITTER: Horne BD

PROVIDER: S-EPMC6124438 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Extreme erythrocyte macrocytic and microcytic percentages are highly predictive of morbidity and mortality.

Horne Benjamin D BD Muhlestein Joseph B JB Bennett Sterling T ST Muhlestein Joseph Boone JB Jensen Kurt R KR Marshall Diane D Bair Tami L TL May Heidi T HT Carlquist John F JF Hegewald Matthew M Knight Stacey S Le Viet T VT Bunch T Jared TJ Lappé Donald L DL Anderson Jeffrey L JL Knowlton Kirk U KU

JCI insight 20180726 14

<h4>Background</h4>The red cell distribution width (RDW) is associated with health outcomes. Whether non-RDW risk information is contained in RBC sizes is unknown. This study evaluated the association of the percentage of extreme macrocytic RBCs (%Macro, RBC volume > 120 fl) and microcytic RBCs (%Micro, RBC volume < 60 fl) and the RDW-size distribution (RDW-sd) with mortality and morbidity.<h4>Methods</h4>Patients (females, n = 165,770; males, n = 100,210) at Intermountain Healthcare were studie ...[more]

PMID: 30046011

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Dataset Information

Extreme erythrocyte macrocytic and microcytic percentages are highly predictive of morbidity and mortality.

Background

Methods

Results

Conclusions

Funding

Publications

Extreme erythrocyte macrocytic and microcytic percentages are highly predictive of morbidity and mortality.

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