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Coşkun A, Eren FA, Eren ŞH, Korkmaz İ. Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels: Neuropsychoses in carbon monoxide poisoning. Am J Emerg Med 2019; 37:1254-1259. [PMID: 30268441 DOI: 10.1016/j.ajem.2018.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Carbon monoxide (CO) poisoning is very common worldwide. In this study, we aimed to evaluate the predictivity of neuro psychosis in carbon monoxide poisoning by the admission levels of red cell distribution (RDW), mean platelet volume (MPV) and troponin I levels which can be measured quickly and easily in the emergency department (ED). PATIENTS AND METHODS This single center observational study included a total of 216 consecutive patients who presented to the ED due to CO poisoning between January 2009 and December 2013. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. According to the carboxyhemoglobin levels, the patients were classified as mildly (COHb < 20%) and severely poisoned (COHb > 20%). In addition, patients were divided into 2 groups, i.e., those with positive (>0.05 ng/mL for our laboratory) and negative (<0.05 ng/mL for our laboratory) troponin levels. RESULTS Patients mean age was 52.58 ± 10.58. 57.9% of the patients had high troponin levels and 51.9% were poisoned severely according to COHb levels. Patients with positive troponin and COHb had longer CO exposure time and higher neutrophil, lymphocyte, mean platelet volume (MPV), COHb and red cell distribution width (RDW) levels at the index admission following CO poisoning than patients with negative troponin (p < 0.05). Age, COHb level, CO exposure time, MPV and RDW (p = 0.001, p < 0.05) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant. CONCLUSIONS In patients presenting to the ED with CO poisoning, RDW and MPV can be helpful for risk stratification of neuropsychosis.
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Xanthopoulos A, Giamouzis G, Melidonis A, Kitai T, Paraskevopoulou E, Paraskevopoulou P, Patsilinakos S, Triposkiadis F, Skoularigis J. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus. Cardiovasc Diabetol 2017; 16:81. [PMID: 28683798 PMCID: PMC5501451 DOI: 10.1186/s12933-017-0563-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/20/2017] [Indexed: 02/08/2023] Open
Abstract
Background Red blood cell distribution width (RDW) is an established prognostic marker in acute and chronic heart failure (HF). Recent studies have pointed out a link among RDW, diabetes mellitus (DM) and inflammation. We sought to investigate the prognostic value and longitudinal pattern of RDW in patients with concomitant HF and DM, which remains unknown. Methods A total of 218 patients (71 diabetics) who presented with acute HF had RDW measured at admission, discharge and 4, 8 and 12 months post-discharge. The study endpoint was all-cause mortality or rehospitalization for HF during 1-year follow-up. Results The study endpoint was met in 33 patients (46.5%) with DM and in 54 patients (36.7%) without DM. RDW at admission was associated with higher event rate both in HF patients with and without DM (adjusted HR: 1.349, p = 0.002, 95% CI 1.120–1.624 and adjusted HR: 1.142, p = 0.033, 95% CI 1.011–1.291 respectively). In addition, a significant interaction was found between diabetes and RDW longitudinal changes (βinteraction = −0.002; SE = 0.001; p = 0.042). Conclusions Despite the similar prognostic significance of RDW in diabetic and non-diabetic HF patients regarding the study endpoint, longitudinal changes were found to be significantly different between these two groups of HF patients. This might be due to the higher inflammatory burden that diabetic HF patients carry and may provide new insights to the pathophysiological mechanism of RDW increase in HF, which remains unknown.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece.
| | - Gregory Giamouzis
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece
| | | | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | | | | | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece
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Sargento L, Simões AV, Longo S, Lousada N, Palma Dos Reis R. Red blood cell distribution width is a survival predictor beyond anemia and Nt-ProBNP in stable optimally medicated heart failure with reduced ejection fraction outpatients. Clin Hemorheol Microcirc 2017; 65:185-194. [PMID: 27716652 DOI: 10.3233/ch-16155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND RDW is an automatic value obtained with the blood count, and represents the erythrocytes dimension variation. OBJECTIVE To evaluate in optimally medicated outpatients with heart failure with reduced ejection fraction (HFrEF) the RDW prognostic value regarding survival in a multivariable model including anemia and Nt-ProBNP. METHODS 233 consecutive outpatients, LVEF <40%, clinically stable were followed-up for 3-years in an HF Unit. End-point was all-cause death. The RDW categorized according to the tertiles (T1 = <13.9; T2 14-15.2; T3> = 15.3). Anemia classified according to the WHO criteria. Cox survival model adjusted for clinical profile, optimal therapeutic, renal function, Nt-ProBNP, etiology, atrial fibrillation, and anemia. RESULTS (1) The 3-years death rate was 33.5%, and increased with the RDW tertiles (17.3%; 25%; 61.1%; p < 0.001). (2) The ROC curve for death associated with RDW (AUC 0.73; p < 0.001); (3) The adjusted death risk increased with the tertiles (Hazard-ratio '[HR] = 1.61; IC 95% 1.09-2.39; p = 0.017). RDW> = 15.3 had greater adjusted death risk than T1 (HR = 2.18; 95% CI 0.99-4.8; p = 0.05) and T1+T2 (HR = 1.54; 95% CI 1.13-2.09; p = 0.006). CONCLUSION RDW determined in optimally medicated outpatients with HFrEF, during dry-state, is a strong, cheap, and independent predictor of long-term survival.
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Xanthopoulos A, Giamouzis G, Tryposkiadis K, Paraskevopoulou E, Paraskevopoulou P, Karagiannis G, Patsilinakos S, Parissis J, Farmakis D, Butler J, Skoularigis J, Triposkiadis F. A simple score for early risk stratification in acute heart failure. Int J Cardiol 2017; 230:248-254. [DOI: 10.1016/j.ijcard.2016.12.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/03/2016] [Accepted: 12/17/2016] [Indexed: 12/11/2022]
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Gombos T, Förhécz Z, Pozsonyi Z, Jánoskuti L, Prohászka Z, Karádi I. Long-Term Survival and Apolipoprotein A1 Level in Chronic Heart Failure: Interaction With Tumor Necrosis Factor α -308 G/A Polymorphism. J Card Fail 2016; 23:113-120. [PMID: 27317841 DOI: 10.1016/j.cardfail.2016.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Apolipoprotein A1 (ApoA1), a major constituent of high-density lipoprotein (HDL), has antiinflammatory and antioxidative properties and plays a prognostic role in chronic heart failure (CHF). Despite increased tumor necrosis factor α (TNFα) levels being linked to worse outcome of HF, the results are ambiguous about the association of functionally active 308 promoter polymorphism of the TNFα gene. The aims of our study were to investigate the association of ApoA1 and TNFα levels with mortality and to evaluate potential interaction between these factors and TNFα -308 polymorphism. METHODS Together with several parameters ApoA1, TNFα levels and TNFα-308 polymorphism were determined in a cohort of 195 patients with CHF who were followed for 5 years. RESULTS Low ApoA1 and high TNFα levels were associated with more severe disease, and ApoA1 showed the strongest relationship with HDL, total cholesterol, C-reactive protein, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). TNFα -308 A carriers had significantly higher ApoA1 levels than wild-type (GG) patients (1.41 ± 0.268 vs 1.29 ± 0.324 g/L; P = .007), whereas levels of TNFα were the same in these groups. Decreased ApoA1 levels were significant predictors of 5-year mortality (NT-proBNP-adjusted HR for 1 decile decrease in ApoA1 level was 1.10 (P = .011). Interaction was found between the ApoA1 level and TNFα -308 polymorphism, because in patients with GG haplotype the adverse effect of low ApoA1 level on survival was more prevalent. CONCLUSIONS Lower ApoA1 levels were strongly associated with adverse outcome in CHF patients in a TNFα -308 polymorphism dependent manner. These observations support the complex involvement of malnutrition and inflammation in the pathogenesis of CHF.
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Affiliation(s)
- Tímea Gombos
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | - Zsolt Förhécz
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Pozsonyi
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Lívia Jánoskuti
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Prohászka
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - István Karádi
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Cohen MS, Cipriano A, Stawicki SP, Firstenberg MS, Papadimos TJ. What's New in Critical Illness and Injury Science: The decades-long quest for a valid prognostic sepsis biomarker continues. Int J Crit Illn Inj Sci 2015; 4:275-7. [PMID: 25625056 PMCID: PMC4296327 DOI: 10.4103/2229-5151.147517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marissa S Cohen
- Temple University/St. Luke's Medical School, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States ; Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Anthony Cipriano
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States ; Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Michael S Firstenberg
- Northeast Ohio Medical University and The Summa Health Care System, Akron, Ohio, United States
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, United States
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Dai Y, Konishi H, Takagi A, Miyauchi K, Daida H. Red cell distribution width predicts short- and long-term outcomes of acute congestive heart failure more effectively than hemoglobin. Exp Ther Med 2014; 8:600-606. [PMID: 25009627 PMCID: PMC4079416 DOI: 10.3892/etm.2014.1755] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/27/2014] [Indexed: 12/15/2022] Open
Abstract
The present study compared short- and long-term prognostic values of red blood cell distribution width (RDW) with those of hemoglobin (Hgb) among patients with acute congestive heart failure (CHF) in a cardiac care unit. The cross-sectional study examined data from 521 patients with acute CHF who were admitted to a cardiac care unit and followed up for 24 months (median). Mean Hgb levels in patients who succumbed (DIH) or remained alive (AIH) were 11.0±1.8 and 11.8±2.6 g/l (P>0.05), respectively. Median values of RDW were 16.2% and 14.4%, respectively (P<0.0001). During the 24-month follow-up, mean levels of Hgb in groups with and without endpoints were 11.4±2.5 and 12.5±2.4 g/dl (P<0.0001), respectively. Median RDW values were 14.9 and 13.8%, respectively (P<0.0001). Logistic regression analysis showed that in-hospital mortality was significantly associated with RDW (P=0.044), New York Heart Association (NYHA) functional class IV (P=0.0037), estimated glomerular filtration rate (eGFR) (P=0.042) and C-reactive protein (P=0.0044), but not with Hgb (P=0.10). The multivariate Cox proportional hazard model selected RDW [hazard ratio (HR), 2.19; P<0.0001], left ventricular ejection fraction (HR 0.81, P=0.0016), age (10-year increase; HR 1.19, P=0.0017) and NYHA functional classes III/IV (HR 1.52, P=0.0029) as independent predictors of long-term outcomes after adjustment, but not Hgb (HR 1.01, P=0.86). Higher RDW values in acute CHF patients at admission were associated with worse short- and long-term outcomes and RDW values were more prognostically relevant than Hgb levels.
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Affiliation(s)
- Yuxiang Dai
- Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan ; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Hakuoh Konishi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Atsutoshi Takagi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
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Kumar S, Sudhakar A, Mohan M, Balachandran R, Raj B, Sumangala SG, Kumar RK. Elevated red cell distribution width is associated with delayed postoperative recovery after correction of Tetralogy of Fallot. Ann Pediatr Cardiol 2014; 6:121-5. [PMID: 24688227 PMCID: PMC3957439 DOI: 10.4103/0974-2069.115252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To study the impact of red cell distribution width (RDW) on postoperative recovery after correction of Tetralogy of Fallot (TOF). Background: Increased RDW indicates dysregulated erythropoiesis and predicts survival in critical illnesses that include idiopathic pulmonary artery hypertension and chronic heart failure. Myocardial injury and oxidative stress induced by cardiopulmonary bypass potentially contribute to prolonged recovery in post TOF repair patients. Materials and Methods: Retrospective analysis of data on 94 consecutive children with TOF undergoing corrective repair (January 2010-March 2011) was done. RDW was higher for the study population when compared to acyanotic patients with ventricular septal defect (17.7 ± 3.7 vs. 16.2 ± 4.2; P < 0.001). The mean RDW obtained from 100 separate age-, sex-, and weight-matched TOF patients (17.8) was chosen as a cut-off. Of 93 survivors (median age: 12 (4-204) months, weight: 8.6 (3.2-70) kg), 29 patients with higher RDW (> 17.8) had a longer ICU stay (155.6 ± 71.3 vs. 122.4 ± 61.3 hours, P = 0.02), hospital stay (18.6 ± 10.5 days vs. 13.4 ± 6.5 days, P = 0.01), ventilation time (57.9 ± 41.6 vs. 38.3 ± 30.8 hours, P = 0.01), and more surgical site infection (24.1% vs. 6.2%, P = 0.01). On multivariate analysis only elevated RDW (other variables included age, weight, hemoglobin, hematocrit, and surgical support times) showed a significant association with hospital stay. Conclusions: Elevated RDW appears to be associated with prolonged recovery after TOF repair, the precise underlying mechanisms are worth investigating.
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Affiliation(s)
- Shine Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Maitreyi Mohan
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rakhi Balachandran
- Department of Pediatric Cardiac Anesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Benedict Raj
- Department of Pediatric CVTS, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Van Craenenbroeck EM, Pelle AJ, Beckers PJ, Possemiers NM, Ramakers C, Vrints CJ, Van Hoof V, Denollet J, Conraads VM. Red cell distribution width as a marker of impaired exercise tolerance in patients with chronic heart failure. Eur J Heart Fail 2014; 14:54-60. [DOI: 10.1093/eurjhf/hfr136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emeline M. Van Craenenbroeck
- Department of Cardiology; Antwerp University Hospital; Wilrijkstraat 10 2650 Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Aline J. Pelle
- Center of Research on Psychology in Somatic diseases (CoRPS); Tilburg University; Tilburg The Netherlands
| | - Paul J. Beckers
- Department of Cardiology; Antwerp University Hospital; Wilrijkstraat 10 2650 Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Nadine M. Possemiers
- Department of Cardiology; Antwerp University Hospital; Wilrijkstraat 10 2650 Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Christian Ramakers
- Department of Clinical Chemistry; St. Elisabeth Hospital; Tilburg The Netherlands
| | - Christiaan J. Vrints
- Department of Cardiology; Antwerp University Hospital; Wilrijkstraat 10 2650 Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Viviane Van Hoof
- Department of Clinical Chemistry; Antwerp University Hospital; Edegem Belgium
| | - Johan Denollet
- Center of Research on Psychology in Somatic diseases (CoRPS); Tilburg University; Tilburg The Netherlands
| | - Viviane M. Conraads
- Department of Cardiology; Antwerp University Hospital; Wilrijkstraat 10 2650 Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
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10
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Van Craenenbroeck EM, Conraads VM, Greenlaw N, Gaudesius G, Mori C, Ponikowski P, Anker SD. The effect of intravenous ferric carboxymaltose on red cell distribution width: a subanalysis of the FAIR-HF study. Eur J Heart Fail 2014; 15:756-62. [DOI: 10.1093/eurjhf/hft068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emeline M. Van Craenenbroeck
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Viviane M. Conraads
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Laboratory of Molecular and Cellular Cardiology; Antwerp University Hospital; Edegem Belgium
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | | | | | - Piotr Ponikowski
- Department of Heart Diseases; Medical University Military Hospital; Wroclaw Poland
| | - Stefan D. Anker
- Applied Cachexia Research, Department of Cardiology; Charité, Campus Virchow-Klinikum; Berlin Germany
- Centre for Clinical and Basic Research; IRCCS San Raffaele; Rome Italy
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Núñez J, Núñez E, Rizopoulos D, Miñana G, Bodí V, Bondanza L, Husser O, Merlos P, Santas E, Pascual-Figal D, Chorro FJ, Sanchis J. Red blood cell distribution width is longitudinally associated with mortality and anemia in heart failure patients. Circ J 2013; 78:410-8. [PMID: 24292127 DOI: 10.1253/circj.cj-13-0630] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been found to be an independent predictor for adverse outcome in patients with heart failure (HF), but there are no data on the association of longitudinal RDW with all-cause mortality and occurrence of anemia. METHODS AND RESULTS 1,702 patients discharged from a previous admission for acute HF (AHF) were included. RDW was measured during the available longitudinal history of the patient. Joint modeling and Multistate Markov were used for the analysis. The median RDW at baseline was 15.0% (IQR: 14.0-16.5), and 45.6% of patients had anemia. At a median follow-up of 1.5 years (IQR: 0.45-3.25), 713 patients died. The last RDW-trajectory value and cumulative RDW-trajectory mean were predictive of mortality (HR, 1.18; 95% CI: 1.12-1.24; and HR, 1.12; 95% CI: 1.08-1.16, respectively; P<0.001 for both). This effect, however, varied according the anemia status (P for interaction<0.001), being more pronounced in absence of anemia [HR=1.31 (95% CI: 1.22-1.42) and HR=1.48 (95% CI: 1.33-1.64)] compared to those with anemia [HR=1.08 (95% CI: 1.04-1.13), 1.12 (95% CI: 1.06-1.18)]. Longitudinal RDW (per 1% increasing) was also independently associated with incident anemia [HR=1.10 (95% CI: 1.03-1.18) P=0.002]. CONCLUSIONS Following an admission for AHF, higher longitudinal RDW values over time were associated to an increased risk for both developing anemia and dying. The effect on mortality was more pronounced among non-anemic patients.
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Affiliation(s)
- Julio Núñez
- Cardiology Department, Clinical University Hospital, INCLIVA
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12
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Kim HM, Kim BS, Cho YK, Kim BI, Sohn CI, Jeon WK, Kim HJ, Park DI, Park JH, Joo KJ, Kim CJ, Kim YS, Heo WJ, Choi WS. Elevated red cell distribution width is associated with advanced fibrosis in NAFLD. Clin Mol Hepatol 2013; 19:258-65. [PMID: 24133663 PMCID: PMC3796675 DOI: 10.3350/cmh.2013.19.3.258] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/18/2013] [Accepted: 04/30/2013] [Indexed: 12/16/2022] Open
Abstract
Background/Aims The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores. Methods This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively. Results After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61±0.41% (mean±SD), 12.70±0.70%, 12.77±0.62%, 12.87±0.82%, and 13.25±0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71±0.72%, 12.79±0.66%, and 13.23±1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and ≥2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of ≥1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score. Conclusions Elevated RDW is independently associated with advanced fibrosis in NAFLD.
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Affiliation(s)
- Hwa Mok Kim
- Division of Gastroenterology and Hepatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Kang W, Kim SU. Chasing after novel non-invasive markers to identify advanced fibrosis in NAFLD. Clin Mol Hepatol 2013; 19:255-7. [PMID: 24133662 PMCID: PMC3796674 DOI: 10.3350/cmh.2013.19.3.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 08/07/2013] [Indexed: 12/14/2022] Open
Affiliation(s)
- Wonseok Kang
- Department of Internal Medicine, Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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14
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Ozsu S, Abul Y, Gunaydin S, Orem A, Ozlu T. Prognostic value of red cell distribution width in patients with pulmonary embolism. Clin Appl Thromb Hemost 2012; 20:365-70. [PMID: 23144178 DOI: 10.1177/1076029612464901] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Elevated red blood cell distribution width (RDW) has been associated with adverse outcomes of heart failure and pulmonary hypertension. A total of 702 consecutive patients with acute pulmonary embolism (PE) were evaluated. There was a graded increase in mortality rate with RDW quartiles of 5.8% in quartile I (≤13.6), 9.7% in quartile II (13.7%-14.5%), 13.1% in quartile III (14.6%-16.3%), and 20% in quartile IV (>16.3%; P < .001). Patients who died had higher baseline RDW values (16.1% [11.7-28.3] vs 14.5% [10.7-32.5]; P < .001). The optimal cutoff value of RDW for predicting in-hospital mortality was ≥15%. The area under the curve of mortality for RDW was 0.649 (confidence interval [CI]: 0.584-0.715); the negative predictive value was 93%. In multivariable regression analysis, RDW remained associated with an increased odds of death (odds ratio: 1.2, 95% CI: 1.1-1.4). High RDW level was an independent predictor of short-term mortality in PE. The RDW levels may provide a potential marker to predict outcome in patients with PE.
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Affiliation(s)
- Savas Ozsu
- 1Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
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Martínez-Velilla N, Ibáñez B, Cambra K, Alonso-Renedo J. Red blood cell distribution width, multimorbidity, and the risk of death in hospitalized older patients. AGE (DORDRECHT, NETHERLANDS) 2012; 34:717-723. [PMID: 21544577 PMCID: PMC3337935 DOI: 10.1007/s11357-011-9254-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 04/17/2011] [Indexed: 05/30/2023]
Abstract
We aimed to assess the association between red blood cell distribution width (RDW) and mortality in patients enrolled by a Geriatric Department. One hundred twenty-two patients were followed up during 5 years. The primary end point was all-cause mortality, and hazard ratios were estimated using a Cox proportional hazard model. Higher RDW values were strongly associated with an increased risk of death. Survival curves across RDW quartiles were statistically different according to the log-rank test (p = 0.017). The first quartile presented higher probability of survival compared to the last one. The gradient from lower to higher risk across quartiles was clear both in the 5-year mortality risk and in the mortality rate per 100 person-years, which ranged from 18.9 to 42.6. However, in the Cox regression model after adjusting for age, severity, and other factors, excess risk was only observed in the highest RDW quartile, with a hazard ratio of 2.24 (CI(95%) 1.13-4.42) vs the first quartile. RDW is a good predictor of mortality in hospitalized older adults beyond those with cardiovascular risk factors, and it could serve as an integrative measure of multiple clinical and subclinical processes simultaneously occurring in complex patients.
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Ozsu S, Abul Y, Gulsoy A, Bulbul Y, Yaman S, Ozlu T. Red Cell Distribution Width in Patients with Obstructive Sleep Apnea Syndrome. Lung 2012; 190:319-26. [DOI: 10.1007/s00408-012-9376-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/12/2012] [Indexed: 01/13/2023]
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