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Mo L, Chen Y, Li Z, Xu L, Dong W, Zhang L, Liang H, Li R, Tao Y, Shi W, Liang X. Red blood cell distribution width as a marker of cerebral infarction in hemodialysis patients. Ren Fail 2018; 39:712-718. [PMID: 29141483 PMCID: PMC6446144 DOI: 10.1080/0886022x.2017.1398664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Red blood cell distribution width (RDW) is a cardiovascular biomarker. We evaluated the association between RDW and cerebral stroke risk in hemodialysis patients. Methods: A cohort of 442 adult patients on hemodialysis was studied. Strokes were defined according to ICD-10 diagnosis codes. Routine complete blood counts, evaluated every 3–6 months, were used for RDW values. Results: Among 442 hemodialysis patients, during the 50-month follow-up, there were 62 cases (14.0%) of cerebral stroke: 41 (9.3%) with cerebral infarction and 21 (4.8%) with cerebral hemorrhage. Compared with nonstroke patients, a significantly higher RDW was measured in patients with cerebral stroke and cerebral infarction. However, no significant difference was seen in RDW between patients with cerebral hemorrhage and nonstroke patients. After adjustment by age, hypertension, albumin, Charlson Comorbidity Score, and C-reactive protein in different multivariable Cox regression models, patients with the highest mean RDW quartile had a 2.55-fold (hazard ratio = 3.55; 95% confidence interval: 1.33–9.51) higher risk of developing cerebral infarction relative to those with the lowest mean RDW quartile. RDW was not an independent risk factor for cerebral hemorrhage. Conclusions: Increased RDW is an independent risk factor of cerebral infarction in hemodialysis patients.
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Affiliation(s)
- Liyi Mo
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China.,b Department of Nephrology , Dongguan People's Hospital , Dongguan , China
| | - Yuanhan Chen
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Zhilian Li
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Lixia Xu
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Wei Dong
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Li Zhang
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Huaban Liang
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Ruizhao Li
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Yiming Tao
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Wei Shi
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Xinling Liang
- a Department of Nephrology , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China
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202
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Kocabaş H, Öncel CR, küçük M, Belgi Yıldırım A, kaçar C. Ankilozan Spondilit Hastalarında Kırmızı Hücre Dağılım Genişliği Ve Subklinik Sol Ventrikül Disfonksiyonu. ACTA MEDICA ALANYA 2018. [DOI: 10.30565/medalanya.393936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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203
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Wang Y, He SS, Cai XY, Chen HY, Yang XL, Lu LX, Chen Y. The Novel Prognostic Score Combining Red Blood Cell Distribution Width and Body Mass Index (COR-BMI) Has Prognostic Impact for Survival Outcomes in Nasopharyngeal Carcinoma. J Cancer 2018; 9:2295-2301. [PMID: 30026824 PMCID: PMC6036710 DOI: 10.7150/jca.24838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022] Open
Abstract
Background: A novel inflammation-and nutrition-based scoring system based on red blood cell distribution width and body mass index (COR-BMI) has prognostic value in nasopharyngeal carcinoma (NPC). Here, we assessed the prognostic value of COR-BMI in NPC. Methods: Retrospective study of 2,318 patients with non-metastatic NPC treated at Sun Yat-sen University Cancer Center was conducted. Patients were stratified into three groups using the COR-BMI score, which is based on two objective and easily measurable parameters: red blood cell distribution width (RDW) and body mass index (BMI). Kaplan-Meier survival analyses were used to compare groups; multivariate Cox proportional models were used to calculate overall survival (OS) and disease-free survival (DFS). Results: Four-year overall survival (OS) rates were 88.7%, 84.5%, and 71.4% for patients with COR-BMI scores of 0, 1, and 2 respectively (P = 0.006). Multivariate Cox proportional hazard analysis revealed COR-BMI was an independent predictor of OS (HR for COR-BMI 1: 1.239, 95% CI: 1.012-1.590; HR for COR-BMI 2: 2.367, 95% CI: 1.311-4.274, P = 0.013), but not DFS (P = 0.482). In subgroup analysis of metastatic NPC, OS rates decreased as COR-BMI increased. In patients with a COR-BMI score of 1, radiotherapy plus chemotherapy led to better OS than radiotherapy alone. Conclusions: COR-BMI may serve as an indicator of poor prognosis in both NPC and metastatic NPC. Radiotherapy plus chemotherapy may benefit patients with a COR-BMI score of 1.
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Affiliation(s)
- Yan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510060, PR China
| | - Sha-Sha He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Xiu-Yu Cai
- Department of VIP region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Hai-Yang Chen
- Department of Radiation Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xing-Li Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Li-Xia Lu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, PR China
| | - Yong Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510060, PR China
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204
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Baggen VJ, van den Bosch AE, van Kimmenade RR, Eindhoven JA, Witsenburg M, Cuypers JA, Leebeek FW, Boersma E, Roos-Hesselink JW. Red cell distribution width in adults with congenital heart disease: A worldwide available and low-cost predictor of cardiovascular events. Int J Cardiol 2018. [DOI: 10.1016/j.ijcard.2018.02.118] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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205
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Lee KH, Cho JG, Park HW, Yoon NS, Jeong HK, Lee N. Role of Red Cell Distribution Width in the Relationship between Clinical Outcomes and Anticoagulation Response in Patients with Atrial Fibrillation. Chonnam Med J 2018; 54:113-120. [PMID: 29854676 PMCID: PMC5972124 DOI: 10.4068/cmj.2018.54.2.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 02/03/2023] Open
Abstract
Little is known as to why elevated red cell distribution width (RDW) is associated with adverse clinical outcomes in patients with atrial fibrillation (AF). We hypothesized that RDW value might predict the intensity of anticoagulation, resulting in higher adverse events in patients with AF taking warfarin. We analyzed 657 patients with non-valuvular AF who took warfarin. The intensity of anticoagulation was assessed as mean time in the therapeutic range (TTR) and defined TTR ≥60% as an optimal intensity. The primary end-point was the composite of stroke/systemic embolism and major bleeding. The secondary end-point was the composite of stroke/systemic embolism, major bleeding and death. The relationship between the baseline RDW with TTR and clinical outcomes was assessed using categorical variables as quartiles or dichotomous variables. The mean value of TTR decreased as an increment of the RDW (45.2% vs. 44.7% vs. 40.8% vs. 35.2%, p<0.001). Primary and secondary end-points were significantly increased when TTR was less than 60% and RDW was more than 13.6%. Ratio of patients achieving optimal anticoagulation were significantly decreased as an increment of RDW. A RDW of ≥13.6% was a significant predictor for poor anticoagulation control (adjusted Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23–0.82), stroke (adjusted hazard ratio [HR] 3.86, 95% CI 1.11–13.40), primary (adjusted HR 1.88, 95% CI 1.12–3.16) and secondary end-point (adjusted HR 2.46, 95% CI 1.26–4.81). RDW was negatively associated with TTR in patients with AF. Therefore, RDW might be a useful marker for the prediction of anticoagulation response and clinical outcomes in patients with AF.
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Affiliation(s)
- Ki Hong Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Ki Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nuri Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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206
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Xu WY, Yang XB, Wang WQ, Bai Y, Long JY, Lin JZ, Xiong JP, Zheng YC, He XD, Zhao HT, Sang XT. Prognostic impact of the red cell distribution width in esophageal cancer patients: A systematic review and meta-analysis. World J Gastroenterol 2018; 24:2120-2129. [PMID: 29785080 PMCID: PMC5960817 DOI: 10.3748/wjg.v24.i19.2120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the previous discrepant conclusions, we performed a meta-analysis to evaluate the prognostic value of red cell distribution width (RDW) in esophageal cancer (EC).
METHODS We searched the PubMed, EMBASE, Web of Science and Cochrane Library databases to identify clinical studies, followed by using STATA version 12.0 for statistical analysis. Studies that met the following criteria were considered eligible: (1) Studies including EC patients who underwent radical esophagectomy; (2) studies including patients with localized disease without distant metastasis; (3) studies including patients without preoperative neoadjuvant therapy; (4) studies including patients without previous antiinflammatory therapies and with available preoperative laboratory outcomes; (5) studies reporting association between the preoperative RDW and overall survival (OS)/disease-free survival (DFS)/cancer-specific survival (CSS); and (6) studies published in English.
RESULTS A total of six articles, published between 2015 and 2017, fulfilled the selection criteria in the end. Statistical analysis showed that RDW was not associated with the prognosis of EC patients, irrespective of OS/CSS [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 0.97-1.57, P = 0.000] or DFS (HR = 1.42, 95%CI: 0.96-1.88, P = 0.000). Subgroup analysis indicated that elevated RDW was significantly associated with worse OS/CSS of EC patients when RDW > 13% (HR = 1.45, 95%CI: 1.13-1.76, P = 0.000), when the patient number ≤ 400 (HR = 1.45, 95%CI: 1.13-1.76, P = 0.000) and when the study type was retrospective (HR = 1.42, 95%CI : 1.16-1.69, P = 0.000).
CONCLUSION Contrary to our general understanding, this meta-analysis revealed that RDW cannot serve as an indicator of poor prognosis in patients with EC. However, it may still be a useful predictor of unfavorable prognosis using an appropriate cut-off value.
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Affiliation(s)
- Wei-Yu Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Bo Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wen-Qin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yi Bai
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yu Long
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Zhen Lin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Ping Xiong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yong-Chang Zheng
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Dong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hai-Tao Zhao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin-Ting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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207
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Lappegård J, Ellingsen TS, Hindberg K, Mathiesen EB, Njølstad I, Wilsgaard T, Løchen ML, Brækkan SK, Hansen JB. Impact of Chronic Inflammation, Assessed by hs-CRP, on the Association between Red Cell Distribution Width and Arterial Cardiovascular Disease: The Tromsø Study. TH OPEN 2018; 2:e182-e189. [PMID: 31249941 PMCID: PMC6524874 DOI: 10.1055/s-0038-1651523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022] Open
Abstract
Red cell distribution width (RDW), a measure of variability in size of circulating erythrocytes, is associated with arterial cardiovascular disease (CVD), but the underlying mechanism remains unclear. We aimed to investigate the impact of chronic inflammation as measured by high-sensitivity C-reactive protein (hs-CRP) on this relationship, and explore whether RDW could be a mediator in the causal pathway between inflammation and arterial CVD. Baseline characteristics, including RDW and hs-CRP, were obtained from 5,765 individuals attending a population-based cohort study. We followed up participants from inclusion in the fourth survey of the Tromsø Study (1994/1995) until December 31, 2012. Multivariable Cox-regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for incident myocardial infarction (MI) and ischemic stroke across quintiles of hs-CRP and RDW. Subjects with hs-CRP in the highest quintile had 44% higher risk of MI (HR: 1.44, 95% CI: 1.14-1.80), and 64% higher risk of ischemic stroke (HR: 1.64, 95% CI: 1.20-2.24) compared with subjects in the lowest quintile. RDW mediated 7.2% (95% CI: 4.0-30.8%) of the association between hs-CRP and ischemic stroke. Subjects with RDW in the highest quintile had 22% higher risk of MI (HR: 1.22, 95% CI: 0.98-1.54) and 44% higher risk of ischemic stroke (HR: 1.44, 95% CI: 1.06-1.97) compared with subjects in the lowest quintile. These risk estimates were slightly attenuated after adjustments for hs-CRP. Our findings suggest that chronic inflammation is not a primary mechanism underlying the relationship between RDW and arterial CVD.
