Background/aim: The prognostic value of the red cell distribution width (RDW) as a cost-effective and noninvasive test in acute pulmonary embolism (PE) is still unknown. We aimed to investigate the prognostic value of the admission RDW level in the long-term survival of PE patients. Materials and methods: In this registry-based, prospective cohort study, a total of 378 patients (mean age: 60.4 ± 17.11 years, 47.4% female) who presented with acute PE were enrolled. All the clinical data for each patient were obtained from our institutional PE registry. The follow-up was performed at a median time of 17 months. e primary endpoint was death at follow-up. Results: The mean RDW in study patients was 14.67 ± 2.13. e all-cause mortality rate during the follow-up was 15.6% (n = 59). A er adjustment for potential confounders, the relationship between RDW and long-term mortality showed a trend of a signi cant level (hazard ratio: 1.109; 95% CI, 0.998?1.232; P = 0.053). We divided patients into 3 groups based on the European Society of Cardiology?s classi cation. As we moved from the low risk to the higher risk categories, the mean RDW increased signi cantly (P = 0.037). Conclusion: It seems there may be an independent association between RDW at presentation and PE mortality within 17 months.