There is an intense focus on the identification of novel biomarkers of chronic obstructive pulmonary disease (COPD) to enhance clinical decisions in patients with stable disease and acute exacerbations (AECOPD). Though several local (airway) and circulatory inflammatory biomarkers have been proposed, emerging evidence also suggests a potential role for routine haematological parameters, e.g., the red cell distribution width (RDW). We conducted a systematic literature search in PubMed, Web of Science, and Scopus, from inception to April 2022, for articles investigating the diagnostic and prognostic role of the RDW in stable COPD and AECOPD. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Significant associations between the RDW and the presence and severity of disease, outcomes (mortality, hospital readmission), and other relevant clinical parameters (right heart failure, pulmonary arterial hypertension) were reported in 13 out of 16 studies in stable COPD (low risk of bias in 11 studies), and 17 out of 21 studies of AECOPD (low risk of bias in 11 studies). Pending further research, our systematic review suggests that the RDW might be useful, singly or in combination with other parameters, for the diagnosis and risk stratification of patients with stable COPD and AECOPD (PROSPERO registration number: CRD42022348304).

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The Emerging Clinical Significance of the Red Cell Distribution Width as a Biomarker in Chronic Obstructive Pulmonary Disease: A Systematic Review

BACKGROUND Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). AIM/OBJECTIVE The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). METHODS Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. RESULTS 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P < .001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P < .001). According to attack severity, low RDW values were determined. CONCLUSION Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.

Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Higher red blood cell distribution width (RDW) levels are associated with mortality in patients with chronic obstructive pulmonary disease (COPD). However, more convincing evidence is still lacking, and the relationship between hemoglobin-to-red blood cell distribution width ratio (HRR) and mortality in patients with COPD remains unclear. This study is a prospective cohort study that includes 3,745 adult patients with COPD from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018 in the United States. COX proportional hazards regression analysis, Kaplan–Meier survival curves and restricted cubic spline models were employed to investigate the association of RDW and HRR levels with mortality. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to evaluate the accuracy of RDW and HRR in predicting mortality in patients with COPD. Higher RDW level was positively associated with increased risk of all-cause mortality (HR = 1.16, 95% CI = 1.11–1.21, P < 0.001), cardiovascular disease (CVD) mortality (HR = 1.13, 95% CI = 1.06–1.21, P < 0.001), and chronic lower respiratory disease (CLRD) related mortality (HR = 1.15, 95% CI = 1.05–1.25, P = 0.003) after adjusting for various potential confounders. HRR was inversely associated with all-cause mortality (HR = 0.14, 95% CI = 0.08–0.25, P < 0.001), CVD mortality (HR = 0.12, 95% CI = 0.05–0.31, P < 0.001). HRR has no significant correlation with CLRD-related mortality. The time-dependent ROC curve showed that RDW exhibited area under the curves (AUCs) of the 5- and 10-year survival rates were 0.707 and 0.714 for all-cause mortality and 0.686 and 0.698, respectively, for CVD mortality. HRR yielded AUCs of the 5- and 10-year survival rates were 0.661 and 0.653 for all-cause mortality and 0.654 and 0.66, respectively, for CVD mortality. Higher RDW levels were positively associated with an increased risk of mortality in patients with COPD. HRR levels were negatively correlated with the risk of all-cause and CVD mortality. The predictive value of HRR for mortality in these patients is lower than that of RDW. 