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Affiliation(s)
- Jostein Lappegård
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Trygve S Ellingsen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hindberg
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology and Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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208
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Spadaro S, Taccone FS, Fogagnolo A, Franchi F, Scolletta S, Ragazzi R, Fanni A, Marangoni E, Govoni M, Reverberi R, Volta CA. The effects of blood transfusion on red blood cell distribution width in critically ill patients: a pilot study. Transfusion 2018; 58:1863-1869. [DOI: 10.1111/trf.14759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care; Erasme Hospital, Université Libre de Bruxelles; Brussels Belgium
| | - Alberto Fogagnolo
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care; University Hospital of Siena; Siena Italy
| | - Sabino Scolletta
- Department of Medical Biotechnologies, Anesthesiology and Intensive Care; University Hospital of Siena; Siena Italy
| | - Riccardo Ragazzi
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Alberto Fanni
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Elisabetta Marangoni
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
| | - Maurizio Govoni
- Blood Transfusion Service, Sant'Anna Hospital; Ferrara Italy
| | | | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale; Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S.Anna, Università di Ferrara; Ferrara Italy
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209
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Red Cell Distribution Width Predicts 90 Day Mortality in Continuous-Flow Left Ventricular Assist Device Patients. ASAIO J 2018; 65:233-240. [PMID: 29734258 DOI: 10.1097/mat.0000000000000803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Red cell distribution width (RDW) measures the variance in size of circulating red blood cells and is a strong independent predictor of morbidity and mortality in cardiovascular disease and heart failure. Predictive power of RDW on mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation remains largely unknown. Four hundred nine patients who underwent CF-LVAD implantation between April 2004 and December 2015 were retrospectively analyzed. The primary outcome of interest was 90 day mortality after CF-LVAD implantation. Median RDW before CF-LVAD implantation was 15.8%. Patients with elevated RDW (>15.8%) at baseline had significantly lower hemoglobin (10.6 ± 1.8 vs. 11.9 ± 2.1 mg/dl; p < 0.001), lower mean corpuscular volume (84.9 ± 7.7. vs. 88.7 ± 5.9; p < 0.001), higher blood urea nitrogen (BUN; 36.3 ± 21.8 vs. 30.1 ± 17.1; p < 0.001), lower albumin (3.4 ± 0.6 vs. 3.7 ± 0.5; p < 0.001), and higher total bilirubin levels (1.67 ± 2.21 vs. 1.29 ± 0.96). Red cell distribution width was independently predictive of 90 day mortality (odds ratio [OR], 1.16 for 1% increase; CI, 1.04-1.31; p = 0.010). Discriminatory power of RDW alone was comparable to model of end-stage liver disease excluding international normalized ratio (MELD-Xi) and HeartMate II risk scores. Mechanical unloading with CF-LVAD was associated with a reduction in RDW levels. These findings suggest that RDW, a simple and inexpensive test available through routine complete blood count, can be successfully used for mortality risk assessment in CF-LVAD candidates.
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210
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Pinho J, Marques SA, Freitas E, Araújo J, Taveira M, Alves JN, Ferreira C. Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis. Thromb Res 2018; 164:4-8. [DOI: 10.1016/j.thromres.2018.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/28/2018] [Accepted: 02/06/2018] [Indexed: 01/14/2023]
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211
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Ellingsen TS, Lappegård J, Skjelbakken T, Mathiesen EB, Njølstad I, Brækkan SK, Hansen J. The association between red cell distribution width and venous thromboembolism is not explained by myocardial infarction, stroke, or cancer. Res Pract Thromb Haemost 2018; 2:327-333. [PMID: 30046735 PMCID: PMC6055489 DOI: 10.1002/rth2.12073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/20/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Red cell distribution width (RDW) is a risk marker of venous thromboembolism (VTE), myocardial infarction (MI), stroke, and cancer. Due to interrelations between these diseases, the association between RDW and VTE may be explained by MI, stroke, or cancer. OBJECTIVE To investigate whether the effect of RDW on VTE could be explained by intermediate development of MI, stroke, or cancer. METHODS RDW was measured in 24 363 participants of the Tromsø Study in 1994-1995. Incident VTE, MI, stroke, and cancer were registered until December 31, 2010. Conventional and cause-specific Cox-regression models were used to estimate hazard ratios (HR) for VTE with 95% confidence intervals (CI) across categories of RDW. RESULTS There were 502 first VTEs during a median follow-up of 16 years. In conventional Cox regression analysis, RDW in the highest quartile was associated with a 71% (HR 1.71, 95% CI 1.09-2.67) and 27% (HR 1.27, 95% CI 0.88-1.85) higher risk of VTE in men and women, respectively, compared to subjects in the lowest quartiles. The risk of VTE among subjects with RDW in the highest quartile was similar for men and women of postmenopausal age. In cause-specific analysis, where each individual contributed with person-time until the first occurring event only, the risk estimates were similar to those of the conventional Cox-regression analysis. CONCLUSION Our findings suggest that the association between RDW and future risk of VTE is not explained by intermediate development of MI, stroke, or cancer.
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Affiliation(s)
- Trygve S. Ellingsen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
| | - Jostein Lappegård
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
| | - Tove Skjelbakken
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Ellisiv B. Mathiesen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
- Brain and Circulation Research GroupDepartment of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
- Department of Neurology and NeurophysiologyUniversity Hospital of North NorwayTromsøNorway
| | - Inger Njølstad
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
- Department of Community MedicineUiT–The Arctic University of NorwayTromsøNorway
| | - Sigrid K. Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC)Department of Clinical MedicineUiT–The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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212
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Silva Litao MK, Kamat D. Back to Basics: Red Blood Cell Distribution Width: Clinical Use beyond Hematology. Pediatr Rev 2018; 39:204-209. [PMID: 29610428 DOI: 10.1542/pir.2017-0118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Melissa Kaori Silva Litao
- Department of Pediatrics, De La Salle Health Sciences Institute College of Medicine, Cavite, Philippines
| | - Deepak Kamat
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
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Ju XF, Wang F, Wang L, Wu X, Jiang TT, You DL, Yang BH, Xia JJ, Hu SY. Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock. Chin Med J (Engl) 2018; 130:1189-1195. [PMID: 28485319 PMCID: PMC5443025 DOI: 10.4103/0366-6999.205858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: The normal range of red cell distribution width (RDW) level is <15%. Several studies have indicated that a high RDW level was associated with mortality in critically ill patients, and the patients with a high RDW level need increased focus in clinical practice. In view of the difficulty in defining the specific value of high RDW level, the key is to focus on the patient with the level beyond the normal upper limit. This study aimed to determine whether dynamic change of RDW levels, rather than the level itself, is predictive of death in elderly patients with septic shock when RDW level is beyond 15%. Methods: Between September 2013 and September 2015, the elderly septic shock patients with RDW level beyond 15% were enrolled in this study. The RDW levels were measured at enrollment (day 1), and days 4 and 7 after enrollment. Sequential Organ Failure Assessment (SOFA) scores were recorded simultaneously. Results: A total of 45 patients, including 32 males and 13 females, were included in the final analysis. Based on their hospital outcomes, these patients were divided into the survivor group (n = 26) and the nonsurvivor group (n = 19). There were no significant differences in age, gender, body mass index, initial level of RDW, Acute Physiology and Chronic Health Evaluation II scores, and SOFA scores between survivors and nonsurvivors. At days 4 and 7 measurement, both RDW level (median [interquartile range]: day 4: 15.8 [2.0]% vs. 16.7 [2.0]%, P = 0.011; and day 7: 15.6 [1.8]% vs. 17.7 [2.5]%, P = 0.001) and SOFA scores (day 4: 7.0 [4.0] vs. 16.0 [5.0], P < 0.001, day 7: 5.5 [4.0] vs. 17.0 [5.0], P < 0.001) were significantly lower in survivors than those in nonsurvivors. Dynamic changes of RDW and SOFA scores in survivor group were significantly different from those in nonsurvivor group (all P < 0.05). Continuous increase in RDW level was observed in 10 of the 13 nonsurvivors, but only in 3 of the 26 survivors. The level of RDW7 and dynamic changes significantly correlated with their counterparts of SOFA scores (all P < 0.05), whereas the levels of RDW1 and RDW4 had no significant correlation with their counterparts of SOFA scores (all P > 0.05). Conclusions: Continuous increase in RDW level, rather than the level of RDW itself, was more useful in predicting hospital death in elderly patients with septic shock when the level of RDW was >15%. The dynamic changes of RDW were highly correlated with the SOFA score in the patients.
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Affiliation(s)
- Xue-Feng Ju
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Li Wang
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Xiao Wu
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Ting-Ting Jiang
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Da-Li You
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Bing-Hua Yang
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Jian-Jun Xia
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Shan-You Hu
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
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214
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Pre-treatment red blood cell distribution width provides prognostic information in multiple myeloma. Clin Chim Acta 2018; 481:34-41. [PMID: 29452082 DOI: 10.1016/j.cca.2018.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/16/2018] [Accepted: 02/10/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The red blood cell distribution width (RDW), a credible marker for abnormal erythropoiesis, has recently been studied as a prognostic factor in oncology, but its role in multiple myeloma (MM) hasn't been thoroughly investigated. METHODS We performed a retrospective study in 162 patients with multiple myeloma. Categorical parameters were analyzed using Pearson chi-squared test. The Mann-Whitney and Wilcoxon tests were used for group comparisons. Comparisons of repeated samples data were analyzed with the general linear model repeated-measures procedure. The Kaplan-Meier product-limit method was used to determine OS and PFS, and the differences were assessed by the log-rank test. RESULTS High RDW baseline was significantly associated with indexes including haemoglobin, bone marrow plasma cell infiltration, and cytogenetics risk stratification. After chemotherapy, the overall response rate (ORR) decreased as RDW baseline increased. In 24 patients with high RDW baseline, it was revealed RDW value decreased when patients achieved complete remission (CR), but increased when the disease progressed. The normal-RDW baseline group showed both longer overall survival (OS) and progression-free survival (PFS) than the high-RDW baseline group. CONCLUSION Our study suggests pre-treatment RDW level is a prognostic factor in MM and should be regarded as an important parameter for assessment of therapeutic efficiency.
