S167 Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is a multi-system disorder driven partly by diffuse inflammation, malnutrition and haematological aberrations. Because the red blood cell distribution width (RDW) is a surrogate of these anomalies, we hypothesised that it might be of prognostic importance in COPD patients. Additionally, we tested the supposition that iron deficiency (ID) per se could be a prevalent and ominous co-morbidity in these individuals. Methods We analysed the relation of red cell indices on admission and over time with mortality in 655 consecutively eligible COPD patients (mean±SD age 77±12 y, FEV1 0.85±0.34 l, FVC 1.44±0.60 l, 54% male). Concomitant heart failure, ischaemic heart disease, and neoplasia were exclusion criteria. The combination of a high RDW and low mean cell haemoglobin (MCH) was utilised to identify ID. Results On admission, an RDW>15%, Hb 15% had lower Hbs, lower FEV1s, and longer median (±IQR) hospital stays (9±11 vs 8±8 days, P 2 16, P 2 11, P 2 5, P 2 ). Over time, 63%, 72%, 65%, and 46% of patients had a rise in RDW, a fall in Hb, a fall in MCH, and evolving ID (rising RDW and falling MCH), respectively. A rising RDW predicted death (adjusted χ 2 32, P Conclusions An elevated RDW alone and iron deficiency predict an amplified risk of death in COPD and could be utilised for risk stratification or therapeutically targeted to improve outcomes.