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Huo LK, Chen KY, Tse G, Liu T. Association of inflammatory markers based on routine blood with prognosis in patients underwent percutaneous coronary intervention. Medicine (Baltimore) 2024; 103:e38118. [PMID: 38728454 PMCID: PMC11081586 DOI: 10.1097/md.0000000000038118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
Inflammation contributes to the pathophysiological processes of coronary artery disease. We evaluated the association between inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), systemic inflammatory index, platelet-lymphocyte ratio, and 1-year all-cause mortality in patients underwent percutaneous coronary intervention (PCI). In this retrospective cohort, we consecutively enrolled 4651 patients who underwent PCI. Baseline demographic details, clinical data, and laboratory parameters on admission were analyzed. The primary outcome was 1-year all-cause mortality after PCI. We performed Cox regression and restricted cubic spline analysis to assessed the association between the inflammatory biomarkers and the clinical outcome. The area under the curve from receiver operating characteristic analysis was determined for the ability to classify mortality outcomes. A total of 4651 patients were included. Of these, 198 (4.26%) died on follow-up. Univariate Cox regression showed that NLR (heart rate [HR]: 1.070, 95% confidence interval [CI]: 1.060-1.082, P < .001), RDW (HR: 1.441, 95% CI 1.368-1.518, P < .001), systemic inflammatory index (HR: 1.000, 95% CI 1.000-3.180, P < .001), platelet-lymphocyte ratio (HR: 3.812, 95% CI 1.901-3.364, P < .001) were significant predictors of 1-year all-cause mortality. After adjusting for other confounders in multivariate analysis, NLR (HR: 01.038, 95% CI 1.022-1.054, P < .001) and RDW (HR: 1.437, 95% CI 1.346-1.535, P < .001) remained significant predictors. Restricted cubic spline analysis showed the relationship between RDW, NLR, and 1-year all-cause mortality was linear after adjusting for the covariables (P for non-linearity < 0.001). The multivariable adjusted model led to improvement in the area under the curve to 0.83 (P < .05). Nomogram was created to predict the probability of 1 year mortality. Among the laboratory indices, RDW and NLR showed the best performance for mortality risk prediction. Multivariate predictive models significantly improved risk stratification.
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Affiliation(s)
- Li Kun Huo
- Department of Cardiology, Tianjin Key Laboratory of Ions and Molecular Function of Cardiovascular Diseases, The Second Hospital of Tianjin Medical University, Tianjin Institute of Cardiology, Tianjin, China
- Department of Emergency, Tianjin Huan Hu Hospital, Tianjin, China
| | - Kang Yin Chen
- Department of Cardiology, Tianjin Key Laboratory of Ions and Molecular Function of Cardiovascular Diseases, The Second Hospital of Tianjin Medical University, Tianjin Institute of Cardiology, Tianjin, China
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ions and Molecular Function of Cardiovascular Diseases, The Second Hospital of Tianjin Medical University, Tianjin Institute of Cardiology, Tianjin, China
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, UK
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong, China
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ions and Molecular Function of Cardiovascular Diseases, The Second Hospital of Tianjin Medical University, Tianjin Institute of Cardiology, Tianjin, China
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Liang Q, Zhang Y, Liang J. Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector. Cardiovasc Ther 2023; 2023:5532917. [PMID: 37705934 PMCID: PMC10497366 DOI: 10.1155/2023/5532917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 09/15/2023] Open
Abstract
Backgrounds Serum total bilirubin (STB) is recently more regarded as an antioxidant with vascular protective effects. However, we noticed that elevated STB appeared in unstable angina pectoris (UAP) patients with diffused coronary lesions. We aimed to explore STB's roles in UAP patients, which have not been reported by articles. Methods and Results 1120 UAP patients were retrospectively screened, and 296 patients were finally enrolled. They were grouped by Canadian Cardiovascular Society (CCS) angina grades. The synergy between PCI with TAXUS stent and cardiac surgery score (SYNTAX score) and corrected thrombolysis in myocardial infarction flow count (CTFC) were adopted to profile coronary features. The results showed that STB, mean platelet volume (MPV), hs-CRP, fasting blood glucose (FBG), red blood cell width (RDW), and CTFC elevated significantly in the CCS high-risk group. STB (B = 0.59, 95% CI: 0.39-0.74, P < 0.01) and MPV (B = 0.86, 95% CI: 0.42-1.31, P < 0.01) could indicate SYNTAX score changes for these patients. STB (≥21.7 μmol/L) could even indicate a coronary slow flow condition (AUC: 0.88, 95% CI: 0.84-0.93, P < 0.01). Moreover, UAP patients with elevated STB had a lower event-free survival rate by the Kaplan-Meier curve. STB ≥21.7 μmol/L could reflect a poor coronary flow status and indicate 1-year poor outcomes for these patients (HR: 2.01, 95% CI: 1.06-3.84, P < 0.01). Conclusion Elevated STB in UAP patients has a close relationship with changes in SYNTAX score. STB (over 21.7 μmol/L) could even indicate a coronary slow flow condition and poor outcomes for the UAP patients.