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215
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Single and combined use of red cell distribution width, mean platelet volume, and cancer antigen 125 for differential diagnosis of ovarian cancer and benign ovarian tumors. J Ovarian Res 2018; 11:10. [PMID: 29357908 PMCID: PMC5778734 DOI: 10.1186/s13048-018-0382-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cancer is widely believed to result from chronic inflammation, and red cell distribution width (RDW) and mean platelet volume (MPV) are considered as inflammatory markers for cancer. We investigated the values of RDW, MPV, and cancer antigen 125 (CA125), alone or in combination, for distinguishing between ovarian cancer and benign ovarian tumors. METHODS The study included 326 patients with ovarian cancer, 290 patients with benign ovarian tumors, and 162 control subjects. Hematologic tests were performed at initial diagnosis. RESULTS RDW was increased and MPV was decreased in the ovarian cancer group compared with the control and benign ovarian tumor groups. RDW was positively correlated and MPV was negatively correlated with cancer stage. Area under the curve (AUC) analysis for ovarian cancer versus benign ovarian tumors revealed that the specificity and sensitivity were increased for the combination of MPV and CA125 compared with either marker alone, and the specificity was increased for the combination of RDW and CA125, compared with either alone. The AUCs for RDW plus CA125 and MPV plus CA125 were significantly larger than for any of the markers alone. CONCLUSIONS In conclusion, combinations of the markers RDW, MPV, and CA125 may improve the differential diagnosis of ovarian cancer and benign ovarian tumors.
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216
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Zurauskaite G, Meier M, Voegeli A, Koch D, Haubitz S, Kutz A, Bernasconi L, Huber A, Bargetzi M, Mueller B, Schuetz P. Biological pathways underlying the association of red cell distribution width and adverse clinical outcome: Results of a prospective cohort study. PLoS One 2018; 13:e0191280. [PMID: 29342203 PMCID: PMC5771602 DOI: 10.1371/journal.pone.0191280] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/02/2018] [Indexed: 01/20/2023] Open
Abstract
Background Red cell distribution width (RDW) predicts disease outcome in several patient populations, but its prognostic value in addition to other disease parameters in unselected medical inpatients remains unclear. Our aim was to investigate the association of admission RDW levels and mortality adjusted for several disease pathways in unselected medical patients from a previous multicenter study. Methods We included consecutive adult, medical patients at the time point of hospital admission through the emergency department into this observational, cohort study. The primary endpoint was mortality at 30-day. To study association of admission RDW and outcomes, we calculated regression analysis with step-wise inclusion of clinical and laboratory parameters from different biological pathways. Results The 30-day mortality of the 4273 included patients was 5.6% and increased from 1.4% to 14.3% from the lowest to the highest RDW quartile. There was a strong association of RDW and mortality in unadjusted analysis (OR 1.32; 95%CI 1.27–1.39, p<0.001). RDW was strongly correlated with different pathways including inflammation (coefficient of determination (R2) 0.30; p<0.001), nutrition (R2 0.20; p<0.001) and blood diseases (R2 0.30; p<0.001 The association was eliminated after including different biological pathways into the models with the fully adjusted regression model showing an OR of 1.02 (95%CI 0.93–1.12; p = 0.664) for the association of RDW and mortality. Similar effects were found for other outcomes including intensive care unit admission and hospital readmission. Conclusion Our data suggests that RDW is a strong surrogate marker of mortality in unselected medical inpatients with most of the prognostic information being explained by other disease factors. The strong correlation of RDW and different biological pathways such as chronic inflammation, malnutrition and blood disease suggest that RDW may be viewed as an unspecific and general “chronic disease prognostic marker”.
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Affiliation(s)
| | - Marc Meier
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Alaadin Voegeli
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Mario Bargetzi
- Division of Hematology, Oncology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- * E-mail:
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Uçar HN, Eray Ş, Murat D. Simple peripheral markers for inflammation in adolescents with major depressive disorder. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1423769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Halit Necmi Uçar
- Department of Child and Adolescent Psychiatry, Van Training and Research Hospital, Van, Turkey
| | - Şafak Eray
- Department of Child and Adolescent Psychiatry, Van Training and Research Hospital, Van, Turkey
| | - Duygu Murat
- Department of Child and Adolescent Psychiatry, Avcılar Hospital, İstanbul, Turkey
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218
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Prognostic significance of the red blood cell distribution width that maintain at high level following completion of first line therapy in mutiple myeloma patients. Oncotarget 2018. [PMID: 29515796 PMCID: PMC5839377 DOI: 10.18632/oncotarget.24076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To investigate the prognostic value of the red blood cell distribution width(RDW) recovery from low levels at diagnosis after completion of first line therapy in mutiple myeloma (MM)patients,we enrolled 78 consecutive patients with MM and followed up from 2005 to 2016 in our hospital. The RDW was measured following completion of first-line therapy.The log-rank test, univariate analysis, and Cox regression analysis were used to evaluate the relationship between RDW and survival. We found that patients with an RDW ≥ 15.5% at diagnosis, as well as at completion of first-line therapy, had significantly lower progression-free survival (PFS) and overall survival(OS) rates than those with an RDW < 15.5%(P < 0.05).Patients with RDW that maintained more than 15.5% upon completion of therapy showed a shorter OS (P < 0.05) and PFS (P < 0.05) compared with patients with an RDW that decreased to a lower level.The multivariate analysis showed that RDW ≥ 15.5% after the completion of first-line therapy were an independent prognostic marker of poorer OS (P = 0.044) and PFS (P = 0.034). Therefore,we demonstrated that RDW at diagnosis, as well as at completion of first-line therapy is an independent predictor for mutiple myeloma patients.RDW maintained at high level, irrespective of whether RDW decreased to the cutoff value predicted an unfavorable prognosis in patients with MM.
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Red blood cell distribution width independently predicts 1-month mortality in acute decompensation of cirrhotic patients admitted to emergency department. Eur J Gastroenterol Hepatol 2018; 30:33-38. [PMID: 29064853 DOI: 10.1097/meg.0000000000000993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to explore whether red blood cell distribution width (RDW) can help predict the risk of short-term mortality in patients with acute decompensation of cirrhosis. PATIENTS AND METHODS We carried out a retrospective analysis of all patients consecutively admitted to the emergency department (ED) of the University Hospital of Verona (Italy) for acute decompensation of liver cirrhosis, between 1 June 2013 and 31 December 2016. The RDW value was measured at ED admission, along with collection of clinical features and other laboratory data, and was then correlated with severity of disease (Chronic Liver Failure Consortium Acute Decompensation score; CLIF-C AD score) and 1-month mortality. RESULTS The final study population consisted of 542 patients, 80 (14.8%) of whom died within 30 days after ED admission. The median RDW of patients who died was significantly higher than the median RDW of those who survived (17.4 vs. 15.5%; P<0.001). The percentage of patients who died significantly increased across different RDW quartiles (6.8, 9.7, 11.5 and 32.1%, P<0.001). In univariate analysis, significant correlation was observed between RDW and clinical severity of acute decompensate cirrhosis (Child-Pugh score: r=0.198, P<0.001; Model for End-Stage Liver Disease score: r=0.311, P=0.001; CLIF-C AD: 0.127, P=0.005). The combination of RDW and CLIF-C AD score exhibited better performance for predicting 1-month mortality than the CLIF-C AD score alone (area under the curve=0.769 vs. 0.720; P=0.006). In multivariate analysis, RDW was independently associated with a 1.2-2.3 higher risk of 1-month mortality. CONCLUSION The assessment of RDW at ED admission may improve risk stratification of patients with acute decompensation of cirrhosis.
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Han F, Shang X, Wan F, Liu Z, Tian W, Wang D, Liu Y, Wang Y, Zhang B, Ju Y. Clinical value of the preoperative neutrophil-to-lymphocyte ratio and red blood cell distribution width in patients with colorectal carcinoma. Oncol Lett 2017; 15:3339-3349. [PMID: 29435077 DOI: 10.3892/ol.2017.7697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 09/09/2017] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the clinical value of the preoperative neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in the peripheral blood of colorectal carcinoma (CRC) patients. Clinical data obtained from 240 patients with CRC undergoing radical surgical resection in Shandong Provincial Hospital Affiliated to Shandong University (Jinan, Shandong, China) between January 2011 and April 2015 were retrospectively analyzed. Data were also collected from 110 patients with colon polyps and 48 healthy volunteers to serve as controls for comparative analysis. The clinicopathological characteristics of the patients in the low and high NLR and RDW groups were compared. The NLR and RDW values were compared prior to and following surgery. Kaplan-Meier analyses and Cox regression modeling were performed to predict overall survival (OS) and disease-free survival (DFS). The NLR and RDW levels in the CRC patients were markedly higher than those in the colon polyp patients and the healthy controls. The optimum NLR and RDW cutoff points for CRC were 2.06 and 13.45%, respectively. Significant differences were detected in tumor location, diameter, degree of differentiation, tumor depth, carcinoembryonic antigen and carbohydrate antigen 199 when comparing the high and low NLR groups (P<0.05). A high RDW was significantly associated with distant metastasis and older age in CRC patients. No significant difference was detected in the NLR and RDW levels of CRC patients prior to and following surgery (P>0.05). CRC patients with an increased RDW had significantly worse OS and DFS rates, particularly those with metastatic CRC (P<0.05). Patients with a high NLR exhibited a reduced DFS time in CRC (P=0.053), although this difference was not significant, and a significantly worse DFS time in metastatic CRC (P=0.047). In conclusion, it is convenient to use preoperative NLR and RDW to predict prognosis following surgery for patients with CRC.
