{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:26:46Z","timestamp":1790184406830,"version":"4.1.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\nBackground<\/jats:title>\nThe correlation between red cell distribution width (RDW) and mortality in breast cancer participants is not well-defined. This study investigates the association between RDW and both all-cause and cardiovascular mortality in the US population.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nA retrospective cohort study was performed using data from 15,806 participants in the NHANES dataset. Multivariable Cox regression models were used to analyze demographic, socioeconomic, clinical, and laboratory factors, with adjustments for potential confounders. Restricted cubic spline (RCS) analysis was utilized to investigate the non-linear associations between RDW and mortality outcomes, and Kaplan-Meier (KM) survival curves were created to illustrate RDW\u2019s effect on survival rates. Subgroup analyses and time-dependent ROC curves were also utilized to further assess the predictive value of RDW across different time intervals and patient subgroups.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nElevated RDW significantly correlates with a heightened risk of all-cause mortality (adjusted HR 2.13, 95% CI 1.42\u20133.20) and cardiovascular mortality (adjusted HR 3.94, 95% CI 1.71\u20139.09) compared to lower RDW in Model 3. The association remained consistent across subgroups, with no significant interaction effects (p\u2009>\u20090.05). The RCS analysis demonstrated a positive linear relationship between RDW and mortality outcomes. Additionally, Kaplan-Meier analysis indicated that individuals with elevated RDW levels exhibited significantly lower survival rates. Time-dependent ROC and AUC analyses demonstrated that RDW was a more robust predictor of short-term mortality, as evidenced by higher AUC values in the initial years following diagnosis.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nRed cell distribution width (RDW) serves as an independent predictor of both all-cause and cardiovascular mortality in breast cancer patients, showing strong predictive power for outcomes in both the short and long term.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0328680","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T17:47:32Z","timestamp":1753724852000},"page":"e0328680","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Higher red cell distribution width (RDW) is associated with increased all-cause and cardiovascular mortality in patients with breast cancer: A retrospective analysis of NHANES data (1999\u20132018)"],"prefix":"10.1371","volume":"20","author":[{"given":"Xuan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiqian","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0167-4050","authenticated-orcid":true,"given":"Jinmin","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"issue":"1","key":"pone.0328680.ref001","first-page":"12","article-title":"Cancer statistics, 2024","volume":"74","author":"RL Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"3","key":"pone.0328680.ref002","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1001\/jama.2023.26730","article-title":"Benefits of breast cancer screening and treatment on mortality","volume":"331","author":"SB Wheeler","year":"2024","journal-title":"JAMA"},{"issue":"3","key":"pone.0328680.ref003","doi-asserted-by":"crossref","first-page":"627","DOI":"10.3390\/cells10030627","article-title":"Progression of metastasis through lymphatic system","volume":"10","author":"H Zhou","year":"2021","journal-title":"Cells"},{"issue":"1","key":"pone.0328680.ref004","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1177\/1358863X231215329","article-title":"Advances in lymphedema: an under-recognized disease with a hopeful future for patients","volume":"29","author":"BJ Carroll","year":"2024","journal-title":"Vasc Med"},{"key":"pone.0328680.ref005","doi-asserted-by":"crossref","first-page":"1274976","DOI":"10.3389\/fcvm.2023.1274976","article-title":"Breast cancer is associated with coronary heart disease: a cross-sectional survey of NHANES 1999-2018","volume":"10","author":"L Dai","year":"2023","journal-title":"Front Cardiovasc Med"},{"issue":"26","key":"pone.0328680.ref006","doi-asserted-by":"crossref","first-page":"2710","DOI":"10.1200\/JCO.2017.77.4414","article-title":"Association of Cardiovascular Risk Factors With Cardiac Events and Survival Outcomes Among Patients With Breast Cancer Enrolled in SWOG Clinical Trials","volume":"36","author":"DL Hershman","year":"2018","journal-title":"J Clin Oncol"},{"issue":"1","key":"pone.0328680.ref007","doi-asserted-by":"crossref","first-page":"6","DOI":"10.24293\/ijcpml.v29i1.1960","article-title":"The Correlation between RDW, PDW, and NLR with the SOFA Score in Septic Patients","volume":"29","author":"LMK Nurtadjudin","year":"2023","journal-title":"Indonesian J Clin Pathol Med Lab"},{"issue":"4","key":"pone.0328680.ref008","doi-asserted-by":"crossref","first-page":"628","DOI":"10.5858\/133.4.628","article-title":"Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients","volume":"133","author":"G Lippi","year":"2009","journal-title":"Arch Pathol Lab Med"},{"issue":"7","key":"pone.0328680.ref009","article-title":"The Predictive Value of Red Cell Distribution Width and Red Cell Distribution Width to Erythrocyte Count Ratio for Adverse Cardiovascular Events During the Hospitalization of Patients of ST-segment Elevation Myocardial Infarction","volume":"66","author":"L-J Xiao","year":"2020","journal-title":"Clin Lab"},{"issue":"4","key":"pone.0328680.ref010","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1002\/biof.1518","article-title":"The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; 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