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Affiliation(s)
- Qi Liang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Rd, Shaanxi, Xi'an 710061, China
| | - Yongjian Zhang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Rd, Shaanxi, Xi'an 710061, China
| | - Jin Liang
- Department of Medical Insurance, Xi'an Affiliated Hospital of the Shaanxi University of Chinese Medicine, China
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Sharma D, Khedar M, Ola V. Red blood cell distribution width - A novel marker of inflammation and predictor of complications and outcomes among surgically managed patients. FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bao D, Luo G, Kan F, Wang X, Luo J, Jiang C. Prognostic value of red cell distribution width in patients undergoing percutaneous coronary intervention: a meta-analysis. BMJ Open 2020; 10:e033378. [PMID: 32912972 PMCID: PMC7485231 DOI: 10.1136/bmjopen-2019-033378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic value of baseline red cell distribution width (RDW) in patients with coronary artery diseases (CADs) undergoing percutaneous coronary intervention (PCI) by conducting a meta-analysis. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed, Embase, Wanfang, CNKI and VIP databases were searched from their inceptions to 19 June 2019. ELIGIBLE CRITERIA Studies investigating the value of baseline RDW for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACEs) in patients with CAD undergoing PCI were included. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted the data and evaluated the methodological quality using the Newcastle-Ottawa Scale. STATA V.12.0 software was applied to produce the forest plots using a random-effect model. RESULTS Twelve studies (13 articles) involving 17 113 patients were included and analysed. Comparison between the highest and lowest RDW category indicated that the pooled risk ratio (RR) was 1.77 (95% CI 1.32 to 2.37) for all-cause mortality, 1.70 (95% CI 1.25 to 2.32) for cardiovascular mortality and 1.62 (95% CI 1.21 to 2.18) for MACEs. The predictive effect of elevated RDW for all-cause mortality was stronger in the subgroup of patients without anaemia (RR 4.59; 95% CI 3.07 to 6.86) than with anaemia. CONCLUSIONS This meta-analysis indicated that elevated RDW was associated with higher risk of mortality and adverse cardiac events in patients with CAD undergoing PCI. The value of elevated RDW for predicting all-cause mortality appears to be stronger in patients without anaemia. RDW may be served as a promising prognostic biomarker in patients undergoing PCI.
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Affiliation(s)
- Donglai Bao
- Department of Cardiovascular disease, Yiwu Central Hospital, Yiwu, China
| | - Gaojiang Luo
- Department of Cardiovascular disease, Yiwu Central Hospital, Yiwu, China
| | - Fuqiang Kan
- Department of Cardiovascular disease, Yiwu Central Hospital, Yiwu, China
| | - Xiaoyan Wang
- Department of Cardiovascular disease, Yiwu Central Hospital, Yiwu, China
| | - Jinwei Luo
- Department of Cardiovascular disease, Yiwu Central Hospital, Yiwu, China
| | - Changhao Jiang
- Department of Cardiovascular disease, Yiwu Central Hospital, Yiwu, China
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5
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Yang QY, Li XF, Lin MQ, Xu JH, Yan H, Zhang ZM, Wang SY, Chen HC, Chen XN, Lin KY, Guo YS. Association between red blood cell distribution width and long-term mortality among patients undergoing percutaneous coronary intervention with previous history of cancer. Biomarkers 2020; 25:260-267. [PMID: 32141338 DOI: 10.1080/1354750x.2020.1734860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: The number of patients suffering from coronary heart disease with cancer is rising. There is scarce evidence concerning the biomarkers related to prognosis among patients undergoing percutaneous coronary intervention (PCI) with cancer. Thus, the aim of this study was to investigate the association between red blood cell distribution width (RDW) and prognosis in this population.Methods: A total of 172 patients undergoing PCI with previous history of cancer were enrolled in this retrospective study. The endpoint was long-term all-cause mortality. According to tertiles of RDW, the patients were classified into three groups: Tertile 1 (RDW <12.8%), Tertile 2 (RDW ≥12.8% and <13.5%) and Tertile 3 (RDW ≥13.5%).Results: During an average follow-up period of 33.3 months, 29 deaths occurred. Compared with Tertile 3, mortality of Tertile 1 and Tertile 2 was significantly lower in the Kaplan-Meier analysis. In multivariate Cox regression analysis, RDW remained an independent risk factor of mortality (HR: 1.938, 95% CI: 1.295-2.655, p < 0.001). The all-cause mortality in Tertile 3 was significantly higher than that in Tertile 1 (HR: 5.766; 95% CI: 1.426-23.310, p = 0.014).Conclusions: An elevated RDW level (≥13.5%) was associated with long-term all-cause mortality among patients undergoing PCI with previous history of cancer.
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Affiliation(s)
- Qing-Yong Yang
- Department of Internal Medicine, Jinshan Branch of Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China.,Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Xiu-Feng Li
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Mao-Qiang Lin
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Jia-Hao Xu
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Han Yan
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Zhi-Ming Zhang
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Sun-Ying Wang
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Han-Chuan Chen
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Xi-Nan Chen
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Kai-Yang Lin
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Yan-Song Guo
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
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Long-term Pattern of Red Cell Distribution Width in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Crit Pathw Cardiol 2019; 19:43-48. [PMID: 31478946 DOI: 10.1097/hpc.0000000000000196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Red cell distribution width (RDW) is an indirect marker of inflammation and an independent predictor of long-term mortality. The aim of this study was to determine RDW values in patients with ST-elevation acute myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) and evaluate its association with adverse outcomes. We measured RDW in STEMI patients before undergoing primary PCI and divided into low and high RDW. Patients were followed up to 3 years after their discharge for the occurrence of in-hospital, 30-days, and long-term major adverse cardiovascular events (MACEs) and mortality. We included 485 patients with a mean age of 61.1(±12.5) years, 62.9% were male. In multivariate analysis, RDW remained independent predictor of long-term mortality and MACE [relative risk (RR) 1.51; 95% confidence interval (95% CI) = 1.11-2.05; P = 0.007 and RR = 1.42; 95% CI = 1.30-1.82; P = 0.004. Area under the curve for long-term mortality was 0.65 (95% CI = 0.61-0.69; P < 0.0001). RDW < 13.4 had a negative predictive value of 87.4% for all-cause mortality. Patients who had worse outcomes remained with higher values of RDW during the follow-up. In conclusion, high RDW is an independent predictor of long-term mortality and MACE in patients with STEMI undergoing primary PCI. A low RDW has an excellent negative predictive value for long-term mortality. Patients with sustained elevated levels of RDW have worse outcomes at long-term follow-up.