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Affiliation(s)
- Fuyan Han
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Xuming Shang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Furong Wan
- Department of Laboratory Medicine, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Zhanfeng Liu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Wenjun Tian
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Dan Wang
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yiqing Liu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Bingchang Zhang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Ying Ju
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Fontana V, Spadaro S, Bond O, Cavicchi FZ, Annoni F, Donadello K, Vincent JL, De Backer D, Taccone FS. No relationship between red blood cell distribution width and microcirculatory alterations in septic patients. Clin Hemorheol Microcirc 2017; 66:131-141. [PMID: 28128746 DOI: 10.3233/ch-160154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased red cell distribution width (RDW), a quantitative measure of erythrocyte size variability, has been associated with increased mortality in critically ill patients. METHODS In this post-hoc analysis of prospectively collected data, we studied 122 septic patients with and without shock who had undergone sublingual microcirculatory assessment using Sidestream Dark Field (SDF) videomicroscopy. Patient demographics, comorbidities, the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission and the Sequential Organ Failure Assessment (SOFA) score on the day of the microcirculatory assessment were collected. The RDW was retrospectively collected on the day of the microcirculatory evaluation from the routine daily blood count analysis. RESULTS Median patient age was 68[55-77] years, and median APACHE II and SOFA scores were 22[17-28] and 10[8-12], respectively; ICU mortality was 43%. On the day of the microcirculatory analysis, the median RDW was 13.8[12.8-15.5]% and was elevated (>13.4%) in 74 (61%) patients. There was no correlation between RDW and microcirculatory parameters (functional capillary density, r2 = 0.12; proportion of small perfused vessels, r2 = 0.17; mean flow index, r2 = 0.14). RDW was not related to disease severity, the presence of shock or survival. CONCLUSIONS RDW is not associated with microcirculatory alterations or prognosis in septic patients.
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Affiliation(s)
- Vito Fontana
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Ottavia Bond
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Federica Zama Cavicchi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Filippo Annoni
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Katia Donadello
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel De Backer
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care and Emergency, CHIREC Hospitals, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Cheng S, Han F, Wang Y, Xu Y, Qu T, Ju Y, Lu Z. The red distribution width and the platelet distribution width as prognostic predictors in gastric cancer. BMC Gastroenterol 2017; 17:163. [PMID: 29262773 PMCID: PMC5738162 DOI: 10.1186/s12876-017-0685-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/17/2017] [Indexed: 02/08/2023] Open
Abstract
Background Increasing attention is focused on the relationship of inflammation biomarkers with malignant tumors. The purpose of the present study was to detect whether the preoperative the red distribution width (RDW) and the platelet distribution width (PDW) can be used to distinguish patients with gastric cancer (GC) or early stage GC from the healthy controls and predict the progression and prognosis of the GC. Methods The RDW and PDW values of 227 patients with GC and 164 patients with early GC were retrospectively analyzed comparing with 101 healthy controls. In addition, the clinicopathological features, survival curves and prognosis of the patients with GC were compared between the high and low groups according to the RDW and PDW values. Results Significant higher RDW and lower PDW were detected in patients with GC and early GC compared to the healthy controls. A higher RDW was significantly associated with older age, a larger tumor diameter, deeper tumor infiltration, and lymph node metastasis while a lower PDW was significantly associated with male, older age, a larger tumor diameter, deeper tumor infiltration, elevated CEA and CA125. Increased RDW was significantly associated with worse overall survival (OS) and disease-free survival (DFS) for GC (P = 0.042 and P = 0.033, respectively) and early GC (P = 0.037 and P = 0.009, respectively) while decreased PDW indicated a significantly association with poor DFS for early GC (P = 0.006). Univariate and multivariate survival analysis showed that RDW and PDW can act as independent prognostic factors for DFS (P = 0.028 and P = 0.020) in patients with early GC. Conclusion The preoperative RDW and PDW were simple and convenient predictive factors for the progression and prognosis of patients with GC.
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Affiliation(s)
- Shiqing Cheng
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Fuyan Han
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Yanqiu Xu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Teng Qu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Ying Ju
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
| | - Zhiming Lu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
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Hu Y, Liu H, Fu S, Wan J, Li X. Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit. Kidney Blood Press Res 2017; 42:1193-1204. [PMID: 29227977 DOI: 10.1159/000485866] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We investigated the hypothesis that RDW is an independent predictor of acute kidney injury (AKI) and mortality in patients in the coronary care unit (CCU). METHODS In this prospective, observational study, we screened 412 adults admitted to the CCU at Zhongnan Hospital of Wuhan University from January 1, 2014 to June 1, 2015. AKI was defined based on the KDIGO-AKI criteria. The survivors were followed up for up to 2 years after hospital discharge. The primary endpoint of the study was the incidence of AKI, while the secondary endpoints of the study were in-hospital mortality and 2-year mortality. RESULTS RDW was significantly correlated with the acute physiology and chronic health evaluation II (APACHEII) score, hemoglobin, mean corpuscular volume, inflammatory marker levels, nutrition and renal function at the time of CCU admission. The incidence of AKI was much higher in the high RDW group (RDW ≥14.0%) than in the low RDW group, a finding that was confirmed by multivariable logistic regression, which showed that RDW was independently associated with the incidence of AKI (odds ratio (OR), 1.059, 95% coincidence interval (95% CI), 1.024-1.095, P=0.001). A total of 61 patients died during their hospital stay, and baseline RDW was also an independent predictor of in-hospital mortality (hazard ratio (HR), 1.129, 95% CI 1.005-1.268, P=0.041). Patients with a high RDW exhibited significantly higher 2-year mortality than patients with a low RDW during a median follow-up period of 19.8 months (P<0.001), and RDW independently predicted the risk of 2-year mortality (HR, 1.189, 95% CI 1.045 to 1.354, P=0.009) in the multivariate Cox proportional hazard analysis after adjustments for other clinical and laboratory variables. CONCLUSION RDW is an independent predictor of AKI and mortality in patients in the CCU.
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Affiliation(s)
- Yugang Hu
- Department of Nephrology, Wuhan, China
| | | | - Shuai Fu
- Department of Nephrology, Wuhan, China
| | - Jing Wan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Sadaka F, Doctors N, Pearson T, Snyders B, O'Brien J. Does Red Cell Distribution Width Predict Outcome in Traumatic Brain Injury: Comparison to Corticosteroid Randomization After Significant Head Injury. J Clin Med Res 2017; 10:9-12. [PMID: 29238428 PMCID: PMC5722039 DOI: 10.14740/jocmr3173w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/28/2017] [Indexed: 11/11/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a leading cause of death and disability. The role of red cell distribution width (RDW) as a prognostic biomarker for outcome in TBI patients is unknown. Based on the corticosteroid randomization after significant head injury (CRASH) trial database, a prognosis calculator (CRASH) has been developed for outcome prediction in TBI. The objectives of this study are to investigate the association between RDW on day 1 of TBI and outcome, and to compare outcome prediction from RDW to that from CRASH. Methods We performed a retrospective review of patients with TBI and a Glasgow coma scale (GCS) score of 14 or less. Day 1 RDW and CRASH data were extracted. CRASH was calculated for each patient. Outcome was defined as mortality at 14 days and GOS at 6 months, with poor outcome defined as GOS of 1 - 3. Patients were stratified according to RDW values into six groups, and according to CRASH values into six groups. Results A total of 416 patients with TBI were included, with 339 survivors (S) and 77 non-survivors (NS). Compared to survivors, non-survivors were of similar age in years (58 ± 23 vs. 58 ± 23, P = 1.0), had lower GCS scores (5 ± 3 vs. 12 ± 3, P = 0.0001), similar RDW (14.0 ± 1.2 vs. 13.9 ± 1.5, P = 0.6), and higher CRASH values (68 ± 26 vs. 24 ± 22, P = 0.0001). Estimating the receiver-operating characteristic (ROC) area under the curve (AUC) showed that CRASH was a significantly better predictor of mortality compared to RDW (AUC = 0.91 ± 0.01 for CRASH compared to 0.66 ± 0.03 for RDW; P < 0.0001). In addition, CRASH was a better predictor of neurologic outcome compared to RDW (AUC = 0.85 ± 0.02 for CRASH compared to 0.76 ± 0.03 for RDW; P = 0.005). Conclusions CRASH calculator was a strong predictor of mortality in patients with TBI. RDW on day 1 did not differ between survivors and non-survivors, and was a poor predictor of mortality. Both RDW on day 1 and CRASH calculator are good predictors of 6-month outcome in TBI patients, although CRASH calculator remains a better predictor.
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Affiliation(s)
- Farid Sadaka
- Mercy Hospital St. Louis, St. Louis University, St. Louis, MO 63141, USA
| | - Nicholas Doctors
- Mercy Hospital St. Louis, St. Louis University, St. Louis, MO 63141, USA
| | - Tallia Pearson
- Mercy Hospital St. Louis, St. Louis University, St. Louis, MO 63141, USA
| | - Brian Snyders
- Mercy Hospital St. Louis, St. Louis University, St. Louis, MO 63141, USA
| | - Jacklyn O'Brien
- Mercy Hospital St. Louis, St. Louis University, St. Louis, MO 63141, USA
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225
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Alvarez-Ortega N, Caballero-Gallardo K, Olivero-Verbel J. Low blood lead levels impair intellectual and hematological function in children from Cartagena, Caribbean coast of Colombia. J Trace Elem Med Biol 2017; 44:233-240. [PMID: 28965581 DOI: 10.1016/j.jtemb.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/25/2017] [Accepted: 08/07/2017] [Indexed: 02/08/2023]
Abstract
Lead produces numerous biochemical and physiological changes in humans, including hematological disorders, toxic effects on the central nervous system and in the function of several organs. The aim of this study was to determine blood lead levels (BLL) in children from Cartagena, Colombia, associating those with hematological and liver damage markers, the intelligence quotient (IQ), as well as with gene expression of the aminolevulinate dehydratase (ALAD), superoxide dismutase 1 (SOD1), gamma interferon (INF-γ), tumor necrosis factor (TNF) and tumor protein (p53). To achieve this purpose, 118 blood samples were collected from children 5-16 years old, with their respective informed consent from their parents. BLL was measured by atomic absorption; hematological parameters were obtained with automated systems; plasma was utilized to analyze hepatic toxicity markers, alanine aminotransferase (ALT), gamma-glutamyltransferase (γ-GT) and alkaline phosphatase (ALP); the Kaufman Brief Intelligence Test (K-BIT) was administered to measure the IQ; and gene expression was quantified from blood RNA. The mean BLL was 1.7±0.3μg/dL. A low proportion of the children (3.4%) had BLL above the CDC recommended limit (5μg/dL). BLL were correlated weakly, but negatively with child age, weight, height, body mass index, platelets wide distribution, mean platelet volume, γ-GT and IQ. There were not significant changes in the expression of evaluated genes. These results support the hypothesis that BLL below 5μg/dL may still be a detrimental factor on children's cognitive abilities, development and hematology, in line with recent concerns that there is no safe level of pediatric lead exposure.
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Affiliation(s)
- Neda Alvarez-Ortega
- Environmental and Computational Chemistry Group, School of Pharmaceutical Sciences, Zaragocilla Campus, University of Cartagena, Cartagena 130015, Colombia
| | - Karina Caballero-Gallardo
- Environmental and Computational Chemistry Group, School of Pharmaceutical Sciences, Zaragocilla Campus, University of Cartagena, Cartagena 130015, Colombia
| | - Jesus Olivero-Verbel
- Environmental and Computational Chemistry Group, School of Pharmaceutical Sciences, Zaragocilla Campus, University of Cartagena, Cartagena 130015, Colombia.
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Cha MJ, Lee HS, Kim HM, Jung JH, Choi EK, Oh S. Association between red cell distribution width and thromboembolic events in patients with atrial fibrillation. Eur J Intern Med 2017; 46:41-46. [PMID: 28781193 DOI: 10.1016/j.ejim.2017.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND We investigated whether an increase in the value of red cell distribution width (RDW) was associated with thromboembolic outcomes in patients with atrial fibrillation (AF). METHODS We performed a retrospective analysis of 5082 consecutive patients with non-valvular AF. Thromboembolic events (N=723, 14.2%) were recorded and analysed according to RDW value. RESULTS The peak RDW value during follow-up was higher in patients with thromboembolic events than in those without thromboembolic events (15.1% vs. 14.2%, p<0.001). The RDW value showed similar power in predicting thromboembolic outcomes compared with the factor of age. The risk of thromboembolic events was higher in patients with a peak RDW≥13.9% than in patients with a peak RDW<13.9% (hazard ratio 1.63, p<0.001), and increased with each quartile increase of RDW. In a subgroup of 739 patients with congestive heart failure (CHF), there were 112 (15.2%) thromboembolic events. The peak RDW value of patients with CHF with thromboembolic events was also significantly higher (16.4% vs. 15.6%, p=0.019) compared to that of those without thromboembolic events. CONCLUSION An increased RDW value during follow-up could be associated with thromboembolic events in patients with non-valvular AF. The suggested cut-off values for RDW used to predict an increased thromboembolic risk in were ≥13.9% in patients with AF in general, ≥15% in patients with co-existing AF and CHF.
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Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Seung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hyun Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Weitzman D, Raz R, Steinvil A, Zeltser D, Berliner S, Chodick G, Shalev V, Arbel Y. Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality. Thromb Haemost 2017; 111:300-7. [DOI: 10.1160/th13-07-0567] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/26/2013] [Indexed: 11/05/2022]
Abstract
SummaryRed blood cell distribution width (RDW) has been shown to predict cardiovascular mortality in various populations, but studies were less conclusive regarding cardiovascular morbidity. We aimed at evaluating the prognostic effect of RDW on cardiovascular morbidity and allcause mortality in the largest community cohort to date. We utilised the computerised database of a large community based healthcare maintenance organization (HMO) in Israel to identify a cohort of 225,006 eligible patients aged 40 or above who performed a blood count during 2006. We evaluated the relationship between 1% increments of RDW values and major cardiovascular events and all-cause mortality over a period of five years. A total of 21,939 incident cases of a major cardiovascular event and 4,287 deaths were documented during a total of six years of follow up, respectively. In comparison with patients with RDW level <13%, the hazard ratio for total mortality gradually increased to 4.57 (95% confidence interval [CI]: 3.35–6.24, p<0.001) among male patients and to 3.26 (95% CI: 2.49–4.28, p<0.001) among female patients with a RDW of 17% or above. Similar results were evident in anaemic and non-anaemic populations. RDW above 17% was also associated with a modest increased risk of major cardiovascular events in females 1.26 (95% CI: 1.03–1.52, p=0.021), while in men it was not significant, 1.08 (95% CI: 0.82–1.41, p=NS). In conclusion, increasing RDW levels significantly increased risk of cardiovascular morbidity and all-cause mortality. Our observation is evident in both anaemic and non-anaemic patients.
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228
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Lappegård J, Skjelbakken T, Brækkan S, Hansen JB, Ellingsen TS. Red cell distribution width is associated with incident venous thromboembolism (VTE) and case-fatality after VTE in a general population. Thromb Haemost 2017; 113:193-200. [DOI: 10.1160/th14-04-0335] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/24/2014] [Indexed: 12/11/2022]
Abstract
SummaryRecent studies suggest an association between red cell distribution width (RDW) and incident venous thromboembolism (VTE). We aimed to investigate the impact of RDW on risk of incident and recurrent VTE, and case-fatality, in a general population. RDW was measured in 26,223 participants enrolled in the Tromsø Study in 1994–1995. Incident and recurrent VTE events and deaths during follow-up were registered until January 1, 2012. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). There were 647 incident VTE events during a median of 16.8 years of follow-up. Individuals with RDW in the highest quartile (RDW≥13.3%) had 50% higher risk of an incident VTE than those in the lowest quartile (RDW≤12.3%). The association was strongest for unprovoked deep-vein thrombosis (HR highest vs lowest quartile of RDW: 1.8, 95% CI 1.1–3.1). VTE patients with baseline RDW≥13.3% had 30% higher risk of all-cause mortality after the initial VTE event than VTE patients with RDW<13.3%. There were no association between RDW and risk of recurrent VTE. Our findings suggest that high RDW is a risk factor of incident VTE, and that RDW is a predictor of all-cause mortality in VTE patients.
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Li B, You Z, Xiong XZ, Zhou Y, Wu SJ, Zhou RX, Lu J, Cheng NS. Elevated red blood cell distribution width predicts poor prognosis in hilar cholangiocarcinoma. Oncotarget 2017; 8:109468-109477. [PMID: 29312621 PMCID: PMC5752534 DOI: 10.18632/oncotarget.22694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/05/2017] [Indexed: 02/05/2023] Open
Abstract
Background Although the red blood cell distribution width (RDW) has been reported as a reliable predictor of prognosis in several types of cancer, the prognostic value of RDW in hilar cholangiocarcinoma (HC) has not been studied. Methods A retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection was conducted. The optimal cutoff value of RDW was determined by the receiver operating characteristic curve (ROC). Survival analysis by the Kaplan-Meier method, the difference between the clinico-pathologic variables and survival were evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS). Results ROC analysis suggested that the optimal cutoff value for the RDW was 14.95. Linear correlation analysis revealed that RDW is associated with white blood cell count (P = 0.007), neutrophil-to-lymphocyte ratio (P = 0.02), and hemoglobin (P < 0.001), albumin (P < 0.001). In a multivariate analysis, the RDW was an independent prognostic factor for OS (HR = 1.755, 95% CI 1.311-2.349, P < 0.001). Conclusions Elevated RDW may be regarded as an indicator of systemic inflammatory response which might facilitate HC growth and metastasis. Current evidence suggests that RDW may have clinical significance in predicting OS after surgery in HC patients.
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Affiliation(s)
- Bei Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhen You
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xian-Ze Xiong
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong Zhou
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Si-Jia Wu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rong-Xing Zhou
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiong Lu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Nan-Sheng Cheng
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Medical significance of simultaneous application of red blood cell distribution width (RDW) and neopterin as diagnostic/prognostic biomarkers in clinical practice. Pteridines 2017. [DOI: 10.1515/pterid-2017-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Abstract
In our individual and collaborative studies, we have played a part in pioneering investigations on the usefulness of biomarkers – red blood cell distribution width (RDW) and neopterin. This mini review includes historical data on the topic and is related to the first contributions in this field, as well as to the possibilities for further improvement and simultaneous application of RDW and neopterin measurements in the prevention, prognosis and treatment of a great number of socially important disease conditions (arterial, cardiovascular, brain vascular, peripheral artery diseases, inflammations, autoimmune states, cancers and leukemias, addictions, etc.). When comparing the results obtained with the immunobiochemical biomarker neopterin with RDW, they are reported to be very similar as independent predictors of the same pathological states in the human body although their biomedical origins are very different. Both the parameters were until now successfully, but only separately used in medical practice. The combined use of these two biomarkers can shed some more light on their interrelationships and provide some clues as to how the interaction between immune system activation and red blood cells biology are intertwined.
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231
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Red Cell Distribution Width Is Associated with All-Cause and Cardiovascular Mortality in Patients with Diabetes. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5843702. [PMID: 29359154 PMCID: PMC5735623 DOI: 10.1155/2017/5843702] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/27/2017] [Indexed: 01/06/2023]
Abstract
Background and Methods Red cell distribution width (RDW) has emerged as a prognostic marker in patients with cardiovascular diseases. We investigated mortality in patients with diabetes included in the National Health and Nutrition Examination Survey, in relation to baseline RDW. RDW was divided into 4 quartiles (Q1: ≤12.4%, Q2: 12.5%–12.9%, Q3: 13.0%–13.7%, and Q4: >13.7%). Results A total of 3,061 patients were included: mean age 61 ± 14 years, 50% male, 39% White. Mean RDW was 13.2% ± 1.4%. Compared with first quartile (Q1) of RDW, patients in Q4 were more likely to be older, female, and African-American, have had history of stroke, myocardial infarction, and heart failure, and have chronic kidney disease. After a median follow-up of 6 years, 628 patient died (29% of cardiovascular disease). Compared with Q1, patients in Q4 were at increased risk for all-cause mortality (HR 3.44 [2.74–4.32], P < .001) and cardiovascular mortality (HR 3.34 [2.16–5.17], P < .001). After adjusting for 17 covariates, RDW in Q4 remained significantly associated with all-cause mortality (HR 2.39 [1.30–4.38], P = 0.005) and cardiovascular mortality (HR 1.99 [1.17–3.37], P = 0.011). Conclusion RDW is a powerful and an independent marker for prediction of all-cause mortality and cardiovascular mortality in patients with diabetes.
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232
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Ozkok A, Nesmith BLW, Schaal S. Association of Red Cell Distribution Width Values with Vision Potential in Retinal Vein Occlusion. Ophthalmol Retina 2017; 2:582-586. [PMID: 31047612 DOI: 10.1016/j.oret.2017.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore a possible association of red cell distribution width (RDW), a parameter that measures variation in red blood cell size or red blood cell volume and is an index of erythrocyte heterogeneity, with vision in patients with retinal vein occlusion (RVO). DESIGN Cross-sectional study. PARTICIPANTS Patients with either branch RVO (n = 70) or central RVO (n = 56) and gender-matched controls (n = 67) were included. METHODS All participants underwent a comprehensive ophthalmologic examination, including fundus fluorescein angiography and macular OCT (Heidelberg Spectralis; Heidelberg Engineering, Heidelberg, Germany). Exclusion criteria included RVO not confirmed by fluorescein angiography, history of malignancy, anemia, follow-up of less than 6 months, and unavailability of RDW value within 3 months of first presentation of RVO. Retinal vein occlusion patients were divided into 4 quartiles according to RDW value: quartile 1 (RDW ≤ 13.8%), quartile 2 (13.8% < RDW ≤ 14.8%), quartile 3 (14.8% < RDW ≤ 16.0%), and quartile 4 (RDW > 16.0%). Unpaired samples t tests, Pearson correlation tests, chi-square tests, analyses of variance, and multiple regression analyses were used for statistical evaluation. MAIN OUTCOME MEASURES Red cell distribution width value and best-corrected visual acuity (BCVA). RESULTS There was no significant difference in the demographics of participants in all 3 groups with respect to age, gender, and associated systemic diseases. Red cell distribution width was significantly higher in RVO patients (14.9±1.6 μm) compared with control participants (12.5±1.4 μm; P<0.0001). There was a statistically significant correlation between RDW value and both initial BCVA (r = 0.443; P<0.0001) and final BCVA (r = 0.379; P<0.0001) in RVO patients. Both initial and final BCVA were better in RDW quartiles 1 and 2 compared with RDW quartiles 3 and 4. CONCLUSIONS Red cell distribution width was significantly higher in RVO patients compared with control participants. Furthermore, higher RDW value was associated with lower initial and final BCVA. Red cell distribution width merits further studies related to being a potential prognostic factor for vision in RVO patients.
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Affiliation(s)
| | | | - Shlomit Schaal
- Department of Ophthalmology & Visual Sciences, University of Massachusetts Medical School, Worchester, Massachusetts.
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Associations of Preimplant Red Blood Cell Distribution Width with Clinical Outcomes Among Individuals with Left Ventricular Assist Devices. ASAIO J 2017; 62:677-683. [PMID: 27798492 DOI: 10.1097/mat.0000000000000431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Left ventricular assist devices (LVADs) are increasingly used for end-stage heart failure. However, post-LVAD complications are potentially devastating and remain unpredictable. The red blood cell distribution width (RDW) is a predictor of adverse events in patients with heart failure but has not been studied in the LVAD population. We reviewed laboratory results and clinical outcomes for all continuous flow LVADs implanted from 2004 to June 2014 (N = 188). Cox proportional hazards models adjusted for demographic, cardiovascular, and laboratory variables were used to assess association of preimplant RDW tertiles with mortality, gastrointestinal bleed, infection, pump thrombosis, and stroke more than 1 year of follow-up. Compared with the lowest tertile (RDW < 15.7%), the higher two tertiles (RDW 15.7-18% and RDW >18.1%) had significantly higher risks of mortality (hazard ratio (HR) 6.95 [confidence interval: 2.67-18.10] and HR 4.61 [1.74-12.21], respectively) after full adjustment. Preimplant RDW was not statistically associated with our secondary outcomes. In conclusion, higher preimplant RDW is independently associated with an increased risk of postimplant mortality and infection. Future studies are needed to understand the prognostic ability of RDW and to understand the biologic mechanism underlying this association.
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234
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Siegler JE, Marcaccio C, Nawalinski K, Quattrone F, Sandsmark DK, Maloney-Wilensky E, Frangos S, Levine JM, Stein SC, Kasner SE, Kumar MA. Elevated Red Cell Distribution Width is Associated with Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2017; 26:26-33. [PMID: 27530692 DOI: 10.1007/s12028-016-0306-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Elevated red blood cell distribution width (RDW) has been associated with thrombotic disorders including myocardial infarction, venous thromboembolism, and ischemic stroke, independent of other inflammatory and coagulation biomarkers. The purpose of this study was to determine whether elevated RDW is associated with cerebral infarction and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). METHODS In this retrospective single-center cohort of aSAH patients (October 2009-September 2014), elevated RDW was defined as a mean RDW >14.5 % during the first 14 days after aSAH. Outcomes included cerebral infarction (CI) by any mechanism and poor functional outcome, defined as discharge modified Rankin Scale (mRS) >4, indicating severe disability or death. RESULTS Of 179 patients, 27 % had a high Hunt-Hess grade (IV-V), and 76 % were women. Twenty-four patients (13.4 %) underwent red blood cell (RBC) transfusion and compared to patients with normal RDW, patients with an elevated RDW were at greater odds of RBC transfusion (OR 2.56 [95 % CI, 1.07-6.11], p = 0.035). In univariate analysis, more patients with elevated RDW experienced CI (30.8 vs. 13.7 %, p = 0.017). In the multivariable model, elevated RDW was significantly associated with CI (OR 3.08 [95 % CI, 1.30-7.32], p = 0.011), independent of known confounders including but not limited to age, sex, race, high Hunt-Hess grade, and RBC transfusion. In multivariable analysis, RDW elevation was also associated with poor functional outcome (mRS > 4) at discharge (OR 2.59 [95 % CI, 1.04-629], p = 0.040). CONCLUSIONS RDW elevation is associated with cerebral infarction and poor outcome after aSAH. Further evaluation of this association is warranted as it may shed light on mechanistic relations between anemia, inflammation, and thrombosis after aSAH.
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Affiliation(s)
- James E Siegler
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
| | - Christy Marcaccio
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Kelsey Nawalinski
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Francis Quattrone
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Danielle K Sandsmark
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Eileen Maloney-Wilensky
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Suzanne Frangos
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Joshua M Levine
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Sherman C Stein
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Scott E Kasner
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Monisha A Kumar
- Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
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Park S, Kim YH, Kim YC, Yu MY, Lee JP, Han DJ, Kim YS, Park SK. Association between post-transplant red cell distribution width and prognosis of kidney transplant recipients. Sci Rep 2017; 7:13755. [PMID: 29062112 PMCID: PMC5653739 DOI: 10.1038/s41598-017-13952-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023] Open
Abstract
The role of elevated post-transplant red cell distribution width (RDW) as a predictive factor for graft loss remains unclear, although RDW was reported to be significantly associated with poor prognosis in various clinical fields. We performed a retrospective cohort study with 2,939 kidney transplant patients from two tertiary teaching hospitals in Korea. RDW level at transplantation and 3-months post-transplantation were collected. Those with RDW in the upper quartile range were considered to have increased RDW (>14.9%). Death-with-graft-function (DWGF), death-censored graft failure (DCGF), and composite graft loss were assessed as the study outcomes, using multivariable cox proportional hazard model. At the median follow-up duration of 6.6 (3.6–11.4) years, 336 patients experienced graft loss. There were 679 patients with elevated RDW at 3-months post-transplant. Elevated RDW was associated with composite graft loss (adjusted hazard ratio, 1.60, 95% confidence interval, 1.23–2.07, P < 0.001), even after adjusted for hemoglobin and various clinical factors. The 1% increment of post-transplant RDW was also significantly associated with the outcome, regardless of the presence of anemia. The worst prognosis was seen in patients with elevated RDW after transplantation, but not at baseline. Therefore, post-transplant RDW level may be significantly associated with patient prognosis, independent of hemoglobin values.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Chul Kim
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Yeon Yu
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. .,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea. .,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Su-Kil Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Zhu X, Zhang M, Lan F, Wei H, He Q, Li S, Qin X. The relationship between red cell distribution width and the risk of Henoch-Schönlein purpura nephritis. Br J Biomed Sci 2017; 75:30-35. [PMID: 28990845 DOI: 10.1080/09674845.2017.1368184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Red blood cell distribution width (RDW) is elevated in various inflammatory diseases, but its clinical significance in Henoch-Schönlein purpura nephritis (HSPN) in unknown. The aim of this study was to determine the value of RDW as a risk factor or marker for HSPN in children. METHODS This was a case-control study of 105 Henoch-Schönlein purpura (HSP) patients, 120 HSPN patients and 192 healthy controls. The relationship between RDW-coefficient of variation (RDW-CV) and the clinical characteristics of HSPN patients was determined by a multiple logistic regression analysis (MVLRA). Receiver operating characteristic (ROC) curves were applied to compare the diagnostic potential of the RDW-CV, a panel of routine markers and combinations of these indices. RESULTS The RDW-CV values were significantly higher in the HSPN group than the HSP group and controls (P < 0.001). Significant correlations were found between RDW-CV and ESR (P = 0.001). A combination of RDW-CV and ESR in a ROC curve showed 80% sensitivity and 84.9% specificity in the HSP patients, and 85.8% sensitivity and 93.8% specificity in the HSPN patients. The MVLRA revealed that RDW-CV (OR 1.69, 95% CI 1.16-2.48, P = 0.007) was an independent predictor of HSPN. CONCLUSIONS The RDW levels were highest in the HPSN group, suggesting that RDW, especially the combination of RDW and ESR, may have value when assessing the risk of HSPN.
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Affiliation(s)
- X Zhu
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - M Zhang
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - F Lan
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - H Wei
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - Q He
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - S Li
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
| | - X Qin
- a Department of Clinical Laboratory , Guangxi Medical University First Affiliated Hospital , Nanning , China
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Fukasawa H, Ishibuchi K, Kaneko M, Niwa H, Yasuda H, Kumagai H, Furuya R. Red Blood Cell Distribution Width Is Associated With All-Cause and Cardiovascular Mortality in Hemodialysis Patients. Ther Apher Dial 2017; 21:565-571. [DOI: 10.1111/1744-9987.12579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/30/2017] [Accepted: 05/17/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Hirotaka Fukasawa
- Renal Division, Department of Internal Medicine; Iwata City Hospital; Iwata Shizuoka Japan
| | - Kento Ishibuchi
- Renal Division, Department of Internal Medicine; Iwata City Hospital; Iwata Shizuoka Japan
| | - Mai Kaneko
- Renal Division, Department of Internal Medicine; Iwata City Hospital; Iwata Shizuoka Japan
| | - Hiroki Niwa
- Renal Division, Department of Internal Medicine; Iwata City Hospital; Iwata Shizuoka Japan
| | - Hideo Yasuda
- First Department of Medicine; Hamamatsu University School of Medicine; Hamamatsu Shizuoka Japan
| | - Hiromichi Kumagai
- The Department of Clinical Nutrition, School of Food and Nutritional Sciences; University of Shizuoka; Shizuoka Shizuoka Japan
| | - Ryuichi Furuya
- Renal Division, Department of Internal Medicine; Iwata City Hospital; Iwata Shizuoka Japan
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Celik A, Karayakali M, Altunkas F, Karaman K, Arisoy A, Ceyhan K, Kadi H, Koc F. Red cell distribution width is correlated with extensive coronary artery disease in patients with diabetes mellitus. Cardiovasc J Afr 2017; 28:319-323. [PMID: 28906531 PMCID: PMC5730728 DOI: 10.5830/cvja-2017-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 03/08/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction: Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM). Methods: Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease wasdiagnosed in the presence of stenosis > 50% in all three coronary artery systems. Result: RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all). Conclusion: RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.
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Affiliation(s)
- Atac Celik
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
| | - Metin Karayakali
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fatih Altunkas
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Kayihan Karaman
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Arif Arisoy
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Koksal Ceyhan
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Hasan Kadi
- Department of Cardiology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Fatih Koc
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Zhang T, Li J, Lin Y, Yang H, Cao S. Association Between Red Blood Cell Distribution Width and All-cause Mortality in Chronic Kidney Disease Patients: A Systematic Review and Meta-analysis. Arch Med Res 2017; 48:378-385. [PMID: 28916240 DOI: 10.1016/j.arcmed.2017.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/23/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Considering results among previous studies regarding the relationship of red blood cell distribution width (RDW) and all-cause mortality in chronic kidney disease (CKD) patients, we aimed to perform a comprehensive meta-analysis to evaluate the potential association between RDW and all-cause mortality in CKD patients. METHODS We conducted a systematic literature using electronic databases (PubMed, Ovid, Embase and Web of Science) to identify the studies reporting the association between RDW and all-cause mortality in CKD patients. We searched the literatures published December 2016 or earlier. We used both fix-effects and random-effects models to calculate the overall effect estimate. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity. RESULTS We retrieved 9 studies with a total of 117,047 patients. For every 1% increase in RDW, the risk of all-cause mortality increased by 47% (HR 1.47, 95% CI 1.35-1.61) with no statistical heterogeneity among the studies (I2 = 44.5%, p = 0.094). When RDW was entered as a categorical variable, mortality risk was significantly increased (HR 1.84, 95% CI 1.21-2.81). Heterogeneity among the studies was observed for all-cause mortality (I2 = 82.3%, p = 0.001). We also performed a predefined subgroup analyses according to study population. We found that for every 1% increase in RDW, the risk of all-cause mortality in hemodialysis (HD) patients increased by 36% (HR 1.36, 95% CI 1.20-1.53). CONCLUSIONS Our meta-analysis suggests that high levels of RDW probably increase the risk of all-cause mortality in CKD patients.
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Affiliation(s)
- Tao Zhang
- Department of Nephrology, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Jing Li
- Department of Transplantation, The First Central Hospital of Tianjin, Tianjin, People's Republic of China
| | - Yan Lin
- Department of Nephrology, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Hongtao Yang
- Department of Nephrology, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Shili Cao
- Department of Nephrology, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.
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240
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Li N, Zhou H, Tang Q. Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases. DISEASE MARKERS 2017; 2017:7089493. [PMID: 29038615 PMCID: PMC5606102 DOI: 10.1155/2017/7089493] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.
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Affiliation(s)
- Ning Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Heng Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
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Akkaya H, Uysal G. Can hematologic parameters predict treatment of ectopic pregnancy? Pak J Med Sci 2017; 33:937-942. [PMID: 29067069 PMCID: PMC5648968 DOI: 10.12669/pjms.334.12418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/25/2017] [Accepted: 07/06/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Ectopic pregnancy (EP) is the major cause of maternal morbidity and mortalityinthe first trimester of pregnancy. EP can be treated either medical or surgical approches. The purpose of our study wasto predict the treatment choice of tubal EP by usinghematologic parameters which are routinely used in clinical practice. METHODS After retrospectively data evaluation was done from Januaryu 2014 to Deceber 201. we had 153 patients with EP. Patientsadmitted to methotrexate (MTX) therapy was Group-1. Patients performed surgerywas Group-II. All patients' initial values including white blood cell (WBC), hemoglobin (Hgb), mean corpuscular volume (MCV), neutrophil and lymphocyte, neutrophil lymphocyte ratio (NLR), platelet, platelet lymphocyte ratio (PLR), red cell distribution width (RDW), platelet distribution width (PDW) and mean platelet volume (MPV)were recorded and compared between groups. RESULTS Of 153 EP patients, there were 93 patients in MTX group and 60 patients in surgery group. RDW, MPV were significantly increased in MTX group (p=0.003, p=0.001, p=0.038, respectively). However, no statistically significant difference was observed between the groups in terms of WBC, Hgb, MCV, PLT, PLR, PDW. CONSLUSION RDW, MPV values were independently associated with MTX therapy. Hematologic parameters can be helpful in the choice of the EP treatment.
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Affiliation(s)
- Hatice Akkaya
- Hatice Akkaya, MD. Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Gulsum Uysal
- Gulsum Uysal, MD. Department of Obstetrics and Gynecology, Adana Numune Education and Research Hospital, Adana, Turkey
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242
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Liang RF, Li M, Yang Y, Mao Q, Liu YH. Significance of Pretreatment Red Blood Cell Distribution Width in Patients with Newly Diagnosed Glioblastoma. Med Sci Monit 2017; 23:3217-3223. [PMID: 28667816 PMCID: PMC5505574 DOI: 10.12659/msm.905204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) is a parameter of the complete blood count (CBC) test. Recent evidence suggests that pretreatment RDW is associated with patient survival in various malignant tumors. We explored the association of pretreatment RDW and other red blood cell (RBC) parameters with clinical parameters and assessed their prognostic impact on overall survival (OS) in patients with glioblastoma (GBM). MATERIAL AND METHODS In total, 109 patients with newly diagnosed GBM were retrospectively reviewed. The Cox proportional hazards regression model and Kaplan-Meier method were used to examine the survival function of pretreatment RDW, mean cell volume (MCV), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC count, and hematocrit (HCT) values in patients with newly diagnosed GBM. RESULTS Univariate analysis showed that MCV, MCHC, and RDW were associated with overall survival (OS). However, only RDW remained significant in multivariate analysis. The Kaplan-Meier survival curves showed that patients belonging to the high-RDW group had a worse median OS (293 days versus 375 days, P=0.023) than those belonging to the low-RDW group. CONCLUSIONS The present study showed that pretreatment RDW was superior to MCV and MCHC as a prognostic predictor of clinical outcome in patients newly diagnosed with GBM. Pretreatment RDW was derived directly from the CBC test, which can be easily performed in clinical practice. Therefore, pretreatment RDW values can provide additional prognostic information for patients with GBM. Further larger and prospective studies are needed to confirm these findings and to investigate the mechanism by which of RDW is associated with prognosis in patients with GBM.
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Affiliation(s)
- Ruo-Fei Liang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Mao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yan-Hui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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243
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Feng GH, Li HP, Li QL, Fu Y, Huang RB. Red blood cell distribution width and ischaemic stroke. Stroke Vasc Neurol 2017; 2:172-175. [PMID: 28989807 PMCID: PMC5628378 DOI: 10.1136/svn-2017-000071] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/28/2017] [Accepted: 05/07/2017] [Indexed: 12/14/2022] Open
Abstract
The red blood cell distribution width (RDW) is a measure of red blood cell (RBC) size heterogeneity, which is easily calculated by dividing the SD of erythrocyte volumes for the mean corpuscular volume. Recent reporter suggested that, besides haematological diseases and anaemia, many human disorders may be closely associated with the elevated RDW. A literature review has revealed the RDW may be closely related to the development of ischaemic stroke, carotid artery atherosclerosis and cerebral embolism. Higher RDW could independently predict adverse outcomes in patients in these conditions.
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Affiliation(s)
- Gang-Hua Feng
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
| | - Hai-Peng Li
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
| | - Qiu-Li Li
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
| | - Ying Fu
- Thyroid Medicine Department/Radionuclide Therapy Department (Ward 31), Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ren-Bin Huang
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
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Chu Y, Yuan Z, Meng M, Zhou H, Wang C, Yang G, Ren H. Red blood cell distribution width as a risk factor for inhospital mortality in obstetric patients admitted to an intensive care unit: a single centre retrospective cohort study. BMJ Open 2017; 7:e012849. [PMID: 28637721 PMCID: PMC5577870 DOI: 10.1136/bmjopen-2016-012849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been shown to predict mortality in critically ill patients. To our knowledge, whether or not RDW is associated with clinical outcomes of obstetric patients requiring critical care has not been evaluated. METHODS This was a single centre, retrospective, observational study of obstetric patients admitted to the intensive care unit (ICU). Patients were excluded from the analysis if they had known haematological diseases or recently underwent blood transfusion. Patients who died or were discharged from the ICU within 24 hours of admission were also excluded. Patient clinical characteristics at ICU admission were retrieved from the medical charts. Multiple logistic regression was used to estimate OR and 95% CI for inhospital mortality associated with RDW. The receiver operating characteristic curve was used to examine the performance of RDW, alone or in combination with the Acute Physiology and Chronic Health Evaluation II score (APACHE II), in predicting inhospital mortality. RESULTS A total of 376 patients were included in the study. The hospital mortality rate was 5.32%. A significant association was found between baseline RDW levels and hospital mortality (OR per per cent increase in RDW, 1.31; 95% CI 1.15 to 1.49). Further adjustment for haematocrit and other potential confounders did not appreciably alter the result (p<0.001). The area under the curve (AUC) for inhospital mortality based on RDW was similar to that based on the APACHE II score (0.752 vs 0.766). A combination of these two factors resulted in substantial improvement in risk prediction, with an AUC value of 0.872 (p<0.001). CONCLUSIONS The study suggests that RDW is an independent predictor for inhospital mortality among ICU admitted obstetric patients. Combining RDW and APACHE II score could significantly improve inhospital prognostic prediction among these critically ill obstetric patients.
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Affiliation(s)
- Yufeng Chu
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhongshang Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Mei Meng
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Haiyan Zhou
- Department of Medical Oncology, Shandong Tumour Hospital, Jinan, China
| | - Chunting Wang
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Gong Yang
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hongsheng Ren
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Zhou S, Fang F, Chen H, Zhang W, Chen Y, Shi Y, Zheng Z, Ma Y, Tang L, Feng J, Zhang Y, Sun L, Chen Y, Liang B, Yu K, Jiang S. Prognostic significance of the red blood cell distribution width in diffuse large B-cell lymphoma patients. Oncotarget 2017; 8:40724-40731. [PMID: 28388534 PMCID: PMC5522205 DOI: 10.18632/oncotarget.16560] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/09/2017] [Indexed: 12/11/2022] Open
Abstract
This study examined the prognostic value of the baseline red blood cell distribution width (RDW) in diffuse large B cell lymphoma (DLBCL) patients. The associations between RDW and clinical characteristics were assessed in 161 DLBCL patients from 2005 to 2016. The log-rank test, univariate analysis, and Cox regression analysis were used to evaluate the relationship between RDW and survival. A RDW of 14.1% was considered to be the optimal cut-off value for predicting prognosis. A high RDW was associated with more frequent B symptoms (P=0.001), a higher International Prognostic Index score (P=0.032), more extranodal sites of disease (P=0.035), and significantly lower Eastern Cooperative Oncology Group performance status (P=0.031). The log-rank test demonstrated that patients with a high RDW had a shorter overall survival (OS) (2-year OS rate, 53.6% vs. 83.6%, P<0.001) and progression-free survival (PFS) (2-year PFS rate, 44.7% vs. 81.8%, P<0.001). The multivariate analysis demonstrated that RDW ≥14.1% was an independent predictor of OS (odds ratio [OR] = 0.345, P<0.001) and PFS (OR = 0.393, P=0.001). We demonstrated that a high RDW predicted an unfavorable prognosis in patients with DLBCL.
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Affiliation(s)
- Shujuan Zhou
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Fang Fang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Huiyao Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Wei Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yang Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yifen Shi
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Zhouyi Zheng
- Department of Hematology and oncology, Traditional Chinese Medical Hospital of Zhuji, Shaoxing, Zhejiang, P.R. China
| | - Yongyong Ma
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Liyuan Tang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jianhua Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Lan Sun
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yi Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Bin Liang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Songfu Jiang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
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Kara AV, Tanrikulu S, Aydın E, Aydın F, Yıldırım Y, Yılmaz Z, Kadiroğlu AK, Yılmaz ME. Evaluation of the effect of red cell distribution width on the development of acute renal failure in patients with sepsis. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.319769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roderick KV, Abelson AL, Nielsen L, Price LL, Quinn R. Evaluation of red blood cell distribution width as a prognostic indicator in cats with acquired heart disease, with and without congestive heart failure. J Feline Med Surg 2017; 19:648-656. [PMID: 27225272 PMCID: PMC11128818 DOI: 10.1177/1098612x16649988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Congestive heart failure secondary to cardiomyopathy is a common manifestation of cardiac disease in cats, carrying a variable prognosis. The objective of this retrospective study was to evaluate the relationship between red blood cell distribution width (RDW) and survival time in feline patients with acquired heart disease with and without congestive heart failure (CHF). Methods Three hundred and forty-nine client-owned cats with echocardiograms and complete blood count, including RDW measurement, performed between March 2006 and December 2011, were included in the study. Patient characteristics, including signalment, hematocrit, RDW, echocardiographic parameters and survival, were recorded. Comparisons between RDW in cats with asymptomatic acquired heart disease and those with CHF were made. Survival was documented and compared at 30 days and 6 months. Results CHF was present in 80 cats and absent in 269 cats. Cats with CHF had an increase in mortality compared with cats without CHF at 30 days and 6 months ( P = 0.007 and P = 0.04, respectively). RDW was not significantly associated with survival in cats with or without CHF at 30 days or 6 months. A significant difference was found between median RDW values in cats with CHF vs cats without CHF (16.3% vs 15.8%; P = 0.02). The median RDW value was significantly higher in cats with unclassified cardiomyopathy compared with cats with other types of cardiomyopathy (16.3% vs 15.8%; P = 0.03). Conclusions and relevance Single RDW values did not predict mortality in cats with acquired heart disease but may be useful in determining if cats have decompensated heart disease and CHF. Human studies indicate that incremental increases in serial RDW measurements are associated with decreased survival; serial RDW measurements in cats may be an area of future study.
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Affiliation(s)
- Kursten V Roderick
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, USA
- Angell Animal Medical Center, MA, USA
| | - Amanda L Abelson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, USA
| | | | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, MA, USA
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Abstract
To investigate whether red blood cell distribution width (RDW) is a marker of the risk of Henoch-Schonlein purpura (HSP) nephritis (HSPN), a total of 669 HSP patients and 168 healthy controls were included in this retrospective study. Two hundred fifty-six (38.3%) of the patients had kidney involvement. Compared with the HSP group, RDW was significantly higher in the HSPN group (P < .001). Binary logistic regression identified that HSPN was independently associated with age, RDW, platelet, and total cholesterol (odds ratio = 1.409, 1.353, 0.996, and 2.019, respectively). In addition, RDW values of HSPN patients with crescents on histopathology (classes III, IV, and V) were higher compared with those of HSPN without crescents (classes I and II) (P = .019). The receiver-operating characteristic curve analysis showed that the RDW at a cut-off point of 13.25 has 61% sensitivity and 79% specificity in predicting the presence of crescents on histopathology. It was first shown that RDW levels in HSPN are significantly higher than those in HSP without nephritis and healthy controls. RDW can be an independent predictor of HSPN and its levels greater than 13.25 were useful in the predicting the presence of crescents on histopathology.
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Affiliation(s)
- Hui Xu
- Department of Clinical Laboratory
| | - Wei Li
- Department of Clinical Laboratory
| | - Jian-hua Mao
- Department of Nephrology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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249
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Increased levels of red cell distribution width is correlated with presence of left atrial stasis in patients with non-valvular atrial fibrillation. North Clin Istanb 2017; 4:66-72. [PMID: 28752145 PMCID: PMC5530160 DOI: 10.14744/nci.2017.72324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/12/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: Red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) have been found to be associated with non-valvular atrial fibrillation (AF) and cardiovascular diseases. However, correlation of these parameters with presence of left atrial (LA) thrombus and/or spontaneous echo contrast (SEC) in patients with non-valvular AF has not been clarified. This study was an investigation of correlation of RDW, NLR, and clinical risk factors with LA thrombus and dense SEC in patients with non-valvular AF in the Turkish population. METHODS: The demographic, laboratory, and echocardiographic properties of 619 non-valvular AF patients who underwent transesophageal echocardiography (TEE) examination before direct current cardioversion (DCCV) or AF ablation treatment were retrospectively investigated. Complete blood count (CBC) and biochemical parameters were studied 6 to 12 hours before TEE examination. Left atrial stasis (LAS) markers were noted as presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (DSEC). RESULTS: Total of 325 (52%) patients with LAS were compared with 294 patients (48%) without LAS. In the LAS group, there were 274 (84%) patients with LA/LAA thrombus and 51 (16%) patients with DSEC. LAS (+) group, values for RDW (14.85±1.48 vs. 13.77±1.30; p<0.01), NLR (2.38 [1.58], vs. 2.10 [1.35]; p<0.01) and C-reactive protein (0.95 [0.61] vs. 0.88 [0.60] mg/L; p<0.01) were significantly higher than seen in LAS (-) group. In multivariate regression analysis, increased level of RDW, age, male gender, heart failure, duration of AF >6 months, and international normalized ratio <2 were independently correlated with presence of LAS. CONCLUSION: Our study indicated that increased level of RDW is independently correlated with higher risk for development of LAS in patients with non-valvular AF.
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250
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Al-Kindi SG, Zidar DA, McComsey GA, Longenecker CT. Association of Anisocytosis with Markers of Immune Activation and Exhaustion in Treated HIV. Pathog Immun 2017; 2:138-150. [PMID: 28713869 PMCID: PMC5505669 DOI: 10.20411/pai.v2i1.199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Treated HIV infection is associated with heightened inflammation which can contribute to increased risk of cardiovascular disease (CVD). We have previously shown that anisocytosis, as measured by red cell distribution width (RDW), is independently associated with prevalent CVD in people living with HIV (PLHIV). In this study, we sought to identify immune correlates of RDW in PLHIV receiving antiretroviral therapy. Methods: We performed a cross-sectional and longitudinal analysis of 147 virally-suppressed PLHIV, who had LDL < 130 mg/dL and evidence of heightened inflammation, in a randomized trial of statin therapy. A complete blood count and biomarkers of inflammation and immune activation/exhaustion were measured in peripheral blood at entry and after 24 and 48 weeks. Associations with RDW were estimated using linear regression and linear mixed models. Results: The median age (IQR) for the cohort at enrollment was 46 (40–53) years; 78% were male and 68% were African American. The median RDW for the cohort was 13.4% (12.9–14.0). Compared with the lowest RDW tertile, patients in the highest tertile were less likely to be male, and more likely to be African American, have lower hemoglobin, lower mean corpuscular volume, and higher platelet counts (all P < 0.05). At baseline, RDW weakly correlated with C-reactive protein (r = 0.196), d-dimer (r = 0.214), fibrinogen (r = 0.192), IL-6 (r = 0.257), CD4+DR+38+ T cells (r = 0.195), and CD4+PD1+ T cells (r = 0.227), all P < 0.05. Only IL-6, CD4+38+DR+ T cells, and CD4+PD1+ T_cells remained associated after adjustment for clinical factors known to affect RDW in the general population. Over 48 weeks, RDW did not change and there was no significant effect of statin (P = 0.45). After adjustment for clinical parameters, RDW remained positively associated with CD4+38+DR+ and CD4+PD1+ T cells across all time points (P = 0.05). Conclusion: In this population of treated HIV+ subjects, anisocytosis was associated with bio-markers of inflammation and T-cell activation/exhaustion over time and independent of clinical confounders. Therefore, RDW may be a useful prognostic biomarker of cardiovascular risk that partially reflects chronic inflammation and immune exhaustion in PLHIV receiving antiretroviral therapy.
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Affiliation(s)
- Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - David A Zidar
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Grace A McComsey
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Pediatric Infectious Diseases, Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Chris T Longenecker
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
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