Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus

Diagnostic and Prognostic Relevance of Red Blood Cell Distribution Width for Vascular Aging and Cardiovascular Diseases

Evidence suggests association of red blood cell distribution width (RDW) with cardiovascular diseases (CVDs). On the contrary, we underline that the sole RDW values cannot represent a valid CVD biomarker. High RDW values are expression of biological effects of a lot of both endogenous and exogenous factors (i.e., age, sex, genetic background, inflammation, hormones, drugs, diet, exercise, hematological analyzers, and ranges of values), modulating the biology and physiology of erythrocytes. Thus, the singular monitoring of RDW cannot be used to predict cardiovascular disorders. Accordingly, we have reviewed the evidence for potential relationship of RDW values with alterations in the cardiovascular system (i.e., regenerative capacity, endothelial turnover, and senescence of cardiovascular cells), associated with vascular aging and disease. In addition, we highlight the inevitable impact of biases in clinical application of RDW related to CVDs. Based on our thorough review of literature, we suggest a combined evaluation of RDW with other emerging biomarkers related to vascular aging and the diagnosis and prognosis of CVDs, including telomere length of leukocytes, circulating nucleated red blood cells (nRBCs) and endothelial progenitor cells (EPCs) in future large scale studies.

Value of neutrophil to lymphocyte ratio combined with red blood cell distribution width for predicting severity of acute pancreatitis

AIM

To explore the value of neutrophil to lymphocyte ratio (NLR) combined with red blood cell distribution width (RDW) for predicting the severity of acute pancreatitis (AP).

METHODS

The clinical data of 120 patients with AP were retrospectively analyzed in this study. The patients were assigned to three groups: mild AP (MAP) group, moderately severe AP (MSAP) group, and severe AP (SAP) group. The clinical indexes (NLR and RDW) of the three groups of patients were measured at 24 h after hospitalization. All of these data were compared among the groups, and between dead patients and surviving cases. The receiver operator characteristic curves (ROCs) of NLR, RDW, and NLR plus RDW were plotted to assess their value in predicting the prognosis of AP.

RESULTS

With the increase of the severity of AP, the value of NLR increased significantly (P < 0.05). There was no significant difference in RDW between the MAP and MSAP groups (P > 0.05). The RDW value of the SAP group was significantly different from those of the MAP and MSAP groups (P < 0.05). The values of NLR and RDW in the death group were significantly higher than those in the survival group (P < 0.05). The area under the curve of NLR in predicting AP severity was 0.794, which was significantly higher than that of RDW (0.745; P < 0.05). The area under the NLR + RDW curve was 0.876 (sensitivity, 0.795; specificity, 0.852), which was significantly higher than that of NLR and RDW alone (P < 0.05).

CONCLUSION

NLR and RDW are both related to the severity of AP, and the combination of the two indexes can improve the sensitivity and specificity of predicting the severity of AP.

Red blood cell distribution width in heart failure: A narrative review

The red blood cell distribution width (RDW) is a simple, rapid, inexpensive and straightforward hematological parameter, reflecting the degree of anisocytosis in vivo. The currently available scientific evidence suggests that RDW assessment not only predicts the risk of adverse outcomes (cardiovascular and all-cause mortality, hospitalization for acute decompensation or worsened left ventricular function) in patients with acute and chronic heart failure (HF), but is also a significant and independent predictor of developing HF in patients free of this condition. Regarding the biological interplay between impaired hematopoiesis and cardiac dysfunction, many of the different conditions associated with increased heterogeneity of erythrocyte volume (i.e., ageing, inflammation, oxidative stress, nutritional deficiencies and impaired renal function), may be concomitantly present in patients with HF, whilst anisocytosis may also directly contribute to the development and worsening of HF. In conclusion, the longitudinal assessment of RDW changes over time may be considered an efficient measure to help predicting the risk of both development and progression of HF.

Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives

Chronic obstructive pulmonary disease (COPD) is a disabling condition that is characterised by poorly reversible airflow limitation and inflammation. Acute exacerbations of COPD are a common cause of hospitalisation and death among COPD patients. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Relatively simple biomarkers of inflammation calculated from routine complete blood count tests, such as the neutrophil to lymphocyte ratio (NLR), might also predict COPD progression and outcomes. This review discusses the available evidence from studies investigating the associations between the NLR, COPD exacerbations and death in this patient group.