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Wu H, Wang X, Zhang J, Sun H. Can red blood cell distribution width predict long‐term cardiovascular event after off‐pump coronary artery bypass? A retrospective study. J Card Surg 2019; 34:988-993. [DOI: 10.1111/jocs.14192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Hengchao Wu
- State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical SciencePeking Union Medical College Beijing China
| | - Xianqiang Wang
- State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical SciencePeking Union Medical College Beijing China
| | - Jing Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical SciencePeking Union Medical College Beijing China
| | - Hansong Sun
- State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical SciencePeking Union Medical College Beijing China
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Dalbó J, Filgueiras LA, Mendes AN. Effects of pesticides on rural workers: haematological parameters and symptomalogical reports. CIENCIA & SAUDE COLETIVA 2019; 24:2569-2582. [DOI: 10.1590/1413-81232018247.19282017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/28/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract Exposure to pesticides by the rural population is increasing worldwide. Pesticides can induce the development of different diseases such as cancer and diseases of the central nervous system. This study analysed the clinical symptoms and haematological changes of a rural population in Conceição do Castelo, Espirito Santo, Brazil. For evaluation of symptomatology exposure to pesticides, 142 rural workers were interviewed. Of these, 22 workers were selected for haematological tests randomly as to evaluate haematological changes during the period of exposure to pesticides. Haematological analyses showed that erythrocytes, haemoglobin, haematocrit, mean corpuscular (VCM) volume, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) are in accordance with the reference intervals in haematology. Variations in the concentrations of rods and neutrophils indicates that exposure to pesticides increases the amount of those cells. Haematological disorders in rural workers exposed to pesticides can be correlated with reported symptoms. The results described in this study are relevant to the health public and reinforce the concern about the indiscriminate use of pesticides.
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Wu TT, Zheng YY, Hou XG, Yang Y, Ma X, Ma YT, Xie X. Red blood cell distribution width as long-term prognostic markers in patients with coronary artery disease undergoing percutaneous coronary intervention. Lipids Health Dis 2019; 18:140. [PMID: 31186012 PMCID: PMC6560761 DOI: 10.1186/s12944-019-1082-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background The aim of this study was to assess the prognostic value of red blood cell distribution width (RDW) in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). Methods A retrospective cohort study (CORFCHD-PCI, [Identifier: ChiCTR-INR-16010153]) of 6050 patients who were hospitalized with a diagnosis of coronary artery disease (CAD) and treated with PCI from January 2008 to December 2016 were enrolled in the study. The primary outcome was long-term mortality after PCI. Clinical follow-up data of participating patients were obtained during an outpatient examination 35.9 ± 22.6 months after PCI. Demographic and clinical data and admission laboratory parameters were recorded, and patients were categorized into two groups according to RDW level (high group ≥13.1%; low group < 13.1%). Results Multivariate Cox regression analysis revealed RDW as an independent prognosis factor for cardiac death. The incidence of cardiac death increased 1.33 times in patients in the high RDW group (HR, 1.331; 95% CI, 1.009–1.755, P = 0.043). Kaplan–Meier survival analysis suggested that patients with high RDW tended to have an increased accumulated risk of cardiac death. However, we did not found significant differences in the incidence of long-term mortality (adjusted HR = 1.203[0.941–1.537], P = 0.140), MACCE (adjusted HR = 1.128[0.979–1.301], P = 0.096), MACE (adjusted HR = 1.155[0.994–1.341], P = 0.059), stroke, bleeding events or readmission between the two groups. Conclusion The baseline level of RDW is an independent predictor for cardiac death in post-PCI CAD patients.
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Affiliation(s)
- Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China
| | - Xian-Geng Hou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Yi Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China.
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China.
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Dai L, Mick SL, McCrae KR, Houghtaling PL, Blackstone EH, Koch CG. Prognostic Value of Preoperative Red Cell Distribution Width: Fine-Tuning by Mean Corpuscular Volume. Ann Thorac Surg 2019; 108:1830-1838. [PMID: 31199898 DOI: 10.1016/j.athoracsur.2019.04.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/19/2019] [Accepted: 04/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Abnormal red cell distribution width (RDW), reflecting heterogeneity of red blood cell (RBC) size, is associated with cardiovascular disease outcomes. However, whether RBC size itself, expressed as mean corpuscular volume (MCV), provides additional prognostic value is unclear. We therefore investigated the relationship between outcomes after cardiac surgery and both RDW and MCV simultaneously. METHODS From January 2010 to January 2014, 16,097 patients underwent cardiac surgery at Cleveland Clinic and had complete blood count findings available for analysis. Outcomes included RBC transfusion, postoperative complications, and intensive care unit (ICU) and postoperative hospital lengths of stay. Risk-adjusted associations of RDW and MCV with outcomes and their relative importance in predicting outcome were identified by random forest machine learning. RESULTS High RDW was associated with more RBC transfusions. Except for postoperative atrial fibrillation, risks of complications and ICU and postoperative lengths of stay were at their minimum when RDW was normal, 13% to 14%. The relationship of MCV to complications was U-shaped: high (macrocytosis) and low (microcytosis) values were associated with higher risk. RDW was an important risk factor for most postoperative outcomes and lengths of stay; MCV was less so, but provided prognostic value in addition to RDW alone, particularly when there was macrocytosis. CONCLUSIONS Abnormal RDW and MCV are associated with higher risk of transfusion and postoperative outcomes after cardiac surgery. RDW is one of the most important variables in predicting outcomes, but MCV provides additional prognostic value. Both should be taken into consideration when estimating the perioperative risk of patients undergoing cardiac surgery.
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Affiliation(s)
- Lu Dai
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie L Mick
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Keith R McCrae
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Colleen G Koch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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11
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The prognostic value of interaction between mean corpuscular volume and red cell distribution width in mortality in chronic kidney disease. Sci Rep 2018; 8:11870. [PMID: 30089848 PMCID: PMC6082905 DOI: 10.1038/s41598-018-19881-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/16/2017] [Indexed: 11/08/2022] Open
Abstract
Recently, both red cell distribution width (RDW) and mean corpuscular volume (MCV) have been associated with unfavorable outcomes in several medical conditions. Therefore, we conducted this retrospective study of 1075 patients with stage 3-5 chronic kidney disease to investigate whether interactions between RDW and MCV influence the risk of mortality. These patients were divided into four groups: group A (n = 415), RDW ≤ 14.9% and MCV ≤ 91.6 fL; group B (n = 232), RDW > 14.9% and MCV ≤ 91.6 fL; group C (n = 307), RDW ≤ 14.9% and MCV > 91.6 fL; and group D (n = 121), RDW > 14.9% and MCV > 91.6 fL. The adjusted hazard ratio (HR) of all-cause mortality for group B versus group A was 1.44 (95% confidence interval [CI], 1.14-2.12, p = 0.02), group C versus group A 2.14 (95% CI, 1.31-3.48, p = 0.002), and group D versus group A 5.06 (95% CI, 3.06-8.37, p < 0.001). There was a multiplicative interaction between MCV and RDW in predicting patient mortality. The use of RDW in conjunction with MCV may improve healthcare by identifying those at an increased risk for mortality compared with the use of either RDW or MCV alone.
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12
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Abdullah HR, Sim YE, Sim YT, Ang AL, Chan YH, Richards T, Ong BC. Preoperative Red Cell Distribution Width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study. Sci Rep 2018; 8:6226. [PMID: 29670189 PMCID: PMC5906451 DOI: 10.1038/s41598-018-24556-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/06/2018] [Indexed: 12/20/2022] Open
Abstract
Increased red cell distribution width (RDW) is associated with poorer outcomes in various patient populations. We investigated the association between preoperative RDW and anaemia on 30-day postoperative mortality among elderly patients undergoing non-cardiac surgery. Medical records of 24,579 patients aged 65 and older who underwent surgery under anaesthesia between 1 January 2012 and 31 October 2016 were retrospectively analysed. Patients who died within 30 days had higher median RDW (15.0%) than those who were alive (13.4%). Based on multivariate logistic regression, in our cohort of elderly patients undergoing non-cardiac surgery, moderate/severe preoperative anaemia (aOR 1.61, p = 0.04) and high preoperative RDW levels in the 3rd quartile (>13.4% and ≤14.3%) and 4th quartile (>14.3%) were significantly associated with increased odds of 30-day mortality - (aOR 2.12, p = 0.02) and (aOR 2.85, p = 0.001) respectively, after adjusting for the effects of transfusion, surgical severity, priority of surgery, and comorbidities. Patients with high RDW, defined as >15.7% (90th centile), and preoperative anaemia have higher odds of 30-day mortality compared to patients with anaemia and normal RDW. Thus, preoperative RDW independently increases risk of 30-day postoperative mortality, and future risk stratification strategies should include RDW as a factor.
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Affiliation(s)
- H R Abdullah
- Consultant, Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore Assistant Professor, Duke-NUS Medical School, Singapore, Singapore.
| | - Y E Sim
- Senior Resident, Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Y T Sim
- Medical Student, University of Tasmania School of Medicine, Hobart, Australia
| | - A L Ang
- Senior Consultant, Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Y H Chan
- Head, Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - T Richards
- Professor of Surgery, Division of Surgery, University College, London, United Kingdom
| | - B C Ong
- Chairman Medical Board, Sengkang Health, Singapore, Singapore
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梁 琦, 雷 新, 李 红, 殷 艳, 任 洁, 范 力, 黄 欣, 袁 祖. [Regression analysis of red cell distribution width and mean platelet volume in patients with acute myocardial infarction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1022-1027. [PMID: 28801280 PMCID: PMC6765727 DOI: 10.3969/j.issn.1673-4254.2017.08.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate clinical implications of changes in red cell distribution width (RDW) and mean platelet volume (MPV) in patients with acute myocardial infarction. METHODS A total of 127 patients (90 men and 37 women) were enrolled in this analysis, including 66 with acute myocardial infarction (AMI) and 61 with unstable angina (UA). The patients' baseline demographic and clinical data were compared between the two groups including age, hypertension, diabetes, smoking, BMI, blood biochemical profiles, cardiac functions and platelet and red blood cell parameters. The patients were further divided into subgroups according to the RDW 50% cumulative frequency, and the MPV, P-LCR, hsCRP, NT-proBNP, RBC, Dimer and MCV were compared. The correlations between platelet and erythrocyte test results were evaluated in both the AMI and UA patients. Regression analysis was performed to identify the factors affecting the RDW in the AMI group and a regression model was established. RESULTS The platelet and red blood cell test results, P-LCR, MPV, and RDW differed significantly between AMI and UA groups (P<0.01 or 0.05). Correlation analysis showed a significant positive correlation between RDW and MPV in AMI group (r=0.34, P<0.01). Between the subgroups with different RDW 50% cumulative frequencies, MPV, P-LCR, hsCRP, D-Dimer, and NT-proBNP all differed significantly (P<0.05 or 0.01). In AMI group, with RDW as the dependent variable, we established a multivariate regression model of RDW=0.19MPV+10.83. CONCLUSION RDW and MPV are closely correlated in patients with AMI. In multiple regression analysis, MPV can explain the changes in RDW in patients with AMI.
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Affiliation(s)
- 琦 梁
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 新军 雷
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 红兵 李
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 艳蓉 殷
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 洁 任
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 力宏 范
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 欣 黄
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
| | - 祖贻 袁
- />西安交通大学医学院第一附属医院心血管内科, 陕西 西安 710061Department of Cardiology, First Affiliate Hospital of Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
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Caire MT, Kumar A, Stravitz RT, Kemmer N. Preliver transplant red cell distribution width predicts postliver transplant mortality. Clin Transplant 2017; 31. [PMID: 28054385 DOI: 10.1111/ctr.12908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Prognostication following liver transplantation is limited. Red cell distribution width (RDW) has been associated with morbidity and mortality in a variety of diseases. We hypothesize RDW is predictive of mortality postliver transplantation. METHODS We performed a retrospective cohort study of all consecutive liver transplantation recipients at a tertiary care center from January 1, 2012 to December 31, 2012. The primary end point was association of RDW with one-year mortality. Statistical analysis was performed using the Mann-Whitney test, independent samples t test, and regression analysis. Discrimination was assessed by calculating area under receiver operating curves (AUC). A P-value <.05 was considered significant. RESULTS RDW was positively associated with one-year mortality (P<.001). The mean difference for survivors compared to nonsurvivors was 3.9% (95% CI 1.9%-5.9%). The AUC for RDW was 0.831 (95% CI 0.727-0.935), compared to 0.723 (0.539-0.908) for total bilirubin and 0.704 (0.479-0.929) for the international normalized ratio. CONCLUSIONS To our knowledge, this is the first report of an association of RDW with post-LT mortality and the results show the predictive value of pre-LT RDW for one-year mortality.