Predictive role of red blood cell distribution width and hemoglobin-to-red blood cell distribution width ratio for mortality in patients with COPD: evidence from NHANES 1999–2018

We read carefully the retrospective study of Tao and Bai was to investigate mean platelet volume (MPV) combined red cell distribution-standard deviation as biomarkers in patients with chronic obstructive pulmonary disease (COPD) with pulmonary heart disease (PHD).1 We would like to emphasize the existence of other factors that may have affected the MPV results of this study. Although it has been stated by the authors that MPV is being investigated as a biomarker in heart diseases and cancers, it is not recommended being used for purposes such as diagnosing or determining prognosis in acquired diseases due to the fact that MPV measurement standardization has not been achieved until today.2 Important variables that lead to significant deviations in MPV measurement results are factors such as the time from blood collection to MPV measurement, the type of anticoagulant used in whole blood tubes, and which devices are used in MPV measurement.3-7 It has been reported that there may be a deviation of 2%-50% in MPV results due to the difference in the time from blood collection to MPV measurement and the anticoagulant used.3-5 Similarly, the difference in the devices used in MPV measurement can lead to deviation of up to 40%.5-7 In this study, it was not stated which anticoagulant was used in MPV measurement, which device was used for measurement, and how long after the MPV measurement was taken, the reliability of MPV results was negatively affected. It was especially emphasized that it is important to prevent the errors that negatively affect the analysis in MPV measurements,8 and it is an important handicap that the analytical errors could not be prevented due to the retrospective nature of the study. In addition, study groups consist of COPD patients with or without PHD, and there was no healthy control group in the study. Since there was no healthy control group in this study, it is impossible to understand the equivalent of MPV results in the normal population. Another point was that the age of COPD patients with PHD was significantly higher than the patients with COPD without PHD, and it was reported that the age difference was also a factor that could lead to a difference in MPV values.2 As a result, MPV values may not change in COPD patients with PHD.

Mean platelet volume may not change in chronic obstructive pulmonary disease patients with pulmonary heart disease.



RDW has been proposed as a routine test and is available as a prognosis for many diseases and disorders, especially respiratory disorders. In this study, we intend to see if the association between pulmonary function and RDW also applies to non-patients.



This study was performed on 800 people including 466 women and 344 men. Participants in the study were staff enrolled in the Tehran University of Medical Sciences cohort [TEC] study. In this study, RDW levels and pulmonary function were assessed. Elderly populations were not included in this study



The results of the univariate analysis showed that normal values versus abnormal values of RDW were significantly associated with pulmonary function index FEV1, FVC, FEV1/FVC in non-patient individuals. On the other hand, a significant correlation was observed between RDW values and FEV1 index and FEV1/FVC ratio. Based on linear regression, there was an association between RDW and FVC [R2=0.721].



In this study, we found an association between RDW and FVC so we suggest that abnormal RDW may consider as a sign of pulmonary dysfunction.


Association between Red blood cell distribution width and pulmonary function among Iranian employees.

Background and objective Platelet activation, inflammatory reactions and oxidative stress are common pathogenesis of chronic obstructive pulmonary disease (COPD) with pulmonary heart disease (PHD). Mean platelet volume (MPV) and red blood cell distribution width (RDW) form part of the pathomechanisms of these conditions. Here, we investigated whether MPV and RDW can be biomarkers of PHD occurring secondary to COPD. Materials and methods This was a retrospective study on 229 participants with COPD. Among them, 69 had PHD. Complete blood count (CBC), blood gas analysis, pulmonary function tests and echocardiography were analyzed. Results MPV and RDW-standard deviation (RDW-SD) were significantly higher in patients with PHD than in patients without PHD (P ≤ 0.001). MPV and RDW-SD were positively correlated with pulmonary artery pressure (PAP) and the size of the right ventricle (P ≤ 0.05). Multivariate regression analysis showed that the risk of PHD increased 3-fold per unit rise in MPV (OR = 2.901, P ≤ 0.001). We observed that the risk of PHD increased 1.5 times per unit rise in RDW-SD (OR = 1.371, P ≤ 0.001).The AUC of ROC curve for the combined MPV and RDW-SD in predicting PHD among COPD patients was 0.900 (95％CI: 0.846-0．954, P ≤ 0.001), with a sensitivity of 76.8% and a specificity of 99.4%. Conclusions Both MPV and RDW-SD were significantly elevated and correlated with disease severity in COPD patients with PHD. A combination of these two parameters presents an effective biomarker of PHD.

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease.

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Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease.