Red cell distribution width can predict intestinal atrophy in selected patients with celiac disease

Diagnostic value of laboratory parameters for complicated appendicitis: A two‑center study

There are two types of treatment for acute appendicitis (AA): surgery and antibiotic therapy. Some patients with complex appendicitis are treated with surgery; however, for uncomplex appendicitis, most could be treated effectively with antibiotics instead. How to distinguish complex appendicitis from uncomplex appendicitis before surgery is currently unknown. The present study aimed to assess the efficacy of the laboratory parameters to diagnose complicated appendicitis. Data from 1,514 cases with acute appendicitis who were admitted to Beijing Tsinghua Changgung Hospital and Beijing Aerospace General Hospital (both Beijing, China) from January 2016 to September 2021 were retrospectively analyzed. All cases were divided into uncomplicated and complicated appendicitis. Independent variables were analyzed by uni- and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in the multivariate logistic regression analysis. Cut-off values, sensitivity, specificity and accuracy with area under the curve (AUC)>0.600 were considered significant parameters. Significant differences were found in age (P<0.001), body temperature (P<0.001), white blood cell (WBC) count (P<0.001), C-reactive protein (CRP; P<0.001), neutrophil count (P<0.001), neutrophil-to-lymphocyte ratio (NLR, P=0.019), platelet-to-lymphocyte ratio (PLR, P<0.001), platelet count (P<0.001), coefficient of variation (CV) and standard deviation (SD) of red blood cell distribution width (RDW); both P<0.001), mean platelet volume (MPV, P<0.001) and total (P<0.001) and direct bilirubin (P<0.001) between the two groups. CRP, neutrophil count, NLR, PLR, platelet count, RDW-CV, RDW-SD, MPV and direct bilirubin levels were found as the independent variables to diagnose complicated appendicitis. In patients with acute appendicitis, CRP >22.95 mg/l, NLR >5.7, serum direct bilirubin >6.1 mmol/l and RDW-SD>17.7 fl were significantly associated with complicated appendicitis.

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Introduction: Despite being one of the most frequent chronic digestive diseases worldwide, with a prevalence of 1%, celiac disease (CD) remains severely underdiagnosed. Among the instruments used to improve its diagnostic rate, hematologic parameters have been proposed as screening tests to select patients with an increased probability of having CD. Assessment of coagulation is included in routine check-ups, and CD has been reported to be associated with coagulopathy. We aimed to assess if subtle changes in coagulation tests could be used in clinical practice to prompt testing for CD. Methods: We retrospectively recruited all patients with clinical suspicion for CD during a study period of 7 years (between 2015 and 2022), who were tested using IgA tissue transglutaminase (tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb and distal duodenum. We stratified patients into three groups: newly diagnosed CD, gluten-free diet-treated CD, and non-CD controls. Results: Altogether, there were 133 CD patients (71 newly diagnosed, 62 GFD-treated) and 57 non-CD controls. Mean age and gender distribution were similar among the three groups: 43.3 years for newly diagnosed CD, 41.6 years for non-CD controls, and 44 years for GFD-treated CD patients, with a male gender distribution of 21.1%, 28%, and 24.1%, respectively. Among the included newly diagnosed CD patients, 14% had a prolonged INR. The mean INR was slightly higher in newly diagnosed CD patients, compared to GFD-treated CD patients and non-CD controls: 1.12 ± 0.30, 1.02 ± 0.83, and 1.00 ± 0.08, respectively (p = 0.009). Consequently, prothrombin activity was slightly lower in newly diagnosed CD patients, compared to GFD-treated CD and non-CD controls: 94.9 ± 19.3%, 102.3 ± 12.8%, and 101.9 ± 15.15, respectively. Interestingly, after GFD, the mean INR and prothrombin activity of CD individuals reached a value similar to that of non-CD controls. Conclusions: Subtle changes in INR, defined as a value within the normal range, but closer to the upper limit, could be an indicator of probability for CD.

The effect of shift work on different hematological parameters among healthcare workers

Shift workers frequently experience alterations in their circadian rhythms, which are correlated with variations in hematological parameters. Changes in blood cells may be related to an individual's health status. Therefore, this study aimed to compare the relationship between shift work and changes in blood cells among a group of healthcare workers in Sri Lanka. A comparative cross-sectional study was conducted among healthcare workers, recruited by a stratified random sampling technique. Socio-demographic data were collected using a structured questionnaire. Venous blood samples were obtained and analyzed for the determination of total and differential blood cell counts. Descriptive statistics were used for the analysis of sociodemographic and hematological parameters. A sample of 37-day workers and 39 shift workers were included in the analysis. The mean ages (years) were not significantly different between the groups (36.8 ± 10.8 vs 39.1 ± 12.0; P = 0.371). Shift employees showed a significantly higher total mean white blood cell count (WBC) of 7548.75 mm-3 compared to day workers' 6869.19 mm-3 (P = 0.027). They also had higher mean absolute counts for all different WBC types (Neutrophils: 3949.2 vs 3557.7  , Lymphocyte: 2756.5 vs 2614.2  , Eosinophil: 317.6 vs 233.4  , Monocytes: 491.63 vs 432.51  , Basophils: 31.68 vs 29.22  ). Shift employees exhibited higher WBC counts than day workers at the same level of work experience. The length of shift work exposure revealed a positive link with neutrophil (r = 0.225  ) and eosinophil counts (r = 0.262  ), whereas these correlations were negative for day workers. Shift workers were associated with higher WBC counts in healthcare workers compared to their day-working counterparts.

Red Cell Distribution Width as a Predictive Factor of Celiac Disease in Middle and Late Adulthood and Its Potential Utility as Celiac Disease Screening Criterion

Red cell distribution width (RDW) could be of interest by its potential use in the assessment of celiac disorder (CD). The main objective of this study was to evaluate the case positive rate of CD and the utility of red cell distribution width (RDW) in the CD diagnosis. This prospective study included 9.066 middle adult (≥45 years old) and elderly patients (≥60 years old) from 2012 to 2021. CD diagnosis was performed by CD antibody tests (serology and Human Leucocyte Antigen genotype (HLA)) and biopsy. Gastrointestinal and extra-intestinal manifestations as well as hematological and biochemical parameters were analyzed. CD diagnoses were confirmed in 101 patients (median (IQR) age = 62 (52.3−73); 68.32% women) by serologic tests (100%) and intestinal biopsy (88.12%), showing mainly marked or complete atrophy (76.24%, MARSH 3a−c). Anemia was the most commonly presenting extra-intestinal manifestation (28.57%). Among 8975 individuals without CD, 168 age and sex matched were included. By comparison of CD and no CD individuals, we observed that high >14.3% RDW was exhibited by 58.40% and 35.2% individuals with CD and without CD, respectively. Furthermore, high RDW is associated with CD and grade III atrophy. We suggest that RDW could be used as a CD screening criterion.

Prognostic significance of red blood cell distribution width in gastrointestinal disorders

The red blood cell distribution width (RDW) is a routinely measured and automatically reported blood parameter, which reflects the degree of anisocytosis. Recently, the baseline RDW was found to have clinical significance for assessing clinical outcome and severity of various pathological conditions including cardiovascular diseases, sepsis, cancers, leukemia, renal dysfunction and respiratory diseases. A myriad of factors, most of which ill-defined, have an impact on the red cell population dynamics (i.e., production, maturation and turnover). A delay in the red blood cell clearance in pathological conditions represents one of the leading determinants of increased anisocytosis. Further study of RDW may reveal new insight into inflammation mechanisms. In this review, we specifically discuss the current literature about the association of RDW in various disease conditions involving the gastrointestinal and hepatobiliary systems. We also present some of the related measurements for their value in predicting clinical outcomes in such conditions. According to our data, RDW was found to be a valuable prognostic index in gastrointestinal disorders along with additional inflammatory biomarkers (i.e., C reactive protein, erythrocyte sedimentation rate, and platelet count) and current disease severity indices used in clinical practice.

Can red cell distribution width be used as a predictor of acute cholecystitis?

OBJECTIVE

Acute cholecystitis is a common disease requiring accurate markers for diagnosis and proper treatment. The aim of this study was to investigate the role of red cell distribution width (RDW) in acute cholecystitis.

MATERIAL AND METHODS

299 were included in the study. The subjects were divided into 2 groups; group 1 (n: 46) acute cholecystitis group and group 2 (n: 253) chronic cholecystitis group. The patients were compared with respect to demographic characteristics, white blood cell count, C-reactive protein, and red cell distribution width.

RESULTS

A statistically significant difference was observed between groups with respect to gender, white blood cell count, C-reactive protein, and red cell distribution width level (p<0.05). The mean red cell distribution width level of group 1 and 2 was 14.19±2.02% and 15.03±2.51%, respectively.

CONCLUSION

Red cell distribution width level can be used as a predictor of acute cholecystitis. Multicenter prospective studies should be performed to elucidate the exact role of RDW level in acute cholecystitis.

Evaluation of Platelet Indices and Red Cell Distribution Width as New Biomarkers for the Diagnosis of Acute Appendicitis

BACKGROUND

Debate around the value of laboratory tests in establishing the diagnosis of acute appendicitis (AA) still continues. This prospective study aimed to investigate the changes in mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) with the diagnosis of acute appendicitis.

METHOD

200 patients who underwent emergency appendectomy were included. According to postoperative histology, patients were divided into three groups: acute non-complicated, acute complicated appendicitis (positive appendicectomy groups), and negative appendectomy group. White blood cell (WBC), neutrophil, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelets (PLT) count, MPV, PDW, RDW, and C-reactive protein (CRP) were compared among the groups.

RESULTS

One hundred twenty-five (62.5%) patients had non-complicated acute appendicitis, 20 (10%) had complicated acute appendicitis, while 55 (27.5%) had normal appendix. WBC (p <.001), neutrophil (p <.001), NLR (p <.001), PDW (p =.003), and CRP (p =.001) were higher, while lymphocyte (p <.001) and PLT counts (p =.020) were lower in positive appendectomy compared with negative appendectomy patients. MPV levels were insignificantly different across the groups. RDW level was significantly higher in complicated compared with non-complicated acute appendicitis (p =.006); however, no significant difference was found between positive and negative appendectomy groups. Using receiver operating characteristic analysis, sensitivity, specificity, and diagnostic accuracy respectively were 44.83, 100.0, and 72.415% for WBC count, 72.41, 81.82, and 77.115% for neutrophil count, 48.28, 90.91, and 69.595% for PDW, 89.66, 63.64, and 76.65% for CRP.

CONCLUSIONS

Increased PDW combined with elevated WBC and neutrophil counts maybe used as diagnostic tests in the cases of acute appendicitis, while MPV and RDW levels were not useful diagnostic markers.

Ratio of spleen diameter to red blood cell distribution width: a novel indicator for celiac disease

Celiac disease (CD) is currently considerably underdiagnosed, setting the need for developing tools to select patients with probability of CD, who warrant further testing. Red blood cell distribution width (RDW) has been shown in previous studies to be a sensitive predictor for CD, but it lacks specificity. Splenic hypotrophy is also noted frequently in celiac patients. Our aim was to evaluate if spleen diameter to RDW ratio can be used as an indicator for CD. We evaluated 15 newly diagnosed CD patients, 52 patients with inflammatory bowel disease, and 35 patients with irritable bowel syndrome (IBS). We evaluated the differences in spleen diameter, RDW, and their ratio among the four groups. Two-thirds of the CD patients had elevated RDW, compared to 9% in the IBS group. A small spleen was seen in 80% of the celiacs, compared to 21.9% in the ulcerative colitis group, 10% in the Crohn disease group, and 9% in the IBS group. A spleen diameter to RDW ratio under 6 had a sensitivity of 73.3% and specificity of 88.5% in predicting CD, with an AUROC of 0.737. Spleen diameter to RDW ratio is a simple, widely available score, which can be used to select adult patients with probability of CD.

Association between red blood cell distribution width and acute pancreatitis

BACKGROUND

We aimed to determine whether there are any alterations in red blood cell width in patients diagnosed with acute pancreatitis.

MATERIAL/METHODS

This was a retrospective study of records of patients treated in emergency units and diagnosed with acute pancreatitis between January 2011 and April 2013. Records were investigated regarding patient age, sex, and causes of acute pancreatitis. Red blood cell width and amylase values obtained from the patients during diagnosis and after a full recovery from acute pancreatitis were added to the records.

RESULTS

Recorded red blood cell width and amylase values of 104 patients diagnosed with acute pancreatitis were statistically compared according to the time of sample collection. Samples were collected in the post-diagnostic period and after full recovery. Values of red blood cell width and amylase were found to be significantly higher in samples collected during hospital admission in comparison to those obtained from patients after fully recovering from acute pancreatitis (p<0.05).

CONCLUSIONS

An increase in red blood cell width value is a marker of acute pancreatitis; therefore, we suggest that red blood cell width can be used as a tool for the early diagnosis and assessment of disease progression.

The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study

PURPOSE

The aim of this study was to seek whether red cell distribution width (RDW) has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of RDW with leukocyte count and C-reactive protein (CRP) level.

METHODS

This study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and February 2013 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. Age, gender, leukocyte count, CRP, and RDW values were recorded. This study is a case controlled retrospective clinical study.

RESULTS

A total of 590 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 711 subjects. The mean RDW levels were 15.4 ± 1.5% in the acute appendicitis group, while 15.9 ± 1.4% in the control group. CRP, leukocyte count were significantly higher in the acute appendicitis group, and RDW level were significantly lower in the acute appendicitis group (p < 0.001, p < 0.001, p = 0.001, respectively). RDW, leukocyte count, and CRP had a sensitivity and specificity of 47% and 67%; 91% and 74%; and 97% and 41%, respectively in acute appendicitis. RDW was not correlated with CRP and leukocyte levels. However, we found a correlation between CRP and leukocyte levels.

CONCLUSION

RDW level was lower in patients with acute appendicitis. The magnitude of difference in RDW seen between acute appendicitis and controls was so slight as to be of no utility in diagnostic testing.