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Affiliation(s)
- M Thure Caire
- Hepatology and Liver Transplant, Tampa General Medical Group, Tampa, FL, USA
| | - Ambuj Kumar
- Evidence Based Medicine & Outcomes Research, University of South Florida, Tampa, FL, USA
| | - R Todd Stravitz
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Nyingi Kemmer
- Hepatology and Liver Transplant, Tampa General Medical Group, Tampa, FL, USA
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Erdem A, Ceylan US, Esen A, Zencirci E, Topcu B, Ozden K, Yazici S, Terzi S, Emre A, Yesilcimen K. Clinical usefulness of red cell distribution width to angiographic severity and coronary stent thrombosis. Int J Gen Med 2016; 9:319-24. [PMID: 27672339 PMCID: PMC5024766 DOI: 10.2147/ijgm.s109452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Red cell distribution width (RDW) is a quantitative measurement and shows heterogeneity of red blood cell size in peripheral blood. RDW has recently been associated with cardiovascular events and cardiovascular diseases, and it is a novel predictor of mortality. In this study, we aimed to evaluate the clinical usefulness of measuring RDW in patients with coronary stent thrombosis. Patients and methods We retrospectively reviewed 3,925 consecutive patients who presented with acute coronary syndrome and who underwent coronary angiography at the Siyami Ersek Hospital between May 2011 and December 2013. Of the 3,925 patients, 73 patients (55 males, mean age 59±11 years, 55 with ST elevated myocardial infarction) with stent thrombosis formed group 1. Another 54 consecutive patients who presented with acute coronary syndrome (without coronary stent thrombosis, 22 patients with ST elevated myocardial infarction, 44 males, mean age 54±2 years) and underwent percutaneous coronary intervention in May 2011 formed group 2. Data were collected from all groups for 2 years. The RDW values were calculated from patients 1 month later at follow-up. Syntax scores were calculated for all the patients. The patients were also divided as low syntax score group and moderate–high syntax score group. Results The patients in group 1 with stent thrombosis had significantly higher RDW level (13.85) than the patients in group 2 without stent thrombosis (12) (P<0.001). In addition, in all study patients, the moderate–high syntax score group had significantly higher RDW level (13.6) than the low syntax score group (12.9) (P=0.009). A positive correlation was determined between RDW and syntax scores (r=0.204). Conclusion RDW is a new marker of poor prognosis in coronary artery disease. Increased RDW level is correlated with angiographic severity of coronary artery disease, and RDW may be an important clinical marker of coronary stent thrombosis in patients undergoing coronary intervention.
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Affiliation(s)
- Aysun Erdem
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Sadik Ceylan
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aycan Esen
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ertugrul Zencirci
- Department of Cardiology, Acibadem Hospital Maslak, Istanbul, Turkey
| | - Birol Topcu
- Department of Biostatistics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Kivilcim Ozden
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Yazici
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sait Terzi
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayse Emre
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kemal Yesilcimen
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Gurbuz O, Kumtepe G, Ozkan H, Karal IH, Ercan A, Ener S. Red blood cell distribution width predicts long term cardiovascular event after on-pump beating coronary artery bypass grafting. J Cardiothorac Surg 2016; 11:48. [PMID: 27059704 PMCID: PMC4826544 DOI: 10.1186/s13019-016-0465-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/05/2016] [Indexed: 01/19/2023] Open
Abstract
Background Reports investigating the predictive value of red cell distribution width (RDW) on major cardiac and cardiovascular event (MACCE) following coronary artery bypass grafting (CABG) have major limitations, including lack of elimination of common factors affecting RDW levels, such as anemia. The purpose of this study is to identify the real effect of higher RDW level, free from the other factors, on MACCE following CABG. Methods Data of 500 consecutive, non-anemic patients (77.2 % male and mean age 63.05 ± 9.24) undergoing ONBHCAB between January 2007 and January 2010, were analyzed retrospectively. Results Overall MACCE was 7.8 % of all cases. Mean follow-up was 66.5 ± 9.96 months. In multivariate Cox regression analysis, RDW (P = 0.022) remained the only independent predictor of MACCE and the ROC analyze revealed an RDW cut-off value of 13.95 % predicting MACCE. Therefore, patients were grouped on this cut-off value. There were 238 patients in the lower RDW group (Group 1) and 262 patients in the higher RDW group (Group 2). Kaplan–Meier survival analysis of freedom from MACCE revealed significantly lower event free survival in Group 2 (P < 0.001 by the log-rank test). Group 2 showed a higher MACCE incidence in 1 year (P = 0.030), in 3 years (P < 0.001) and in 6 years (P < 0.001). The long-term follow-up was similar regarding noncardiovascular mortality. Conclusion An RDW level greater than 13.95 % in hospital admission is independently associated with an increased incidence of MACCE after CABG. Physicians should be more aggressive in the management of these patients.
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Affiliation(s)
- Orcun Gurbuz
- Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey.
| | - Gencehan Kumtepe
- Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey
| | - Hakan Ozkan
- Department Of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - Ilker Hasan Karal
- Department of Cardiovascular Surgery, Samsun Hospital for Education and Research, Ilkadim, 55090, Samsun, Turkey
| | - Abdulkadir Ercan
- Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey
| | - Serdar Ener
- Department of Cardiovascular Surgery, Acıbadem Bursa Hospital, Bursa, Turkey
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Zhao N, Mi L, Liu X, Pan S, Xu J, Xia D, Liu Z, Zhang Y, Xiang Y, Yuan Z, Guan G, Wang J. Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. PLoS One 2015; 10:e0140532. [PMID: 26468876 PMCID: PMC4607415 DOI: 10.1371/journal.pone.0140532] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022] Open
Abstract
Global Registry of Acute Coronary Events (GRACE) risk score and red blood cell distribution width (RDW) content can both independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI) for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58%) patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40). GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p < 0.001; 1.699; 1.294-2.232; p < 0.001; respectively). Furthermore, Kaplan-Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001). For GRACE score alone, the area under the receiver operating characteristic (ROC) curve for MACEs was 0.749 (95% CI: 0.707-0.787). The area under the ROC curve for MACEs increased to 0.805 (0.766-0.839, p = 0.034) after adding RDW content. The incremental predictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001) and integrated discrimination improvement (IDI = 0.023, p = 0.002). Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.
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Affiliation(s)
- Na Zhao
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Lan Mi
- Department of Medical Affairs, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaojun Liu
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shuo Pan
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Jiaojiao Xu
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Dongyu Xia
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Zhongwei Liu
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Yong Zhang
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Yu Xiang
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Province People’s Hospital, Xi’an, Shaanxi, China
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Red blood cell distribution width is worthwhile when interpreted with other inflammatory markers. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:457-8. [PMID: 26345736 PMCID: PMC4554792 DOI: 10.11909/j.issn.1671-5411.2015.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology. DISEASE MARKERS 2015; 2015:824624. [PMID: 26379362 PMCID: PMC4563066 DOI: 10.1155/2015/824624] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 12/30/2022]
Abstract
Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D3 and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.
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Amplitud de distribución eritrocitaria y enfermedad coronaria. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Evaluation of red cell distribution width in dogs with pulmonary hypertension. J Vet Cardiol 2014; 16:227-35. [PMID: 25465342 DOI: 10.1016/j.jvc.2014.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/04/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare red cell distribution width (RDW) between dogs with different causes of pulmonary hypertension (PH) and a control dog population to determine whether RDW was correlated with severity of PH as measured by echocardiography. A further aim was to determine the prognostic significance of increased RDW for dogs with PH. ANIMALS Forty-four client-owned dogs with PH and 79 control dogs presented to a single tertiary referral institution. METHODS Signalment, clinical pathological and echocardiographic data were obtained retrospectively from the medical records of dogs with PH, and RDW measured on a Cell-Dyn 3500 was compared between dogs with pre- and post-capillary PH and a control population. Referring veterinary surgeons were contacted for follow-up information and Kaplan-Meier analysis was conducted to investigate differences in survival time between affected dogs with different RDW values. RESULTS The RDW was significantly greater in dogs with pre-capillary PH compared to control dogs. There was no difference in median survival times between dogs with PH divided according to RDW values. The RDW was positively correlated with mean corpuscular volume and haematocrit in dogs with PH, but did not correlate with echocardiographic variables. CONCLUSIONS An association was found between dogs with PH and increased RDW; however there was considerable overlap in values between control dogs and dogs with PH. The RDW was not associated with survival in this study.
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Red cell distribution width and coronary artery disease. ACTA ACUST UNITED AC 2014; 67:967-8. [PMID: 25239181 DOI: 10.1016/j.rec.2014.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/18/2014] [Indexed: 11/21/2022]
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Lack of harmonization of red blood cell distribution width (RDW). Evaluation of four hematological analyzers. Clin Biochem 2014; 47:1100-3. [PMID: 24925288 DOI: 10.1016/j.clinbiochem.2014.06.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess analytical imprecision and comparability of red blood cell distribution width (RDW) on Abbott Sapphire, Mindray BC6800, Siemens Advia 2120 and Sysmex XE-5000. DESIGN AND METHODS Within-run imprecision was assessed on three pools and comparability using 132 inpatient samples. RESULTS The imprecision of RDW was comprised between 0.3 and 1.2%, but the values exhibited broad variation among different analyzers, with bias exceeding the desirable quality specifications. CONCLUSIONS Harmonization of RDW is still an unmet need.
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Kurtul A, Yarlioglues M, Murat SN, Demircelik MB, Acikgoz SK, Ergun G, Duran M, Cetin M, Ornek E. Red Cell Distribution Width Predicts Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. Angiology 2014; 66:433-40. [PMID: 24834929 DOI: 10.1177/0003319714535238] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We investigated the relationship between red cell distribution width (RDW) and contrast-induced nephropathy (CIN) in patients (aged 61 ± 12, 69% men) with acute coronary syndrome (ACS). Consecutive patients diagnosed with ACS (n = 662) who underwent percutaneous coronary intervention (PCI) were included in the study. Patients were divided into 2 groups: CIN and no CIN. Contrast-induced nephropathy was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after PCI. Contrast-induced nephropathy occurred in 81 (12.2%) patients. Red cell distribution width, creatinine, and high-sensitivity C-reactive protein levels were significantly higher in the CIN group than in the no-CIN group. Multivariate regression analysis revealed that baseline RDW level (odds ratio 1.379, 95% confidence interval 1.084-1.753, P = .009), age ( P = .025), creatinine ( P = .004), and left ventricular ejection fraction ( P = .011) were independent risk factors for the development of CIN. In conclusion, increased RDW levels are independently associated with a greater risk of CIN in patients undergoing PCI for ACS.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mikail Yarlioglues
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sani Namik Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | | | - Sadik Kadri Acikgoz
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Gokhan Ergun
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mustafa Duran
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Numune Education and Research Hospital, Ankara, Turkey
| | - Ender Ornek
- Department of Cardiology, Numune Education and Research Hospital, Ankara, Turkey
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Red blood cell distribution width and long-term outcome in patients undergoing percutaneous coronary intervention in the drug-eluting stenting era: a two-year cohort study. PLoS One 2014; 9:e94887. [PMID: 24722190 PMCID: PMC3983260 DOI: 10.1371/journal.pone.0094887] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background Previous studies suggest the higher the red blood cell distribution width (RDW) the greater the risk of mortality in patients with coronary artery disease (CAD). However, the relationship between RDW and long-term outcome in CAD patients undergoing percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) remains unclear. This study was designed to evaluate the long-term effect of RDW in patients treated with drug-eluting stent for CAD. Methods In total of 2169 non-anemic patients (1468 men, mean age 60.2±10.9 years) with CAD who had undergone successful PCI and had at least one drug-eluting stent were included in this study. Patients were grouped according to their baseline RDW: Quartile 1 (RDW<12.27%), Quartile 2 (12.27%≤RDW<13%), Quartile 3 (13%≤RDW<13.5%), and Quartile 4 (RDW≥13.5). Results The incidence of in-hospital mortality and death or myocardial infarction was significantly higher in Quartiles 3 and 4 compared with Quartile 1 (P<0.05). After a follow-up of 29 months, the incidence of all-cause death and stent thrombosis in Quartile 4 was higher than in Quartiles 1, 2, and 3 (P<0.05). The incidence of death/myocardial infarction/stroke and cardiac death in Quartile 4 was higher than in Quartiles 1 and 2 (P<0.05). Multivariate Cox regression analysis showed that RDW was an independent predictor of all-cause death (hazard ratio (HR) = 1.37, 95% confidence interval (CI) = 1.15–1.62, P<0.001) and outcomes of death/myocardial infarction/stroke (HR = 1.21, 95% CI = 1.04–1.39, P = 0.013). The cumulative survival rate of Quartile 4 was lower than that of Quartiles 1, 2, and 3 (P<0.05). Conclusion High RDW is an independent predictor of long-term adverse clinical outcomes in non-anemic patients with CAD treated with DES.
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Abstract
AIM Red blood cell distribution width (RDW) is a marker of cardiovascular morbidity and mortality. However, there is little data on the relationship between RDW and diabetes-associated complications. The aim was to investigate whether there is any association between RDW, nephropathy, neuropathy and peripheral arterial disease (PAD) in a type 2 diabetic population. METHODS This study included 196 diabetic patients with proliferative diabetic retinopathy. All subjects were investigated for diabetic nephropathy, diabetic neuropathy and PAD. Participants underwent 24-h blood pressure monitoring and were analysed for markers of the metabolic syndrome, inflammation, and insulin resistance. RESULTS 57% of the participants had diabetic nephropathy, 46% had diabetic neuropathy while 26% had PAD. No significant association was found between RDW, diabetic neuropathy and PAD (p=NS). However, RDW was strongly associated with diabetic nephropathy (p=0.006), even following adjustment for potential confounding variables. Multivariate logistic regression analysis showed RDW (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.15-2.35, p=0.006), estimated glomerular filtration rate (OR 0.98, 95% CI 0.96-0.99, p<0.001), night-time diastolic blood pressure (OR 1.07, 95% CI 1.03-1.11, p=0.001) and erythrocyte sedimentation rate (OR 1.03, 95% CI 1.004-1.05, p=0.019) to be independently associated with diabetic nephropathy. CONCLUSIONS This is the first study to report lack of association between RDW, neuropathy and PAD in subjects with type 2 diabetes mellitus. More importantly, RDW was shown to be significantly associated with diabetic nephropathy in a type 2 diabetic population with advanced proliferative retinopathy independent of traditional risk factors, including diabetes duration and glycaemic control.
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Affiliation(s)
- Caroline J Magri
- Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida, Malta; Department of Medicine, University of Malta Medical School, Tal-Qroqq, Malta.
| | - Stephen Fava
- Diabetes & Endocrine Centre, Mater Dei Hospital, Tal-Qroqq, Msida, Malta; Department of Medicine, University of Malta Medical School, Tal-Qroqq, Malta
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Osadnik T, Strzelczyk J, Hawranek M, Lekston A, Wasilewski J, Kurek A, Gutowski AR, Wilczek K, Dyrbuś K, Gierlotka M, Wiczkowski A, Gąsior M, Szafranek A, Poloński L. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovasc Disord 2013; 13:113. [PMID: 24320974 PMCID: PMC4028953 DOI: 10.1186/1471-2261-13-113] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 12/01/2013] [Indexed: 11/21/2022] Open
Abstract
Background Data regarding the association between red cell distribution width (RDW) values and mortality in patients with stable coronary artery disease are scarce. We aimed to investigate the link between mortality and RDW in patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI). Methods We analyzed 2550 consecutive patients with stable coronary artery disease who underwent PCI between 2007 and 2011 at our institution. The patients were divided into four groups according to RDW quartiles. The association between the RDW values and the outcomes was assessed using Cox proportional regression analysis after adjusting for clinical, echocardiographic, hemodynamic and laboratory data in the whole population and in subgroups stratified by gender, presence of diabetes, anemia or heart failure. Results In the entire population, there was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often burdened with diabetes, heart failure and chronic kidney disease. There was an almost 4-fold increase in mortality during an average of 2.5 years of follow-up between the group of patients with RDW values lower than 13.1% (25th percentile) and the group with RDW values higher than 14.1% (75th percentile), (4.3% vs. 17.1%, p < 0.0001). After adjusting for the covariates, RDW remained significantly associated with mortality in the whole cohort (HR-1.23 [95% CI (1.13-1.35), p < 0.0001]) and in the subgroups stratified by gender, age (over and under 75 years), presence of anemia, diabetes, heart failure and chronic kidney disease. Conclusion Higher RDW values correspond to higher comorbidity burdens and higher mortality. RDW is an independent predictor of mortality in patients with stable coronary artery disease.
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Affiliation(s)
- Tadeusz Osadnik
- IIIrd Chair and Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Medical Faculty in Zabrze, Ul, Marii Skłodowskiej Curie 9, 41-800, Zabrze, Poland.
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Lam AP, Gundabolu K, Sridharan A, Jain R, Msaouel P, Chrysofakis G, Yu Y, Friedman E, Price E, Schrier S, Verma AK. Multiplicative interaction between mean corpuscular volume and red cell distribution width in predicting mortality of elderly patients with and without anemia. Am J Hematol 2013; 88:E245-9. [PMID: 23828763 DOI: 10.1002/ajh.23529] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/17/2013] [Accepted: 06/25/2013] [Indexed: 12/31/2022]
Abstract
Recent studies have shown that an elevated red cell distribution width (RDW) is an important predictor of adverse outcomes. However, the strength of this biomarker has not been tested in a large outpatient elderly population. Also since increased RDW can be due to a variety of etiologies, additional biomarkers are needed to refine the prognostic value of this variable. We assembled a cohort of 36,226 elderly (≥65yo) patients seen at an outpatient facility within the Einstein/Montefiore system from January 1st 1997 to May 1st 2008 who also had a complete blood count performed within 3 months of the initial visit. With a maximum follow-up of 10 years, we found that an elevated RDW (>16.6) was associated with increased risk of mortality in both non-anemic (HR = 3.66, p < 0.05) and anemic patients (HR = 1.87, p < 0.05). The effect of RDW on mortality is significantly increased in non-anemic patients with macrocytosis (HR = 5.22, p < 0.05) compared to those with normocytosis (HR = 3.86, p < 0.05) and microcytosis (HR = 2.46, p < 0.05). When comparing non-anemic patients with both an elevated RDW and macrocytosis to those with neither, we observed an elevated HR of 7.76 (higher than expected in an additive model). This multiplicative interaction was not observed in anemic patients (HR = 2.23). Lastly, we constructed Kaplan-Meier curves for each RDW/MCV subgroup and found worsened survival for those with macrocytosis and an elevated RDW in both anemia and non-anemic patients. Based on our results, the addition of MCV appears to improve the prognostic value of RDW as a predictor of overall survival in elderly patients.
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Affiliation(s)
- Anthony P. Lam
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Krishna Gundabolu
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Ashwin Sridharan
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Rishi Jain
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Pavlos Msaouel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | | | - Yiting Yu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ellen Friedman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Elizabeth Price
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Stanley Schrier
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Amit K. Verma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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29
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Increased level of red blood cell distribution width is associated with deep venous thrombosis. Blood Coagul Fibrinolysis 2013; 24:727-31. [DOI: 10.1097/mbc.0b013e32836261fe] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Red blood cell distribution width and 3-year outcome in patients undergoing cardiac catheterization. J Thromb Thrombolysis 2013; 37:469-74. [DOI: 10.1007/s11239-013-0964-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fatemi O, Torguson R, Chen F, Ahmad S, Badr S, Satler LF, Pichard AD, Kleiman NS, Waksman R. Red cell distribution width as a bleeding predictor after percutaneous coronary intervention. Am Heart J 2013; 166:104-9. [PMID: 23816028 DOI: 10.1016/j.ahj.2013.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/17/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Red cell distribution width (RDW), a measure of variability in the size of circulating erythrocytes, is an independent predictor of mortality in cardiovascular disease and in patients undergoing percutaneous coronary intervention (PCI). We set out to determine if RDW is a prognostic marker of major bleeding post-PCI. METHODS The study population included 6,689 patients who were subjected to PCI. The RDW was derived from a complete blood count drawn before PCI. Major inhospital bleeding was defined as a hematocrit decrease ≥12%, hemoglobin drop of ≥4, transfusion of ≥2 units of packed red blood cells, retroperitoneal, or gastrointestinal or intracranial bleeding. Multivariable logistic analysis of major inhospital bleeding was performed using a logistic regression model that comprised the National Cardiovascular Data Registry (NCDR) risk score model as a single variable. RESULTS Major bleeding (P < .001), vascular complications (P = .005), and transfusions (P < .001) were significantly higher in patients with higher baseline RDW values. After adjustment for known bleeding correlates, RDW was a significant predictor for major bleeding (odds ratio 1.12, 95% CI 1.06-1.19, P < .001). Although the c statistic of the NCDR risk prediction model changed from 0.730 to 0.737 (P = .032), the net reclassification improvement increased significantly after the addition of RDW as a continuous variable (17.3% CI 6.7%-28%, P = .002). CONCLUSIONS Red cell distribution width, an easily obtainable marker, has an independent, linear relationship with major bleeding post-PCI and incrementally improves the well-validated NCDR risk prediction model. These data suggest that further investigation is necessary to determine the relationship of RDW and post-PCI bleeding.
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Affiliation(s)
- Omid Fatemi
- MedStar Washington Hospital Center, Washington, DC 20010, USA
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Aung N, Dworakowski R, Byrne J, Alcock E, Deshpande R, Rajagopal K, Brickham B, Monaghan MJ, Okonko DO, Wendler O, Maccarthy PA. Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation. Heart 2013; 99:1261-6. [PMID: 23735935 DOI: 10.1136/heartjnl-2013-303910] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the prognostic value of baseline and temporal changes in red cell distribution width (RDW) in patients undergoing transcatheter aortic valve implantation (TAVI). DESIGN Single-centre retrospective observational study. SETTING Tertiary cardiac centre. PATIENTS 175 patients undergoing TAVI were included in this study. MAIN OUTCOME MEASURE Survival. RESULTS We analysed data from 175 TAVI patients (mean (± SD) age 83 ± 7 years, 49% men, mean Logistic EuroSCORE 23 ± 1, 66% preserved left ventricular ejection fraction (LVEF)). Immediately pre-TAVI, mean RDW was 14.6 ± 1.6% with an RDW>15% in 29% of patients. Over median follow-up of 12 months, the median rate of change in RDW was 0.2% per month, and 51 (29%) patients died. On multivariate survival analyses, baseline RDW ≥ 15.5% predicted death (adjusted HR 2.70, 95% CI 1.40 to 5.22, p=0.003) independently of LVEF, transfemoral approach, baseline pulmonary artery systolic pressure, moderate/severe mitral regurgitation and body mass index. A greater rate of increase in RDW over time was associated with increased mortality (adjusted HR 1.11, 95% CI 1.04 to 1.18, p=0.001) independently of baseline RDW and other significant temporal variables including a change in creatinine, bilirubin, mean cell haemoglobin concentration or urea. An increase in RDW>0.1%/month was associated with a twofold increased risk of mortality. CONCLUSIONS Baseline RDW ≥ 15.5% and a rising RDW over time strongly correlate to an increased risk of death post-TAVI, and could be used to refine risk stratification. Investigating and ameliorating the causes of RDW expansion may improve survival.
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Affiliation(s)
- Nay Aung
- Cardiovascular Division, King's College Hospital and King's Health Partners, London, UK
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